According to The Times (London), Guy’s & St Thomas Hospital has cut patient wait times via some workflow process improvements…analogized to a Formula One pit stop.
Sounds pretty impressive. I do wonder, though: are these results sustainable? Or do they require a level of intensity that people can keep up for a certain period of time but not for the long run?
Link via Dr Anton Howes, who writes interestingly about the history of technology.
It sure looks like they’re doing a series of one-time sprint efforts to clear over-long waiting-lists in different specializations.
I suspect that since you set up the appointments where you need to keep reasonably close to a schedule like this, that they’re also choosing the patients who are least likely to have complications pop up in the procedure.
If you’ve had patients waiting over a year for surgery and can clear 30% of the waiting list in a day by, then there isn’t really a need to do this routinely.
One also needs to be in a situation where there can be two similarly-equipped adjacent operating theatres running concurrently with the attending personnel required — you’re not going to share anaesthetist between two rooms for example.
With the “certificate of need” program running for healthcare facilities and equipment where I am, I could forsee that here, distant bureaucrats would have eliminated the possibility of this setup several years ago.
We were doing this at St Joseph’s hospital in Burbank CA in 1972. We were a group of three surgeons. Two did a case in one room while the third started a case in the next room. The senior partner would finish the critical part of one case and go next door to do the same. As I was the most junior, I got to finish the first case with the scrub nurse. I left after a year and the government surely must have found a way to stop that soon after. After my move, I practiced with a fellow I had trained with closer to my age.
Mike…so was it something that could have continued, or was the intensity too much? Also, did the other surgeons like the approach?
Theodore Dalrymple described 15 years ago how the NHS reduced the wait time before a patient got a bed (wait for it)…by redefining a gurney in the hall as a “bed.” So I am forever suspicious of any paper improvements out of Britain. An unfair generalisation on my part, sure. But they earned it.
AVI…I’ve heard worse…apparently some wait-time clock didn’t start until patients showed up at the desk…so they made them wait in the ambulance.
Long waiting lists are the premiere method of rationing care. Given long enough, those with a choice get care somewhere else, like the U.S. or in England private for those with the money. Conveniently for the bureaucrats, patients also remove themselves from the waiting lists by dying.
Looking for an old post, I ran across this, which seems relevant to this thread:
https://www.leanblog.org/2009/10/reducing-interruptions-and-improving/
So I’ll make a confession…. I find operations planning to be exciting stuff. It’s probably that :how-do-things-work†for people who aren’t the best at rebuilding car engine thing, but I find it a fascinating both as a practitioner and as a student.
To build on what David wrote in the post regarding the long-term viability of HIT, I wonder what the effect of lean project management would have on the practicing of medicine. Perhaps Mike K., with his experience both as a doctor and as per his comment regarding St. Joseph’s, could elaborate if thinks such an approach as HIT would change how the culture of doctor-patient care works.
I have found that a lot of improvements, even within the Six Sigma lean paradigm, tend to be counter-productive over time. Policies and processes (to a point) are beneficial not only because it ties together parts of the enterprise, but because it off-loads a lot of the work into both the personal and organizational unconsciousness allowing more brain power to be freed for creative activity. The problem is of course within the short span of an organizational generation the processes become both outdated/counter-productive and start to change the culture for the worst
I have had these problems in fairly routinized environments such as warehouse operations. David brought up the issue of long-term viability in the form of burn-out, I would be curious if Mike K. or anybody else who is a doctor would see problems in how the culture of medicine would change. The article is of course limited in how it can explore the topic and it does seem within its context that everyone “wins†from the expedited care but how would that wear long-term?
Mike…so was it something that could have continued, or was the intensity too much? Also, did the other surgeons like the approach?
No, it was more efficient but the bureaucracy has to agree. St Joes was run by nuns who were terrific. Actually, there were only three of them at that point but one was the administrator. Our group was the busiest surgical group. I left because they did not want me to do vascular surgery. I did about 1/3 vascular surgery at my new location.
Here is an example of organizing a program. Only cooperative bureaucrats would let you do this. Non-profits typically add 100 administrators and they need something to do. Obstructing new ideas is a favorite.
I wonder how many British doctors see those long wait lists as job security? The last line of the article rather ominously mentions “job action”. Medicine seems to be something that Englishmen and English Women just don’t do. They are recruiting from just about everywhere. How did it go from multiple candidates for every position to where they are now? Pretty sure we’re in the process of finding out.
Late to the discussion. Behind schedule I guess.
Sure, an assembly line will always be more efficient than a bespoke, artisanal shop. And for most things that’s great. Even in medicine sometimes. But an organized assembly line depends on highly efficient logistics. You need all the parts and raw materials. You need the power turned on and your workforce in place and trained. One thing goes wrong and the line stops. Ooops, no 1/4-20 bolts today. Ooops, unexpected blizzard and half the workers not in.
With surgical procedures your patients are the raw materials. And a fallible bunch at that. Somebody has the sniffles. Somebody forgot and ate breakfast. Somebody checked the wrong boxes on the form listing allergies.
The only way to make it run smoothly would be to overbook to account for the procedures that should have happened but don’t, for above and sundry other reasons.
This sort of works for a whole batch of similar to identical procedures. Some of my ophthalmologist colleagues got very good at doing a series of cataracts in rapid order. For things more complex it starts to fall apart fast.
With surgical procedures your patients are the raw materials. And a fallible bunch at that. Somebody has the sniffles. Somebody forgot and ate breakfast. Somebody checked the wrong boxes on the form listing allergies.
Agreed but the trauma center did not have those issues.