I recently had an opportunity to work with a series of hospitals on improving patient throughput. With the WWII generation in their 80s and the Boomers hitting 60, hospitals are full. Emergency rooms are full. For the safety of patients, emergency rooms are sometimes forced to go on "divert" for a period of time to prevent ambulances from delivering patients. And the nursing shortage is at 9% and rising.
We can't build enough hospitals or train enough doctors and nurses to meet the demand, so we need to find ways to accelerate the patient, because as any patient can tell you, a stay in the hospital is filled with long periods of inactivity punctuated by high bursts of doctor drive-bys, lab work, and so on.
The biggest challenge to getting new patients into the hospital is getting discharged patients out of the hospital. Happily ignorant about how insurance worked, I was surprised to find out that hospitals aren't paid for the day of discharge. It doesn't matter if you leave at 1am or 11pm, no money changes hands.
Over half of the delays involve waiting for a family member to pick up the patient (and take responsibility for their care). Almost half of the discharges happen after 5 p.m. when staffing is reduced. Some of the lateness of discharge is caused by doctors who "round" on their most critical patients first (e.g., ICU) and then their least critical (and most likely to be discharged). But to make room to move a patient from the ER to the ICU and from the ICU to a nursing floor, the nursing floor has to be emptied first.
The Power of Limiting Beliefs
As I started to work on this project, I quickly found myself immersed in the corporate culture both spoken and unspoken. It took me a while to realize that the entire hospital had adopted a couple of limiting beliefs:
- We can't change the patient's family's behavior.
- We can't change physician behavior.
There is an implied "because" in both of these statements: We can't change family behavior because they aren't within our control. We can't change physician behavior because they are headstrong and impervious to change.
Limiting beliefs of the form "I can't because..." have tremendous power, because they prevent the search for solutions.
Discovering the Limiting Belief
When working with individuals, it's usually easy to discover the limiting belief because they will say things like "I can't because..." With cultures, it's a little more difficult, because the belief is often unspoken.
With cultures, I begin by listening for what isn't spoken or what solutions aren't being discussed. The "impossible" solutions aren't even discussed, so the silence around them is a clue to the existence of a limiting belief.
Once I get an idea of what's missing, I look and listen for confirmation before suggesting it to the employees.
Busting the Belief
Once I have a clue about the existence of a limiting belief like "we can't change family behavior," I try it out on a few key members of the staff to see if it strikes them as correct. If I get an "Oh my God, that's so true!" or something similar, then I offer it to the rest of the organization.
Once you find and reveal a limiting belief, most people are ready to at least consider how to change it.
In the case of the hospital, we quickly found that they were only getting one contact name and number for pickup. Why not two numbers (home, work, cell)? Why not more than one contact name (father, mother, spouse, son, daughter, etc.)? On investigation, we found that there were five-to-ten common diagnoses where the typical length of stay was 3-4 days. We began to wonder, could we start setting the family's expectation that the patient would be getting out in 3-4 days? Could we start setting expectations that someone would need to be ready to pick them up as soon as the doctor discharges them on that day? Could we offer limo rides home to ambulatory patients who would not need care? Sure! All of these things are possible.
You see, once we challenged the limiting belief, the solutions started to pour in.
What about doctors? By talking to physicians who belong to groups that work at several hospitals, we discovered that other hospitals have monthly patient throughput meetings for their physicians. In these meetings, doctors discuss how to accelerate their patients through the hospital. Doctors coming up with their own ideas for improvement quickly get clear that they are part of the problem and simple changes like changing the order of their rounds or writing conditional discharge orders the day before discharge could really make a difference.
Get the idea? When you find and reveal a limiting belief, it frees up a lot of stuck creativity.
I worked with one wireless company that had too many calls to their customer care center. One out of every two customers called each month. What was their limiting belief? "Customer's don't know how to use cell phones." Truth was, the wireless unit was part of a wireline phone company staffed with "Bell-shaped" heads. The customers knew how to use a cell phone, but the employees didn't.
Every bit of marketing material and even the cell phone instructions were geared to get the customer to call the care center so that they could explain the use of the cell phone. Even when I pointed this out to them, they had a hard time seeing it. I suggested rewriting everything to make the customer self-sufficient and to stop assuming that they didn't understand.
Here's My Point
Limiting beliefs can stop you from looking for solutions to your most pressing problems. If you don't believe it's possible to do anything to prevent them, you won't even try.
Listen for what you aren't saying. Look for what you aren't even attempting to resolve. There's always a limiting belief. It's not that it's impossible to solve, it's that you don't yet know how to solve it. It's a matter of know how, not possibility.
Challenge your limiting beliefs. It will free up tremendous creative power to solve some of your most vexing problems.