Navigating Hospital Processes (or a Lack Thereof): Systemic Issues in Outpatient Surgery


It's interesting to observe a hospital process (or lack thereof) when a family member needs surgery. I had the opportunity to do so one day last week. I originally shared this on LinkedIn as a post and real-time updates.

Thankfully, the clinical care seemed to be good, and that family member is recovering well from the outpatient procedure.

But, the experience could have been better. I'm critiquing the process and the apparent culture, not the individuals involved. They are part of a system, which includes their job role design, training, and supervision.

Arriving at Pre-Op?

We all arrived at the pre-op area, which doubles as the waiting room. It seemed.

The signage wasn't completely clear, but we found our way. There was some debate and discussion about whether were in the correct place. Was this waiting room indeed also the pre-op check-in? Registration had already been done near the lobby.

Nobody was sitting at the desk in the room to greet anybody.

A sign said to call a specific phone number if you've been waiting for more than 15 minutes.

After about 20 minutes, the family member called that number.

Shortly after, a nurse came out and seemed completely surprised that the patient had been sitting out here the whole time.

We had arrived exactly at the scheduled time. It's not like the patient arrived early.

These are solvable process problems. They can calculate how much they're saving by not paying somebody to sit at the desk. But what is the cost of the problems caused by that??

Maybe the sign should just say, “Call this number when you arrive.”

It seems like evidence of a “cost-cutting mindset” instead of a “process mindset” or a “patient-focused mindset.”

More than a decade ago, this exact health system was saying:

“As a health care system committed to providing patient-centered care, we want every patient to expect more…”


Other Observations While Waiting

After a while, a volunteer arrived. She was surprised that nobody had been at the desk at all today (said other waiting family members who had been there longer than us).

To me, this seems like a job that should be done by a paid employee. That's a different issue. Surgery brings in a lot of revenue for hospitals. And the job of greeting and coordinating with patients and families seems like an important one.

Shortly after arriving, the volunteer left because she had other tasks to do. She was there from maybe 2 pm to 5 pm (we had arrived at 12:30).

She left promptly at 5 pm, even though many families were still waiting.

None of this was her fault, of course. It's a system design issue.

Liz Davis commented, on LinkedIn:

That practice has always been suspect to me. Volunteers are not employees, but they are routinely placed in gaps where an employee should be. Volunteers should not be expected to maintain attendance – and yet, I've seen many hospitals rely on them as a regular staff employee in key patient-facing areas (surgery check-in/waiting areas).

Volunteers are wonderful people who give of themselves and their time – please don't turn them into unpaid “employees.”

Is This Patient-Centered?

Another thing that wasn't the least bit “patient-centered” (or “family-centered”) was that the patient status board says “Intra” instead of plain English like “In Surgery.”

Here was another opportunity for improvement… A woman (also waiting for a patient) needed to charge her phone. There was an outlet nearby with a lamp plugged into one plug, while the other plug was empty.

The plug that she tried was apparently really loose and not working, so the woman unplugged the lamp to see if it would work in the other plug.

It did not.

The lamp kept going off and on.

The volunteer walked over… and basically just scolded the woman for messing with the plug and to stop doing that.

Is This a Culture of Continuous Improvement?

The volunteer never asked WHY she was messing with the plugs… and she didn't point the woman to the phone charging station on the wall. She just said to stop doing that.

I was then the one to point out the wall-mounted charging station to my fellow waiter.

In a culture of continuous improvement, the volunteer (or a paid employee) would note the plug problem and would report it to maintenance. I doubt that happened. I wonder how long it's been broken?

The health system's website also claims they are:

“Cultivating a culture of continuous improvement of service and inquiry.” 

A step further might be submitting an idea for how to make the phone-charging station more obvious to somebody who is here for the first time. I also doubt that happened.

But it could happen. We CAN have a culture of improvement and a culture of engaged staff (and volunteers)… but it's dependent upon leaders leading and engaging people.

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


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