Observations from One End of the Hospital

Lean Leap to Health Care #7 (click for Part #6)

by Scott McDuffee

“Where is the main entrance? Why do I follow the signs to HERE? Now you are telling me to go all the way down THERE! How far is it? Are we better off driving?”

At one end of the hospital each Wednesday, I volunteer at the satellite information desk. Since, I am the first person people see on the way in and the last person they see when leaving, I greet everyone warmly and take pride in bringing smiles with my enthusiasm. It's like being a Walmart greeter, only not nearly as much traffic. Mondays are a bit more interesting when I am the Surgery-to-Waiting-Area liaison. In either role, I find myself “staying busy” or “over-processing” to fill the day.

The quiet times also afford me the chance to read. By now, I have acquired a growing list of Health Care continuous improvement books. Although I haven't read them all, they include:

• Lean Hospitals: Improving Quality, Patient Safety, and Employee Satisfaction
  
• Hardwiring Excellence
• The Toyota Way to Healthcare Excellence
• Going Lean – Busting Barriers to Patient Flow

And, two I just received in a box from ACHE / Health Administration Press are called

• If Disney Ran Your Hospital
• Growing Leaders in Healthcare.

These roles also give me a chance to observe and interact with various hospital “customer” groups – patients, families, physicians, nurses, technicians, administrators, food services, construction, human resources, chaplains, volunteers, sales reps, pharmacists, laboratory personnel, police officers, registration / reception, radiologists, mail services, etc.

Among other observations, I am gaining understanding of sequences of events, timing of waiting / recovery, room cleaning and allocation, security access and the complicated (often counter-intuitive) door opening systems. Important at the information desk, I am also getting very connected to the hospital layout and the path of patients through the building.

Approximately 70% (small sampling) of the questions I receive at this information desk have to do with arriving patients or family/friends who have parked then walked in the wrong entrance. Others might be in the right place but ask where to go because they are unsure. Because it is not intuitive or visual, this situation causes the “rework” of walking some distance or some actually get back in their car to drive around. Last Wednesday, a silver-haired couple came in wearing matching tan outfits; they gave me the verbal lashing at the top of this blog.

As I was reading Studer's Hardwiring Excellence later the same day, I jotted down the following phrases on a sticky note (a great tool for lean leaders): “people in Health Care typically want three things 1) a sense of purpose, 2) worthwhile work, and 3) making a difference.” As I read, I try to put things into personal context so they resonate with me. The couples' words came back to me. Was I really doing worthwhile work?

Most people including other volunteers would say I was adding value. Visitors needed information and I was giving it to them. As a lean thinker, I'm inclined to peel back the onion another layer (I don't know why I use the onion analogy except I've used it in explanations of 5-Whys for years).

Am I adding real value to visitors or is what I'm doing really a “work-around” for inadequate and unintuitive design? The couple in the matching tan outfits went on to say specifically, “We took care to follow the signs and still ended up in the wrong spot.” Apparently, the well intended people who put up the signs already knew where they were going and didn't bother to see things from the perspective of the customer.

As illustrated, hospitals can be complicated and confusing places. Couple this with anxiety about a procedure or concern for a loved one and we have a potential downward spiral triggered at the important first impression. My lean management system training, coming mostly from insights from David Mann, Tom Luyster, Kevin Duggan, and Jeff Liker, suggests we connect to the process, engage the people, and embrace the problem.

Here is another analogy I often use in cases where the waste has been “institutionalized” by a workaround: Is it better to learn to walk with a limp or take the rock out of your shoe? Or stated more specifically, is it possible to fix the “visitors are lost” problem? Could the outside and inside of the hospital be so clearly designed and marked as to bring arriving visitors directly to their point of access into a smooth flowing process?

What would it take?

Click for Part 8

“Scott McDuffee is an experienced Lean professional who is currently searching for a new career opportunity. He is based in Mansfield, TX.

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