The Ordeal 1

The First Week—Further Diagnosis and Follow-Up

“Prepare, Jaded Julie, to be dismayed, disgusted, and disheartened by today’s discussion.  Every cancer patient’s experience is an ordeal; some are quite tolerable, but some are horrible.  We are going to discuss one that started out in the horrible category.”

“Curmudge, I sense that you are in a black mood that can only be assuaged by feeding it to the computer, pressing the ‘save’ button, and ultimately posting it on our Kaizen Curmudgeon blog (http://kaizencurmudgeon.blogspot.com).  So how are you and I going to tackle this?”

“To maintain our focus on Lean management systems in health care, we will pluck the organization’s systemic problems from the patient’s experience.  Most of these first- and second-order ‘screw-ups’ will be described by quoting the patient’s spouse.”

“Screw-ups, Curmudge!  Those are harsh words coming from an ancient but dignified professor.  We know that hospitals work hard to avoid ‘never’ events, wrong site surgeries, surgical site infections, and medication errors, but it’s the seemingly minor and more frequent screw-ups, as you describe them, that make life miserable for patients and their families.”

“Patient-focused care doesn’t always happen, Julie.  Here’s the story.  My close friend, Jay (not his real name), was diagnosed with Burkitts lymphoma quite recently.  In fact, the full extent of the disease has not yet been determined.  In any case, it will be treated quite aggressively beginning with a week as an inpatient in a hospital outside the immediate Fox Valley.  Jay’s wife, Ann (not her name either), has been providing daily updates to friends and family.  Quoted below with her permission (and with some editing) is how she described Friday:       

‘Jay is finally an inpatient after a snafu that took all day.  The morning began with a PET scan.  Then at noon we got lots of our questions answered at the oncology clinic.  The PET scan results were not what we hoped.  There is mall lymph involvement in Jay’s chest—only 1 cm more than normal but still there in two little places.  The spinal test still has to come back.’

‘We then walked over to Inpatient, but there were no orders, not even an order for food. Poor starving Jay; he has had nothing to eat since yesterday.  Our hope was to get a jump-start on treatment today.  The orders got lost between the oncology clinic and the hospital, which incidentally are in the same building!  Orders had to be re-done—followed by lots of apologies.  Apparently the problem was the staff’s unfamiliarity with their new computer system.  But we still lost a day of treatment.   Jay is just now getting settled in at 7 p.m.  We were there all day!’ “

“Now I understand your blue funk, Curmudge.  What a horrible way to treat the patient and his family who are already under a level of stress that neither of us can fully appreciate.  It was unconscionable!  So how might a hospital avoid these situations?”

“Every hospital knows its own system best, and some may have their screw-ups under control.  Those that do not will need a person or persons with strength to walk through the hospital’s silo walls and the stature to be heard when he or she speaks.  It’s critical that these problems be nipped in the bud, so patients will need to know whom to contact when things appear to be going awry.”

“So what do you foresee in Ann’s next report, Curmudge?”

“It’s time for some good news, Julie, so I remain hopeful.  Many years ago Jay and Ann and I hiked together in the Rockies, and I want to do it again.”

Kaizen Curmudgeon