Second Chance
You don’t often get a second chance in life. The hospital that inspired my previous posting, “My Operation,” (see June 2006) got one last week when my wife went there for surgery. Guess what! Nothing has changed. Her experience does provide some insight on where the opportunities for efficiency exist in healthcare: They called the week before for a phone interview. On surgery day, we took a number at the admissions desk to see a woman 10 feet away and repeat the same information they already had. In short, the admissions process added no value and could be cancelled without ill effect. Savings: salaries of two people, 45 min of patient time, and some space in the lobby.
We were sent to “Two West.” As we exited the elevator, a woman sitting under a sign saying “Two East” assured us we needed to see her, in spite of the sign. Unless she wasn’t there, in which case, we would indeed have to search for Two West. Turns out 2W is a hallway, and no one’s there. OK, not inefficient. Just comical, but it doesn’t inspire confidence.
After 40 minutes, a nurse repeated the same interview we just had downstairs and the week before. Slow learners.
Surgeon visit. Excellent communication. A+. Anesthesiologist visit: two expressed goals (ours) Keep her warm, and rapid awakening in recovery. Since the patient survived, the anesthesiologist must get a passing grade. But just barely. D-. She did stay warm, but only partial credit here, because of the method used--a Behr Hugger, an expensive option whose use indicates a lack of attention to other details that are free/cheap and just as effective. For example, keep the patient warm rather than try to add heat. For surgery on the arm, why can’t you wear pants into the OR? And a hat. And wool socks.
I guess we failed to specify what “rapid” meant, but 90 minutes in acute recovery is beyond anybody’s definition of “rapid.” Then, it took another 90 minutes before she was able to sit up long enough to be wheeled to the car. A little over 3 hours for recovery.
The entire recovery process took twice as long as it should have--and I’m being generous. An extra 90 minutes. Why is that inefficient? (other than wasting my time.) Every minute a patient is there, the hospital pays an RN to be there too. Ninety minutes here, 90 minutes there, and pretty soon, you’re talking about real money. If there were price competition in healthcare, this place would lose and never know why. The anesthesiologist has no idea what time we left--he went home before we did.
Is this really his problem? A personal study of several thousand ambulatory surgery patients showed that recovery time had no relationship with the duration of surgery (shotgun data) but did correlate with particular anesthesiologists. There were surgical factors for a few outliers, but the key factor was anesthesia. So yes, it’s possible to do it well. But you have to have a goal and a plan for reaching the goal.
As you read about value stream mapping, any step that doesn’t add value is waste. (admissions) Any time the patient waits for more than X minutes is waste. (X = 10) Why did we come 3 hours before surgery? I know it’s possible to get a patient from street clothes into the OR in less than 60 min. Take a lesson. Less time = less money spent on waste = greater efficiency.
We were sent to “Two West.” As we exited the elevator, a woman sitting under a sign saying “Two East” assured us we needed to see her, in spite of the sign. Unless she wasn’t there, in which case, we would indeed have to search for Two West. Turns out 2W is a hallway, and no one’s there. OK, not inefficient. Just comical, but it doesn’t inspire confidence.
After 40 minutes, a nurse repeated the same interview we just had downstairs and the week before. Slow learners.
Surgeon visit. Excellent communication. A+. Anesthesiologist visit: two expressed goals (ours) Keep her warm, and rapid awakening in recovery. Since the patient survived, the anesthesiologist must get a passing grade. But just barely. D-. She did stay warm, but only partial credit here, because of the method used--a Behr Hugger, an expensive option whose use indicates a lack of attention to other details that are free/cheap and just as effective. For example, keep the patient warm rather than try to add heat. For surgery on the arm, why can’t you wear pants into the OR? And a hat. And wool socks.
I guess we failed to specify what “rapid” meant, but 90 minutes in acute recovery is beyond anybody’s definition of “rapid.” Then, it took another 90 minutes before she was able to sit up long enough to be wheeled to the car. A little over 3 hours for recovery.
The entire recovery process took twice as long as it should have--and I’m being generous. An extra 90 minutes. Why is that inefficient? (other than wasting my time.) Every minute a patient is there, the hospital pays an RN to be there too. Ninety minutes here, 90 minutes there, and pretty soon, you’re talking about real money. If there were price competition in healthcare, this place would lose and never know why. The anesthesiologist has no idea what time we left--he went home before we did.
Is this really his problem? A personal study of several thousand ambulatory surgery patients showed that recovery time had no relationship with the duration of surgery (shotgun data) but did correlate with particular anesthesiologists. There were surgical factors for a few outliers, but the key factor was anesthesia. So yes, it’s possible to do it well. But you have to have a goal and a plan for reaching the goal.
As you read about value stream mapping, any step that doesn’t add value is waste. (admissions) Any time the patient waits for more than X minutes is waste. (X = 10) Why did we come 3 hours before surgery? I know it’s possible to get a patient from street clothes into the OR in less than 60 min. Take a lesson. Less time = less money spent on waste = greater efficiency.
Comments
That sounds like an unpleasant experience, even if you did not have the knowledge of Lean that you possess. And I think that you are justifiably angered at the anesthesiology treatment, given your specialty.
However, I firmly disagree when you categorize a salary as a savings. Perhaps it is a disagreement over semantics and the use of the word semantics, but as soon as you state that a process can be removed or reduced, and that someone's salary could be saved, the implication is that the person will lose their job. In the practice of lean, I insist that people and their experience get put toward other pursuits, with the end effect of increasing capacity. All improvements will be lost if there is any indication of headcount reduction.
Posted by: Matt Meyers | September 10, 2007 10:42 PM
My daughter just had similar surgery at Duke University Hospital. She had an interscalene block and IV sedation for the procedure, woke promptly without pain or other unpleasant symptoms, and was home within the hour. Sibly Hosital take a lesson.
Posted by: Robert Burney MD | October 16, 2007 08:24 PM