| I want to tell you some ways to eliminate waste | | | | tocount the number of successes/failures in |
| at your medical site. Am I talkingabout physical | | | | communications. Many unintendedconsequences |
| waste, like soiled bandages or used needles? No, I | | | | occur at transition points and handoff points due |
| mean any actionthat results in a poor or | | | | to poorcommunication. You might count if a |
| unintended outcome. I mean taking too long to | | | | supply was missing and someone had toscurry to |
| accomplishsome outcome, like taking too long to | | | | find another one. You will want to later find the |
| get an operating room ready for the nextsurgery. | | | | mean and standarddeviations of these measures. |
| The National Institute of Health in "Crossing the | | | | The goal is achieve a target mean with as small |
| Quality Chasm" statedthat any waiting time for a | | | | aspossible standard deviation. For example, you |
| patient is a waste. A patient waiting past the time | | | | should have 0 as a target for thenumber of times |
| of his/her scheduled appointment is an example. A | | | | a supply was missing. |
| patient having to wait too long to beadmitted to a | | | | After reaching a mapping that all agree |
| hospital after being seen in the emergency room | | | | represents as best as possible the presentflow of |
| is an example ofpoor processes--a waste. A | | | | events, the group should brain storm ways to |
| patient who develops an infection after being | | | | improve the flow. The goal isto find a significantly |
| treated orgoing through surgery is a good | | | | better path. If a consensus is reached, fine; |
| example of waste from unintended outcomes. | | | | implement it. Ifnot, then perhaps you will want to |
| These are just a few examples. I am sure that | | | | try the various ways and then decide which |
| you are aware of many more. | | | | isbest, based upon agreed upon measures of |
| Japanese manufacturers are leaders in eliminating | | | | outcomes. |
| waste. One trick they use is tosend a new | | | | Once an optimized process is developed by the |
| employee to the manufacturing floor and have | | | | staff, you should write it down. |
| him/her watch someoneperforming a task; the | | | | Make it a standard operating procedure and try to |
| new employee is told to watch until he/she sees | | | | have all involved parties adopt it. |
| a better wayto do the job. These manufacturers | | | | You might want to allow a little bit of wiggle room |
| know that the time spent doing this will savemore | | | | for individual differences inperforming a task; the |
| time and money in due time. Hospitals and | | | | goal of a common target with small standard |
| healthcare sites are notmanufacturing plants, | | | | deviationshould the goal of all, though. |
| though. Yet many of the same principals can be | | | | Another tool to use is open communication. Too |
| applied. Theeffort will more than pay for itself. In | | | | often a staff person or nurse willsee some event |
| fact, savings of 3 to 100 times the investmentis | | | | unfolding that will lead to poor outcomes. If the |
| not unusual. The movement going on in the | | | | work environmentis not conducive to positive |
| healthcare field adapted from the | | | | communication--communication which does not |
| Japanese manufacturers is commonly called "lean | | | | resultin negative outcomes for the reporting |
| healthcare." Perhaps you haveheard of some of | | | | individual--mistakes and waste will alwaysoccur |
| the terms associated with it, like Kaisen events or | | | | that could easily have been prevented. To reach a |
| poka-yoke. Youdon't have to be a master of | | | | high level of positivecommunication, the leaders at |
| these tools and terms to make good use of | | | | a site must work long and patiently to build trust. |
| them,though. Many are just applying logic with | | | | Itis not easy to do, but the payoffs are |
| common sense. | | | | tremendous. Everyone wins! |
| The tools are best applied in efficient working | | | | Most healthcare leaders think of quality |
| teams or groups where someproblems with | | | | improvement as applying to activities thatdirectly |
| processes or outcomes are already agreed upon. | | | | involve the patient. However, the best healthcare |
| If the workinggroup is larger than 3 or 4 people I | | | | providers use these toolsand others to evaluate |
| suggest that one tool you use are string and 3by | | | | all the processes at a healthcare site. The |
| 5 cards. You are going to use these to map out a | | | | admissions andbillings departments are ripe |
| process from beginning to endand see if the | | | | targets, for instance. The result will be happier, |
| group can find waste and suggest ways to | | | | moremotivated employees who are working |
| eliminate it. Use the cardsto describe what | | | | more efficiently. In fact, sites which |
| physically happens during a process and use the | | | | wereexperiencing a shortage of staff often finding |
| string to connectthe activities that flow from one | | | | themselves well staffed because ofquality |
| to another. For example, you might want to track | | | | improvement processes. I do suggest that you |
| apatient in a doctor's office coming in for a | | | | promise all employeesinvolved in these processes |
| physical. The first card would representthe | | | | that you guarantee there will be no layoffs. Doing |
| patient's encounter with the first staff person | | | | sowill produce better outcomes. |
| who records the patient'spresence. From there, | | | | If you want more examples of system wide |
| strings would indicate communicating with other | | | | applications of quality improvement inhealthcare |
| pertinentpersonnel of the patient's presence and | | | | facilities, I suggest that you go to the Baldrige |
| the ensuing events as well a string and cardthat | | | | Award site on the internetand read the success |
| would indicate the patient waiting in the waiting | | | | stories of winners. Their results will amaze you, I |
| room. In all of these mappingsyou should be | | | | promise. |
| thinking of what you would like to use as variables | | | | I hope that you seriously consider adopting these |
| to measure. Youcertainly should be measuring | | | | tools and research other methods. |
| time by all involved parties. You might also want | | | | Many are described at various healthcare sites. |