by Ted Eytan, on 13 Apr 2006 09:36 am
The Journey
Vancouver General’s ER doctors and LEAN
globeandmail.com : Vancouver General’s ER doctors warn patients
In a care sysem like this (Canada), it might feel that leaders have become disconnected from the customer – sometimes it seems that people see their “boss” as the Ministry of Health, rather than the true “boss,” the taxpayer. I suppose we’re fortunate in our care system at Group Health that we’re clear that the member is the boss, since we report to them on paper.
There’s more to look at under the surface. The ER situation is the tip of a very large iceberg. It’s probably not helping patients for physicians to call out their own inefficient and wasteful system. Queuing them in other parts of the hospital and not looking inward (hansei) is a critical mistake. If they value stream mapped the entire care experience from the first symptom to needing to go to the ER, I bet their eyes would be opened.
For example:
- How many of these patients could have been treated earlier by their primary care doctor?
- What if the Canadian system embraced e-visits, allowing patients to handle early symptoms and have confidence in their self care?
- What about the rest of the system is so not valuable to patients that they want to “pay” (with their tax dollars) to sit in a hallway at VGH? If you think about it, that’s pretty extreme for a customer to do.
The challenge for those in health care is that the hospital and ER get all the “glamour” if you will, around issues, yet they only administer 1% of the care. But they get 99% of the press. I always wonder about all of the patients who aren’t on beta blockers for their hearts, or aren’t getting their blood pressure treated. That’s estimated to cause 50,000 deaths annually, a few at a time. That should get our attention – every patient who leaves a doctor’s office with their blood pressure unchecked.
When I read the story, I can feel the feeling that the staff in these institutions (the doctors, too) are victimized by their own system and without leadership cannot realize their own power to change things. That is sad. There’s some room for top-down/bottom-up collaboration, and I’m afraid it seems that the bottom-up includes the doctors, nurses and the patients. That way of treating staff seems thick to me. The irony is that the “top” is really the taxpayer, who’s paying for their loved ones to sit, unattended to.