Friday, May 25, 2007

The "I" in Team

How many surgeons does it take to change a lightbulb? One – to hold up the bulb and let the world revolve around him.

Think I've been doing this on my own? No way; I'm just the glory hound. Let's meet the team:

Office staff

Amanda, Delores, and Donna have expanded my definition of muda. (Ladies, this is not personal - read on!) A few weeks ago, I wrote about muda as waste in our appointment booking system (rebooking appointments, no-shows, etc.). Now I think there's an even more important source of waste: untapped potential.

Our Advanced Access project has been new ground for most of the team. We're learning as we go. No one is the expert. That fosters a different interaction between physician and office staff. Usually, I'm "the boss" and ideas flow only one way because... the boss is always right. (It's hard to be right all the time, especially when you're wrong.) As there's no boss at our team meetings, I see a new level of interaction and sharing of ideas. Our staff representatives have some great improvement ideas that wouldn't occur to me. Imagine if we could uncork that creative energy in all our staff.

Friday, May 18, 2007

Gaining Momentum

How do you eat an elephant? One bite at a time.

We're starting to see some changes! But, first...

Epilogue to last week

Thanks to everyone who sent best wishes for my father. He's back home, doing well. I received a note from someone wondering how much of my father's "exceptional service" could be attributed to the fact that we are a "medical family" (Dad's a retired surgeon).  This person (a notorious and flagrant straight-shooter) suggested that medical types might get preferential treatment from other medical types.

No argument from me. I've been guilty of this myself. However, at Calgary Foothills ICU, I saw ample evidence that the terrific, patient-centred care provided to my father was given to all patients. Maybe this idea – that health care workers sometimes get "perks" from the system – should be part of the definition of exceptional service. That is, treat all our patients as we expect to be treated. Golden Rule, anyone?

Back to our story

Feel the burn! Over the last 4 weeks of working down our backlog, we've seen 207 extra patients.  For the urologists, this meant seeing patients during snippets of time usually reserved for phone calls and paperwork. For the staff, it meant 207 extra appointments to book, 207 additional charts to create, 207 more letters to type... Great work, everyone! 

I've been introduced to the concept of good backlog. I thought all backlog, or waiting, was bad but there are circumstances where that isn't necessarily so. If someone chooses to have their appointment scheduled in 6 weeks rather than 2 weeks, perhaps to accommodate holiday plans or harvest time, their wait is considered good backlog.

Friday, May 11, 2007


"Every little thing she does is magic..." The Police

Dear Reader: Forgive me for wandering off topic in this post.

Saskatoon Health Region's vision is "Healthiest people, healthiest communities, exceptional service." Exceptional service. What does that mean in health care? As a member of the region's patient- and family-centred care steering group, answering that question was my homework last week.

I decided on the literal interpretation of exceptional, that is, "beyond what is expected." A friend of mine who’s a businessman describes exceptional customer service (somewhat cynically) as: "Underpromise, overdeliver."

It shouldn't be hard to "overdeliver" in health care. Let's face it: we've set the bar pretty low. Expectations are so dismal that they're clich├ęs:
  • Check your dignity at the hospital door.
  • It'll be cold.
  • It's going to hurt.
  • Wait to see the busy specialist.
  • You're the doctor.

Friday, May 4, 2007


“No battle plan survives contact with the enemy” Helmuth von Moltke

Project team assembled. Goals set. Baseline data gathered. So far, this Advanced Access stuff has been a breeze. Fun, even. It seems a shame to ruin it by actually getting down to work, but it's time. Charge!

Where to start? Our plan took shape after we read a great AA success story from Fargo, North Dakota. By a urologist! Dr. Duffy started AA by working down his backlog of waiting patients. He doesn't sugar-coat it - this is hard work.

Our team calculated the backlog and how many extra patients we would need to see every week in order to eliminate the backlog over 6 months. I emailed the figures out to the urologists. This was one reply:

“As you know I am personally scared about this program. I thought I was seeing enough patients per month and 30 more seems a lot. I wish I could be more optimistic about things being a whole lot better after the backlog is eliminated. Seeing more patients potentially generates even more review visits although I understand we are to be hardnosed about getting them back into the care of primary care physicians. I am not sure what constitutes good backlog and what constitutes bad backlog.

I see more work (dictating letters, reviewing investigations, and catching up to consults) having to be done after hours of our already long days or on holidays. However I also do not have any other constructive solution so I will try to be cooperative but I am concerned if I have the energy to cope with more work and stress.”

Uh oh.