Recent lessons from NICU innovation, primary care access, fan safety in baseball, and ongoing VA wait-time gaming
This post is a collection of recent updates and follow-ups to topics I've written about before–spanning healthcare improvement, patient access, safety in sports, and ongoing challenges with government performance metrics.
I recently saw some updates and new details related to some topics I've covered here on the blog, so I'm combining them into this batch update.
In this post, we cover everything from a hospital NICU, to baseball, to healthcare waiting times and a scandal there that won't die.
NICU Innovation in Action: How Frontline Kaizen Improved Infant Safety
You might remember this post and video from almost exactly a year ago: Franciscan Kaizen Video #7: From Kaizen to Innovation in the NICU.
It's a story from a visit to Franciscan St. Francis Health in Indianapolis, where my Healthcare Kaizen co-author Joe Swartz leads their Lean efforts. In the NICU, they've implemented hundreds of staff-driven improvements… lots and lots of little changes.
But, sometimes people get innovative and, as a NICU nurse, Kelly, describes in the video, she designed a special cover for special gel mattresses that are easier to change and… long story short…. this helps prevent pressure ulcers. Be sure to check out the video of her talking about this.
Two weeks ago, when I was back at Franciscan for our Kaizen Live! event, I was told that the manufacturer of the special mattress now provides covers that are the same as (or similar to) Kelly's design… with the slit running the length of the cover instead of being like a pillowcase. More nurses and more babies will get to benefit from Kelly's innovation and the supportive Franciscan culture. Great job!
Hear Mark read the post (subscribe to the podcast):
Reducing Patient Waits in Primary Care: When Technology and Process Align
Last June, I wrote a post titled “A Tale of Two Clinics – What I Wish My Primary Care Could Be,” where I lamented that it took me many weeks to get basic lab results while Dr. John Toussaint could get results back DURING his appointment as a patient of a ThedaCare clinic.
Now that I've finally moved to the DFW area, I am much happier with my primary care provider here. He's part of the Baylor Scott & White Health system. They have better technology and a better process.
Here's what happened:
1) I went in for a blood draw Friday morning (and, by the way, you know it's a skilled phlebotomist when you don't even feel the needle).
2) Over the weekend, I got a notification and could see the test result in my patient portal iPhone app
3) This morning, the MD office sent an electronic message saying to continue the same dose and did I need another refill?
This is waaaaaay better than waiting for weeks… it's so much better than playing phone tag or trying to deal with paper, faxes, and another visit.
It's great when technology AND a better process work together.
MLB Netting and Fan Safety: A Countermeasure That's Still Being Improved
Last year, I wrote about the dangers to fans at Major League Baseball games after visiting Boston and seeing a story in the news about a woman being hit by a flying bat: “A Lean Guy Reads the Boston Papers: Facts, Respect, and Baseball Fan Risks.”
In the post, I wrote about the time I saw a professional baseball game in Tokyo, and the TokyoDome had netting that ran all the way down the left and right field lines.
At the time, the MLB Players Association (the players' union) was advocating for the netting to be installed in American ballparks (putting safety first?) but owners and the league were resistant because the fans might complain that their view was being blocked a bit.
MLB agreed to recommend the netting for the 2016, as described here: “MLB recommends extending netting at ballparks.”
“MLB announced in December recommendations to extend safety netting at ballparks to the ends of both dugouts and anywhere within 70 feet of home plate. Some organizations already met those benchmarks, while most either extended their netting to the recommended distance or stretched it beyond.”
Even with netting, fans really do need to pay attention when they are sitting close to the field. This happened the other day in Tampa: “Rays fix netting at Tropicana Field day after woman hit by foul ball.”
What happened if there was netting?
“The ball went through a small gap in the protective netting behind an area for photographers. Stadium workers were on the field Saturday adjusting the netting on both the first and third base sides.
“Having that hole there covered [is] probably a little peace of mind for the fans sitting there today,” Souza said.
It goes to show that sometimes a “countermeasure” isn't a perfect solution. Should they have identified the risk from the gap? Maybe… but they've at least reacted to the hole / gap being there. Plan Do Study Adjust. And keep your eyes on the game, not your phone :-)
VA Wait Times Revisited: How Unrealistic Targets Continue to Drive Data Gaming
On a more serious subject (as if being hit in the head with a baseball or bat isn't serious enough), it seems like there are still systemic organizational problems in the Veterans Administration.
I've written a number of posts about the “gaming of the system” or the “fudging of the numbers” that occurred across the country when patient appointment waiting time targets weren't being met.
The Inspector General (part of the federal government) admitted the targets that were set were “unrealistic” but people were still being rewarded or punished based on hitting those goals (or not hitting them). When it's easier to game the system than it is to improve the system… that's a recipe for gaming, fudging, and cheating. It's a systemic problem… firing individuals probably won't help if you don't fix the system.
Was either problem (the long waits or the cheating) solved by replacing the head of the VA or firing a number of managers?
Here's a headline from just two weeks ago: “VA bosses in 7 states falsified vets' wait times for care.”
From USA Today:
“But VA whistle-blowers say schedulers still are manipulating wait times. Shea Wilkes, co-director of a group of more than 40 whistle-blowers from VA medical facilities in more than a dozen states, said the group continues to hear about it from employees across the country who are scared to come forward.
“Until the VA decides it truly wants to change its corrupt and poor culture, those who work on the front lines and possess the true knowledge relating to the VA's continued data manipulation will remain quiet and in hiding because of fear of workplace harassment and retaliation,” said Wilkes, a social worker at the VA Medical Center in Shreveport, La.”
The Common Thread: Systems Shape Behavior Everywhere
What ties together NICU mattress innovations, faster lab results, extended MLB netting, and the VA's ongoing struggles isn't the industry — it's the system.
In baseball, MLB eventually acknowledged a hard truth: asking fans to “pay attention” wasn't enough. The system itself had to change to reduce risk. Netting wasn't about blaming fans or players; it was about redesigning the environment so safety didn't depend on perfect human behavior. And when gaps were found, the response wasn't denial — it was adjustment.
That same thinking applies everywhere else in this post.
When systems support people — nurses, physicians, schedulers, fans — good outcomes follow. When systems rely on pressure, unrealistic targets, or fear, people predictably work around them, whether by gaming metrics or staying silent about problems.
Improvement doesn't come from slogans, replacements at the top, or hoping people try harder. It comes from leaders who are willing to see reality, remove fear, and redesign systems so doing the right thing is the easiest thing.
That's as true in healthcare and government as it is on a baseball field — and it's a lesson we keep relearning, sometimes the hard way.
