Friday, November 28, 2008

Silver Platter

There's a great article – The Ergonomics of Innovation – linked at the IHI website. It's a case study of IHI's 100,000 Lives campaign, and how they succeeded by making innovation easier rather than harder.

Easier is better than harder? Well, duh!

It seems obvious, but complicated solutions are appealing. Don't we feel smart when we cobble together a multi-stage change initiative that comes with a thick instruction manual?

The authors spotlight IHI's ventilator-associated pneumonia bundle that included elevating the head of the patient's bed to 45 degrees. Some hospitals drew a line on the wall behind the patient's bed and encouraged anyone – families, janitors, other patients – to notify medical staff if the head of the bed was below the line. Simply brilliant – brilliantly simple!

Ergonomics of Innovation made me think of some recent changes we made at the office.  They seem ridiculously simple and obvious (so much so that I debated even mentioning them in the blog) but have been very effective. I've described them in a previous post.

The file-folder containing all X-ray and lab requisitions, along with paperwork bundles for booking surgery, has been a great success. Because the forms are right at hand, I'm more likely to complete the paperwork just after I've seen my patient, and we've decided to proceed with surgery. Although it means completing the forms by hand, it saves me the time of reviewing them later before signing off on them. Also, it gets the form into the surgery booking office 3-5 days faster, again because it's not coming back to me for review. That shaves precious days off my patients' surgery wait times.

Amanda tells me that staff like the file-folders because it makes refilling requisitions easier, knowing that there is one consistent location in all the doctors' offices.

The post-vasectomy letter is a real winner. It turns up on my desk, with the semen analysis report stapled to it. I review the report and sign the letter giving the man the “all clear.” Previously, staff would scan the semen analysis report into my electronic “results to review.” I considered these results much less urgent than looking at biopsy or X-ray reports. As such, it could be up to a week before I got around to playing phone tag with my patient, trying to give him his results. If I did decide to dictate a letter instead of making a call, it would take 1-2 days for it to come back for me to sign.

Now, staff generate the form letter as soon as they receive the report. It requires less work from me, so it gets done quicker. Patients get their results quicker and in a consistent way. Plus, staff don't have to field increasingly-urgent calls from patients requesting their results.

Creating the letter to patients is now done by the most appropriate person, rather than moving that task to the physician. Repetitive work is standardized. Unnecessary steps have been cut out.

From my point of view, the icing on this change was the suggestion to attach the copy of the semen analysis to the letter. Having it immediately available means that I don't even need to open the patient's chart on my computer.

I used to groan mentally when I received a post-vasectomy semen analysis result. Now, it just means a stroke of the pen.

Now that's serving it up on a silver platter!

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