“Cancer patient, Jay, and his devoted wife, Ann, have begun
six days of in-patient chemotherapy in a
different hospital. Hopefully,
they will not be subjected to any hospital screw-ups that we’ll want to
discuss.”
“So we’re done for the day? I’m outta’ here.”
“Nicht so schnell,
Julie! We’ve still got work to
do.”
“Based on the tone of your voice, Curmudge, I perceive that
you just said ’Not so fast’ (in German).”
“Right as usual.
As we promised last week, we’ll summarize what we learned from Jay and
Ann’s ordeal. In addition, we’ll
provide some unsolicited suggestions that the original hospital (which will
remain anonymous) needs to consider.
Let’s start this way: Julie, if a hospital said that they were providing
patient-centered care—and most of them say that—what would you, as a patient,
expect?”
“First of all, if I were in severe pain, I would expect the hospital to do everything feasible
to alleviate it. Nothing else
matters to one experiencing intractable pain. If I had nausea or constipation or other physical discomforts, I’d expect help there too. Also, I would consider a noisy environment to be a physical discomfort. Finally (but definitely not least), the
hospital should minimize the patient’s and family’s emotional stress. Not
knowing, waiting, or poor communication in general would be almost as bad as
pain. Things often not known would
include one‘s diagnosis, when the next test will be and when its results will
be available, and when one will be able to eat. If a hospital can’t communicate with its patients, its
supporting elements like clinics and pharmacies, and within itself, it might as
well be a cottage industry in Kyrgyzstan.”
“Well put, Julie.
And at some point during Jay and Ann’s ordeal, they experienced each of
the above. The biggest issues at
the first hospital were emotional stress and communication problems, which
started with the computer hang-up in getting Jay admitted. Then there were the almost non-existent
communications between the hospital and pharmacy.”
“I was really concerned about Jay’s having to wait a day—in
pain—for a CT scan and then overnight for the result. CTs are run 24 hours a day in most hospitals, and there are
services that read them overnight.
Of course, Jay, Ann, or nurses in the hospital should have stayed
abreast of the constipation problem before it became serious. Most everyone knows that narcotic
painkillers cause constipation.”
“On the other side of the ledger, I was impressed by the
on-call oncologists who answer the phone at 2:30 a.m. It’s amazing that they can be alert and give sage advice to
someone who might not even be their patient.”
“So, Curmudge, what’s the bottom line? The original hospital seems to have a
peck of systemic problems.”
“Julie, my one-word answer is the same as it has been for
the past six years. Lean! The hospital needs a Lean
transformation. Anyone who is not
acquainted with Lean can start with the first Kaizen
Curmudgeon posting in May of 2007 and read the next 240. In a nutshell, the hospital needs to
empower the employees to map their processes, find the root causes of problems,
and then use plan, do, study, act cycles to implement continuous improvements. They need to find the waste and
inefficiencies in their systems and get rid of them. And finally, the hospital must do this with the full support
and leadership of management at every level. If Jay and Ann’s first hospital has already started a Lean
journey, it needs more attention.”
“That was a pretty concise rant, Curmudge. If a hospital can get its systems in
order, they should be well on their way to providing patient-centered
care. So what kind of problem will
we illuminate—but not resolve—next?”
“We’ll take a break for a couple of weeks, read some books,
and then present some stuff about a little-known issue that a few readers might
not believe.”
“Sounds interesting.
I’m with you, Old Guy.”
Kaizen Curmudgeon
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