Since my last posting on this subject, with a family member having been admitted into care in a hospital I was able to talk to other health professionals who particpated in the care giving. For the past two weeks, I had the impression of smooth flow and wait free attendance of the care and auxiliary staff who needed to attend to the care and recovery of one particular patient at hand. I had sampled the Nursing staff who were explicitly assigned on the ward when sharing what I had observed.
However, its quite possible I have conveyed skewed perspective given that my daily visits were around the same time window between 12:00 – 2:30 pm. I managed to discuss my observation of what appeared to be smooth flow in providing the patient with the daily need in care (medicine, meals, clean up, exercise etc.) with couple of the aides who came in to give a breathing treatment, this usually lasting no more then 15 minutes. It works out that not every task, even the medical treatment task, appears on the ward Scrum board that I had previously mentioned. In fact he pointed out that his daily orders of which patients to attend to for this particular type of treatment appeared from the Pharmacy. He pointed out, more often than appearances had so far led me to believe, there would be a bottle neck in the patients room with number of care personal trying to serve one need or another. This resulted in waiting and lining up similar to the lines we see at a grocery check out – his exact statement. Fortunately they have some slack and really freedom to coordinate their time, so often they’d go to a nearest patient needing service and return there after. No doubt there are others who may not be permanent fixtures to the ward but do provide service to it that have similar experience, and waiting may not be the only waste that they see or experience.
Clearly, there is room for improvement that can lead to better coordination and collaboration amongst all the care providers. In the ideal case having a shared and common information system, Scrum or Kanban board at the ward level would be of great value. In general I would say at the strategic level there is an opportunity to work at the ward level with all the care staff to Train, Map and Check on Lean principles, in particular their role in helping identify and eliminate waste. I say do this at the ward level, as in my mind this is the effort of a team. Though I consider Lean thinking to take place a many levels, including individual, role as well as team based. I like the following example 8 Wastes with Healthcare examples (ref: Lean Healthcare Exchange).
I also realize that the Paul Levy‘s recent blog Kaizen Corner – standardized work was in part addressing this and the opportunity of better coordination in order to deliver value to the customer. His blog is aptly called Running a Hospital.