Today's “Throwback Thursday” is a look at a document written by the late, great W. Edwards Deming back in 1987 after he was hospitalized. You might want to read that first.
In the post, I review Dr. Deming's notes and share some of my reflections and questions about the progress that's been made (or not made) in the 30 years since he wrote that (and in the 12 years since I moved into healthcare).
An excerpt from the post follows…
Read Dr. Deming's original article first (PDF):
Excerpt from my post:
The scenarios that Dr. Deming describes in the article could all happen today in a hospital, although he'd likely have a private room and slightly better food. I heard similar complaints from my grandfather before he passed away last year at age 93 (the same age as Dr. Deming when he passed, I just realized). These problems, the same in 1987 or in 2016 include:
- Nurses get distracted (due to poor systems and work design) and forget to come back to the room, as promised. Care gets delayed.
- Variation in work methods and practice that are noticeable to patients (and sometimes affect their care).
- Hospitals run out of medications or supplies due to poor supply chain design (due to choosing the low cost supplier or trying to cut corners on inventory due to a misapplication of “just in time” principles).
- Nurses can't perform nursing duties (such as giving medications at the right time) because they're busy with tasks that could be done by housekeeping or a “tech.” The same is often true with pharmacists and anesthesiologists. The hospital often thinks they are saving money by skimping on support staff, but that might not really pan out.
- Little details are often ignored, such as the wash basin or shower design in Dr. Deming's room. A current example might be a hospital not putting a hook for an IV bag in the patient bathroom (a problem often avoided through use of Lean Design methods).
- Charting often gets done in advance, as a way of saving time, but medications or orders sometimes don't get followed, leading to missed care and inaccurate records.
- When problems are reported or discovered, the response is too often reactive, with promises to do better and no real improvement.
As Dr. Deming would have said, the problem is not the workers. Hospital leaders need to “learn something about supervision” as only they can “make the changes in procedure and responsibility that are required.”
How much progress has been made? Why do so many of the same problems still exist in too many hospitals?
What would you teach leaders about “supervision” that could lead to better patient care and a better workplace for healthcare providers?