I love standing in line.
Or, more accurately, I love what I learn from standing in line. Being stuck in traffic, waiting at the grocery store checkout – they're all golden learning experiences if you're a student of queues. But nothing beats air travel...
Over the holidays, I enjoyed a tremendous learning opportunity courtesy of a leading national airline. So many of the problems I observed at Toronto airport were analogous to the situation in physicians' offices. Because so many people have experienced the frustration of waiting in line at the airport, perhaps this could be an effective model to explain Advanced Access/Clinical Practice Redesign to novices.
Before we even arrived at the airport, we had been primed to expect a long wait. Airlines establish cultural norms with the advisory printed on every ticket: Be at the airport at least 60 (or 90, or 120) minutes before your flight departure. So we shrug our shoulders and drag our suitcases to the end of the line, because... that's the way it's always been!
Sound familiar? It takes forever to get in to see my doctor. You'll wait a long time to see a specialist. Health care sets the same norms. Earlier this week, I heard a presentation about a new project in the Saskatoon Health Region, aimed at reducing patient wait times when they come for assessment and education at the Pre-operative Clinic. The project coordinator showed a sign currently posted at the entrance of the clinic. It showed a drawing of a man resigned to his fate (shrugging his shoulders in a C'est la vie kind of way) and said: Your visit to the pre-operative clinic may take 4-5 hours. Those are the expectations we establish for our patients. That's the promise of service we give as our patients come through our door.
Friday, January 9, 2009
Friday, December 12, 2008
Cup Holder Conundrum
Over the last few days, many of you watched, as I did, the Pan-Canadian Broadcast of IHI's National Forum. The keynote speeches weren't very cheery.
Don Berwick looked downright ticked off. Change isn't progressing fast enough for his liking. I suspect that most people involved in quality improvement share his frustration. Dr. Berwick imagined 2 letters that he would write, for his daughter to open 20 years from now. One letter presumes that the quality agenda will flourish over the next 2 decades. The second letter is an apology: Sorry we let the nay-sayers beat us down. Sorry we couldn't budge the inertia of groups with a vested interest in the status quo. Sorry that you're paying the price 20 years from now.
John Kitzhaber – ER physician and former Oregon governor – made a passionate appeal for reforming the US healthcare system before it becomes financially unsustainable. His perspective is purely American, but in the current economic situation, Canadians should take notice as well.
Gloomy!
It made me think of automobile cup-holders.
North American automakers have been pilloried as they plead (and make not-so-veiled threats) for a financial bailout. GM has made an astonishing mea culpa: We acknowledge we have disappointed you. Whether or not you think they are sincere (GM gets savaged in some of the comments below the article), some of their admissions could just as easily come from the healthcare industry.
Don Berwick looked downright ticked off. Change isn't progressing fast enough for his liking. I suspect that most people involved in quality improvement share his frustration. Dr. Berwick imagined 2 letters that he would write, for his daughter to open 20 years from now. One letter presumes that the quality agenda will flourish over the next 2 decades. The second letter is an apology: Sorry we let the nay-sayers beat us down. Sorry we couldn't budge the inertia of groups with a vested interest in the status quo. Sorry that you're paying the price 20 years from now.
John Kitzhaber – ER physician and former Oregon governor – made a passionate appeal for reforming the US healthcare system before it becomes financially unsustainable. His perspective is purely American, but in the current economic situation, Canadians should take notice as well.
Gloomy!
It made me think of automobile cup-holders.
North American automakers have been pilloried as they plead (and make not-so-veiled threats) for a financial bailout. GM has made an astonishing mea culpa: We acknowledge we have disappointed you. Whether or not you think they are sincere (GM gets savaged in some of the comments below the article), some of their admissions could just as easily come from the healthcare industry.
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.
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.
Friday, November 14, 2008
Making Lemonade
I've had a sour taste in my mouth for the last couple of weeks.
Whenever I have the opportunity to share our Advanced Access results, I love to show this chart as the presentation's punchline:
It's our 3rd NAA (next available appointment) from the start of our work in March 2007 (61 days), and from February 2008 (39 days). Nice!
But recently, I've had to follow that slide with this slide:
Our 3rd NAA in September 2008 was up to 60 days. And it looks like I'll need to start showing this chart (with data up to mid-October) in the near future:
Whenever I have the opportunity to share our Advanced Access results, I love to show this chart as the presentation's punchline:
It's our 3rd NAA (next available appointment) from the start of our work in March 2007 (61 days), and from February 2008 (39 days). Nice!
But recently, I've had to follow that slide with this slide:
Our 3rd NAA in September 2008 was up to 60 days. And it looks like I'll need to start showing this chart (with data up to mid-October) in the near future:
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