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Lean Healthcare? A Case Study

Recently, my mom was diagnosed with colon cancer. Her journey speaks volumes about the problems facing healthcare.

In early March, she began having three bowel movements a day--not normal. She saw her regular doctor who referred her to a specialist. It was a week before she could get in to see the specialist. (7 day delay)

He recommended adding more fiber to her diet and sent her home. The gastro guy saw her two more times without taking further diagnostic action. (This resulted in a 100+ day delay.)

In June, my wife and I went on our 20th anniversary trip and when I came back I noticed a radical decline in my mom's health and energy. I encouraged her to call her regular doctor, but she had an appointment for the following week so she waited. (9 day delay.)

I rode shotgun to flog the doctors into action. Her regular doctor ordered blood tests and an upper GI CT scan for the following day, Friday (1 day delay). While the blood test showed an elevated white blood cell count, the CT scan didn't show anything. So the doctor scheduled a lower GI CT scan, but we had to wait until Monday when the CT unit reopened (3 day delay). Tuesday, the doctor called us in to give us the bad news. Next stop: surgery.

When could we get in to meet with the surgeon? Not until the following Monday (6 day delay). After a brief exam, we scheduled the colonoscopy and surgery for Wednesday of the following week (9 day delay).

During the surgery, the surgeon discovered complications that required another surgeon to come from another hospital a 30 minute drive from the operating room (1 hour delay).

Because the surgery was delayed, my mom couldn't be transferred to a surgical nursing unit because of the upcoming shift change. (2 hour delay)

Once mom got to the unit, it was all about recovery and healing which took six days before she could go home. (She's doing better every day, I'm happy to say.)

Lean Lessons for Patients and Healthcare

From the initial visit to the gastroenterologist to the day of the surgery was exactly five months (March 6th to August 6th).

In that period of five months she met with doctors and had medical tests for perhaps three or four hours total.

The surgery took three hours and recovery took six days. Even in the surgical unit, she was only touched by the nursing staff perhaps 10 minutes out of every hour. (Most nurses have four or five other patients.)

So, out of 160 days, she was only "touched" by clinicians for six or seven days maximum. I call this the 3-57 rule: the patient is only touched by medical care for 3 minutes out of every hour, leaving 57 minutes of delay. While medical mistakes can kill patients, the invisible delays in diagnosis and treatment are probably killing far more.

I'm no expert, but a five month delay isn't really desirable when dealing with cancer. It could have spread. The pathologist said it was a stage 2 cancer, which means she has a 1-in-4 chance of recurrence. What if we'd caught it five months earlier? What then?

Most of these delays were a function of the medical system--the scheduling of tests and treatment. The biggest delay was in diagnosis. Most were unnecessary delays. In a lean world, diagnosis, treatment and recovery could have been done in about 10 days.

I hope heathcare gets a lot faster before we need it.