Sunday, June 27, 2010

Teaching lean healthcare. What a humbling experience.

This Saturday, I spent eight hours face-to-face with a new cohort of Executive Management of Healthcare Administration (EMHA) students at the University of Washington's School of Public Health. Doctors, nurses, pharmacists, IT specialists, finance people, food service people: all so very very bright and so very motivated to improve our healthcare system, in the United States--and healthcare systems all over the world.

The content of our interaction in this, the first of three 8-hour classroom experiences in June, July, and August, was the application of the Toyota Production System to healthcare operations. Without belaboring details, this means that we talked about ways to reduce healthcare "lead time," as defined by the total time experienced by the patient, from the beginning to end of what (in healthcare terminology) we might call a "treatment experience." (In healthcare we sometimes refer to this as a "patient encounter," which is rather revealing, as if we didn't know they were coming to see us...)

In a clinical or emergency room experience, this experience might normally include:

1. registration
2. waiting
3. assessment
4. waiting
5. treatment
6. waiting
7. discharge

Of course, this is an extremely truncated view of the patient experience, but it captures the essentials:

a. Who are you?
b. What's wrong with you?
c. What can we do about it?
d. Let's do what we can.
e. Get out of here...

Clearly, from the patient's perspective, we would like this experience to be over quickly, so that we can go home and rejoin life in progress. As quickly as possible, thank you very much.

Unfortunately, the clinician's experience is, for practical reasons, often determined by a compelling need to get on to the next patient.

Of course, that is all well and good if I am the next patient. But what if I am this patient? And, life begin what it is, I am normally this patient.

Hello. Remember me? Your patient?

And, I am waiting for you to get around to me.