Lean bells ringing at the hospital

Last week I was working at my house together with my father and we removed a wall to create a bigger room for the upcoming baby. While the last stone was removed he damaged his thumb quite badly. We needed to go to the hospital.
As soon as we arrived at the hospital my Lean bells started ringing.

We all know that a doctor or a specialist’s time is precious, but what I saw was an overacting on “we should use valuable time of a doctor”.

Starting at the reception we experienced a bit of value added time (administration). After 5 minutes delay it was the triage that opened the door for a short visit. The nurse gave a short inspection on the injury and concluded that it was not fatal (surprise). She gave my father 2 pills for the pain; a little value added time again. After 5 minutes we were outside and the nurse said my father was given a code green, meaning we should be out of the hospital within two hours. No added value for us.  2 Hours for just some stitches in my fathers thumb. I was thinking they must have been kidding.
We waited for half an hour and a nurse asked my father in for a photo. 15 minutes later the photo was taken and delivered to the doctor to see the injury form inside. The photo was valued added for us.  Next, it was time for waiting again, time was ticking and the thumb was still very painful. 45 minutes later… A nurse asked us in to see the doctor; she cleaned the blood from the thumb. Another 5 minutes delay and a doctor appeared and inspected the injury and asked another nurse to get the photo for inspection. A third nurse was added to the team. She prepared for the stitching of the thumb and the doctor was waiting on the nurse to finish his job.  Again 5 minutes later the doctor finally starting stitching… 2 minutes of work, but value added! Another Doctor showed up to discus how to handle the next steps. After this the second nurse taped the thumb, two minutes of work and we left the hospital 2 hours later.

My conclusion; “Wow, what a waste!” Of the total of two hours processing time only 10% was value added. A whopping 90% of our time spent at the hospital was waste. And a total of eight people performed some kind of work on my fathers thumb.

Who did add value to the treatment of my fathers thumb? Looking at the added value only three people added costumer value. Five people’s jobs didn’t, what if their work was added value, would the treatment be nine times faster?! Not only 90% is waste but also increasing a lot work in progress, which has side affects like needing bigger waiting rooms, a larger emergency parking place and the possibility to eat and drink etc.

In the end, the three actions that did add value were:

1 The receptionist performing administration (added a little costumer value as these actions are necessary for insurance etc.).
2 The nurse that made a photo.
3 The doctor that stitched the thumb added the most real value.

If there was just one nurse that made the photo and the doctor cleaned, stitched and taped the thumb it would be much faster. During the treatment the doctor can give all information needed.
This means less work in progress and more flow and way less handing over information. The time that the nurse is not spending on my fathers thumb could be used for preparations aka continuous improvement. It makes it more interested and you get a very happy costumer. Helping the costumer is where we should put all our energy in; it is key to keep him happy and healthy. So,

“Optimize the patient’s time and not the doctor’s time.”

You will see this happening a lot in software development, focusing on adding the wrong values. Let us learn from this experience by checking your job’s costumer added value. Change your job if it is not adding costumer value.

Now, 4 weeks later, my father came back at the hospital for a checkup. Where yet a different physician told him, the reason his injury did not heal that nicely was that it was stitched to late.


About pascaldufour

Passionate Agile Tester
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2 Responses to Lean bells ringing at the hospital

  1. Mark Graban says:

    As somebody who works in lean healthcare, I certainly understand your frustration. Things are often oriented around keeping the doctors 100% busy, which means patients have to wait. Yes, the MD time is valuable, but things are often taken to such an extreme that waiting times for patients are longer than they need to be. Hospitals that are using lean methods to improve the E.D. are finding that they can change the process to reduce waiting times while still being very efficient – as documented in this book:

    The Definitive Guide to Emergency Department Operational Improvement: Employing Le… by Joseph T. Crane http://t.co/tLOTYpv

    I’d question the “value add” a bit-

    1) Is filling out insurance forms really “value” to the patient? I’d argue this is necessary waste (necessary for the hospital to get paid). Filling out forms doesn’t directly get the thumb fixed. Some hospitals are moving registration to take place AFTER triage (get care first).

    2) Is taking a photo really value when an MD could be just directly looking at the thumb? It seems like waste to take a picture (added cost and work). Some hospitals are doing “team triage” where an MD and RN are actually working together to see patients that first time.

    You’re right to point out that a relatively small percentage of the time was actually “value” to the patient.

  2. pascaldufour says:

    Thanks Mark

    Moving registration after the traige makes sense to me. The photo was even not neccessary the docter said

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