My Morning Run - Reflections on Healthcare

From Guest Blogger Peg Pennington

March 08, 2009

Mile 1:

Kelly and I are going to save the world. Today’s topic… health care. Kelly, never one to shy away from the big topic asks, "How is Obama going to fix health care?” I can hear Drew Dillon on my shoulder talking about root cause and I make some cursory remarks about better diets and exercise would be a good start. And there are some things I've learned about the lean system that might help.

Mile 2:

For the 10th time I describe to Kelly the elements of the Toyota Production System and Steven Spears, DNA of Lean. Didn't you read that book by Atul Gwande yet? I think she's tuning me out and trying to run ahead of me now.

Mile 3:

Basic huffing and puffing, no good conversation here.

Mile 4:

By mile four I’m a good 10 steps behind and struggling to keep up. It's time to try one of my typical ploys to reel her back in. "How's work going?" I asked. "What?" she says. "HOW'S WORK GOING?" Then Kelly does what I know she's going to do, which is slow down and talk to me. (Yes, I really am that kind of evil running partner)

"Well I cried at work yesterday" she said. If you knew Kelly you would be surprised by this. She has a deep reservoir of compassion, but she's also a roll with the flow kind of gal. I was expecting another heart rendering story about a cancer patient too sick to live and too young to die. That's not the story I got. It went like this:

Kelly was asked by a physician to clean and pack a wound. Well this particular wound is the biggest she's seen in her career. It takes her an entire hour hunched over the patient to complete the task. By the end, she's sweaty and her back is killing her. Just as the last piece of tape is getting put in place the physician comes in and wants to see the wound. Of course, we want the physician to see the wound because they are inspecting for infection. But here's the problem.

This process was performed out of order. Had the physician communicated that she wanted to see the wound then the process flow would look like this:

Inspect —> Clean and Pack

Instead of:

Clean and Pack —> Inspect —> Clean and Pack

Here's an estimate of the cost to the system when work is performed out of order:

  • Increase in labor cost (additional hour spent on rework)
  • Increase in the cost of supplies
  • Decrease in patient satisfaction
     ‐Patient #1 satisfaction decreases due to multiple handling
     ‐Patient #2 — the one not getting the needed attention because Kelly is doing rework
  • Decrease in employee satisfaction due to rework and perceived lack of respect by the physician for her time

It's a small cost when you look at the cost of the entire health care system, but multiply this incident across all hospitals and it adds up.

How are we going to fix healthcare? Many, many small steps in a system of plan, do, check, adjust. I know this message is going out to the choir of angels that are working hard on implementing operational excellence. Your work is not in vain.

Happy Trails,

Peg Pennington is the Executive Director of the Center for Operational Excellence at the Fisher College of Business at The Ohio State University.