Imagine air-traffic control using nothing but telephones, pagers and white-boards. Seems like a bad idea, doesn't it?
It might work for a few dozen simultaneous flights but how about a few hundred or the 4,710 commercial flights that are in the air as I write this? In this Flintstones' world, I imagine, flying is unpredictable, expensive and, relative to our world, dangerous.
Stepping into Bedrock, would you suggest that they fix their problems through process improvement initiatives focused on improving taxiing, refueling and flight-planning? Or, would you recommend the use of modern technology and install a state of the art air-traffic control system that ensures all flights fly at their best possible rates with regard to safety and efficiency? I'm betting on the later.
Well, with respect to flowing all patients simultaneously from arrival through discharge we are basically in Bedrock. So, instead of improving sub-processes of patient flow why not tackle the root of the problem by installing an enterprise-wide hospital operating system?
Just as bad air-traffic control has dire consequences, so does not having this hospital operational control. I believe that there is evidence that its absence leads to tens of billions of waste annually and probably contributes to the 44,000 avoidable deaths due to medical and medication errors.
It might work for a few dozen simultaneous flights but how about a few hundred or the 4,710 commercial flights that are in the air as I write this? In this Flintstones' world, I imagine, flying is unpredictable, expensive and, relative to our world, dangerous.
Stepping into Bedrock, would you suggest that they fix their problems through process improvement initiatives focused on improving taxiing, refueling and flight-planning? Or, would you recommend the use of modern technology and install a state of the art air-traffic control system that ensures all flights fly at their best possible rates with regard to safety and efficiency? I'm betting on the later.
Well, with respect to flowing all patients simultaneously from arrival through discharge we are basically in Bedrock. So, instead of improving sub-processes of patient flow why not tackle the root of the problem by installing an enterprise-wide hospital operating system?
While it’s true that a hospital may have some technology assist – hotel-like software helping manage the "booking" and cleaning of rooms and facilitating transports – most have nothing that approaches a system whose aim is ensuring all patients flow simultaneously at their best possible rates with respect to length of stay, service times, quality, safety and resource consumption.
The truth is that today’s modern hospital is too complex, with too many simultaneous transactions not to have a system that is responsible for patient-flow, yet most often they have none. As a result hospitals tend to operate as a collection of independent departments that compete for limited resources: clinicians, patient beds, wheelchairs, medications, IV pumps and other essential diagnostic and treatment resources. Most attempt to treat this systemic problem by repairing its parts, but the treatments tend to be outside of any global system-aim or "organizational consistency of purpose", as W. Edwards Deming might say. Thus, state of the art process improvement methodologies are applied to one department at a time, but process improvement which rests on the shoulders of siloed operations and technology won't be transformative and is difficult to sustain.
Without an enterprise control-system, process improvement initiatives are unlikely to provide meaningful, sustainable, enterprise impact. If you believe that it is vital to transform hospital operations, start by installing a hospital operating system. And then start improving processes.
In future posts, I will describe the characteristics of a successful hospital operating system, and I will offer a few case studies of their success.
Without an enterprise control-system, process improvement initiatives are unlikely to provide meaningful, sustainable, enterprise impact. If you believe that it is vital to transform hospital operations, start by installing a hospital operating system. And then start improving processes.
In future posts, I will describe the characteristics of a successful hospital operating system, and I will offer a few case studies of their success.
There are these two young fish swimming along and they happen to meet an older fish swimming the other way, who nods at them and says "Morning, boys. How's the water?" And the two young fish swim on for a bit, and then eventually one of them looks over at the other and goes "What the hell is water?"
Isn't technology a key component to improving processes? I.T. solutions overlaid onto poorly performing processes will only magnify the inefficiencies, not improve them. Where breakthrough improvement occurs is when the processes are improved and also automated by technology. Thus, process improvement and technology solutions are not mutually exclusive. They are as intertwined as Yin and Yang.
ReplyDeleteScott,
ReplyDeleteThank you for your comment, and I suspect we are in violent agreement.
When dealing with something as complex as hospital operations, technology (in my opinion) is a necessary component, but not sufficient. One needs to deploy the right technology in the context of processes design and mindset activities which bring about an organizational system-aim or consistency of purpose. Unless all sub-processes are conspiring to bring about the same system-goal, technology will not help you. However, there is no way (again, my opinion) that one can sustain anything like a simultaneous patient-flow system-aim without the proper technology.
Having said all that, the *right* technology (in the context of hospital operations) helps interconnect all processes relevant to patient-flow thereby providing a type of system-aim infrastructure by which one can operationalize procedures, have visibility, change the environment, etc. Basically it will act as a process improvement platform. More on this in subsequent posts.
If you have a bad process and automate it, you have an automated bad process.
ReplyDeleteObviously, all system improvements begin (or ought to) with an audit, like a value stream map, and then work hard to eliminate slack time -- waste, white space, muda, whatever you want to call it -- and only then should it be automated.
In a sense automation casts the newly revised system in digital cement, but for certain it minimizes system variability. On a two-lane highway you can ride in the right lane or the left, but you can't ride off of the highway (at least not well).
Bill,
ReplyDeleteI do not disagree with your comments at all.
In my own clumsy way, what I was trying to say is that it feels like, in the world of hospital operations, people are (metaphorically) trying to reduce plane accidents without ever noticing and addressing the fact that they have no air-traffic control system. In the absence of air-traffic control, optimizing processes isn't going to fundamentally change flight safety. So, first put in a hospital operations system (people, processes and technology), and then return to optimizing processes in the context of that hospital operations system.
A very nice and informative article, this will surely help me a lot when I start on my work involving a process improvement scenario for a healthcare facility. I am using a process simulation software to improve the processes.
ReplyDelete