by Lee Fried, on 30 Jun 2008 08:19 pm
The Journey | Tags: standard work and healthcare
Why I Work In Healthcare
I spent some time today debated if I would write this posting, because I have lot of energy right now around the subject matter due to an experience my family is going through as I write to you today. I started this posting a couple of times and then walked away from the computer for a while. So I will start with a story to provide some context. A family member of mine recently had surgery at a very well respected hospital on the East Coast. A couple of weeks after the surgery he developed some complications and was rushed back the hospital. He appeared in the emergency room on a very busy, and chaotic Friday night and after waiting for quite some time was finally admitted and treatment began. After his initial treatment there was some additional complications and in the chaos of the situation there were several missed communications between clinicians. Additionally, the proper treatment path was not followed even though it would be considered “evidence based.” Luckily, the mistakes were realized when one of my other relatives that happens to be a physician intervened from afar and things seem to have stabilized. Afterwards it was very clear that if the processes were standardized and the standards were followed it would have been simple to have avoided the mistakes. But caught up in the chaotic environment with no clear processes to follow it was easy to make very preventable mistakes. Throughout this experience my family was taken care of by incredible nurses, physicians and other care takers. Great people that were trying to work in a broken system.
I often find myself debating with people within my industry whether standard work can be applied to patient care. I often hear back that it does not apply because ”no two patients are the same” or “healthcare is far too complex for standard work” to work. This argument is frustrating and we need to find ways to put to rest. I am sure that every industry has heard the same exact argument about why standard processes can not be applied in their field. I was telling my neighbor about what happened and he confirmed that in his industry (aerospace) twenty years ago it was the same story. “Airplanes are far to complex to be built by standard processes.”
The healthcare industry needs to start to pay attention to what other industries have already figured out. That the same reasons that we give as excuses on why processes cannot be standardized is the exact reason why we need to make them standard. The more complex a process the more important it is to standardize in order to bring it under control and then understand where it can be simplified. This also applies to the variation argument. If there a high degree of variation in inputs it is essential that you standardize to understand how much variation really exists and then have a strategy to respond to it. This is the only way to effectivly minimize the variation of outputs.
Like in Aerospace we work with a product (patients) where the stakes are very high and mistakes can be very painful. This is why I work in healthcare.
on 01 Jul 2008 at 10:36 am 1.From Seattle said …
Lee,
I can’t tell you how grateful I am that you posted this today.
I too made a decision to work in healthcare after an experience that sounds very similar to what you described. For me, it came during my first year in Seattle (2005) and was a lengthy hospitalization that was chock full of mistakes, wasteful procedures, bills up to my ears, and worst of all–I was sicker than I was when I walked in 46 days earlier. It ultimately ended up in a major surgery that had complications, not to mention a pretty big impact on my body.
I think keeping this in front of us is essential, especially in light of some of the “push back” we can get from time to time working with leaders, physicians, nurses, etc. Although sharing these experiences is difficult (and at times, awkward for those listening) it truly puts in the “voice of the customer” and reminds us and those around us why we do the work we do.
I never want a patient to go through the nonsense your family and mine has gone through, and that is not a slam against providers or certain hospitals–just a daily reminder of why I’ve chosen this path.
on 01 Jul 2008 at 11:11 am 2.Brian Buck said …
Lee,
Fantastic post! Attacking complexity as the reason for standardization is a great response to this common pushback in healthcare.
Your blog is inspiring, informative, and awesome. Keep up the great work!
on 01 Jul 2008 at 5:39 pm 3.Mark Graban said …
Lee - thanks for sharing that story, what a great post. I sincerely hope your family member is doing better…
on 02 Jul 2008 at 5:40 pm 4.Lee Fried said …
Thanks to you all for writing back with your support!
Lee
on 05 Jul 2008 at 11:56 am 5.Anthony Reardon said …
Hi there,
Just doing some surfing this morning and noticed your forum/ post. Please excuse if my comments are out of context.
Physicians are expected to rate their judgement highly and for good reason- however, that has no direct correlation to their abilities to run businesses nor understand organizational concepts (though most probably don’t know that).
The problems in hospitals are going to be physician driven. This is because of the politics associated with negotiating for higher pay in a declining reimbursement environment. They will point the finger at the hospital administration, regulations, and unfair litigious obligation… who will point along to government, insurance providers, and patients who abuse the system/ don’t pay.
What most physicians do understand is triage and patient care. So I presume most care about doing the right thing and believe they know what to do- if “properly staffed, supported, and paid”. They are obliged to (i.e. need for receptionists). Any mention of practical business process in that environment is quickly absorbed into the whining, politics, and “production overload”.
The implementation requirements to affect the healthcare system require buy-in from all stakeholder levels from patients all the way to government. I understand sitting there in an emergency room seeing the missed communications etc. suggests to you a simple organizational level focus on improvement is the prescription. However, my opinion is that will only treat the symptoms and will not be sustainable. Not a politically good move to endorse, back, and drive.
I agree this is a perfect environment to utilize improvement methodologies and experience. However, I think almost better to build your own system across the street rather than negotiating improvement solutions into a system that is vehimently opposed to any form of personal ownership or buy in. Its an entreprenuerial solution- probably a more direct, immediate, and cost-effective solution to the problem you want to solve.
My two cents anyway
on 01 Aug 2008 at 10:37 am 6.Curious Cat Management Improvement Blog » Management Improvement Carnival #40 said …
[...] Why I Work In Healthcare (Lee Fried - Daily Kaizen): “Great people that were trying to work in a broken system.” [...]