Improvement Insights Blog

Coronavirus means that we can’t wait weeks for training and months for improvements. Healthcare has to embrace Agile Lean Six Sigma to handle an infection that could overwhelm existing care facilities. (Hint: This has nothing to do with doctors and nurses, but everything to do with the patient.) Here’s how to do it:

“Hi, I’m Jay Arthur, author of “Lean Six Sigma for Hospitals” and the QI Macros [software]. You know, I think we’re at this place in time where we can no longer wait two to four weeks for training and four to six to twelve months for projects to get done. We have to start making improvements right now.

“At this moment the coronavirus is causing all kinds of consternation in the nation, but I think it’s especially true among healthcare professionals because they’re worried they’re not going to be able to handle it if it really becomes a pandemic. So what’s your choice? Well, your choice right now is to figure out “How do I start to streamline everything we do so that we can get people through into care in a timely fashion.”

“I’ll tell you the one thing patients hate more than anything in the world: waiting rooms. Waiting rooms, right? Nobody wants to go into a waiting room (especially with a bunch of other sick people there) and spend a bunch of time with other sick people. No, they want to be taken in, they want to get care, they want to be either discharged or admitted into a hospital. I can tell you I’ve been doing this for quite some time, and it’s not that hard, all right?

“If you imagine this is the clinician and these are the delays between things that are happening with the clinician, guess what? Most of the time is here. This is the patient waiting for something. I want you to take your eyes off the clinicians. Do not try and make clinicians any faster; that’s stupid. Watch your patient from the time they walk in the door until they either leave without being seen or they go through the whole process of admissions and triage and then diagnostics and getting them on into some sort of treatment. If you watch them very closely you’ll find that they’re sitting there for all kinds of time. 90% of the time that they’re there they’re waiting on something to happen and that’s not because the clinicians are slow. It’s because the care is not bumper-to-bumper fast and easy.

“Back in 2004 Robert Wood Johnson hospital won the Baldrige Award but they were turning discharged patients in 38 minutes and admitting patients in 90 minutes. This is a far cry from what Press Ganey says the average length of stay in an E.D. is: Four hours… unchanged for a decade.

“Now there are people out there who are actually doing this really well like Virginia Mason. Go read about their story; great story, okay? This can be done, and it can be done quickly. All you need are the advanced technology for Lean: (Little Post-It notes) and a little bit of time sitting around talking with each other about how you can accelerate the patient’s journey. Accelerate the patient.

“The funny thing about this is currently I think health care is designed to try and optimize the clinicians’ time – the doctor or the nurse or whatever. That’s stupid; optimize the patient’s time, because if you optimize the patient’s time you’ll see lots more patients, you’ll deliver lots more care, you’ll immediately make all the clinicians more effective, more efficient, [they’ll] see more patients, do more good and make fewer mistakes, which is what we’re really looking for. Patient safety and better outcomes, because it’s timely. If you have a big full waiting room in your E.D., that’s not a good thing. That’s a sign of bad management; bad running of the hospital, right? We want to be able to get them in and out.

“The other thing too is you’re going to have to get better at discharge, you’re going to have to get better in admissions, you’re going to have to get better at getting people out of the E.D. into a bed so they can be cared for and not just boarded in the Emergency Department. Then you have to go on diversion so that all these other things have to happen. No! Speed is the healing app.

“If you learn how to embrace speed of the patient, not the clinician, the patient, I’m telling you what… you can create a superhighway for people to go through your Emergency Department or your doctor’s office. I go to a doctor’s office and sit there for 45 minutes with a bunch of other sick people. I don’t want to do that. I want to walk in and sign my name and be taken back into the care facility.

“So that’s my Improvement Insight for this week. Let’s go out and accelerate the patient’s flow. Let’s go out and accelerate the patient’s flow so we can get them into care, we can diagnose them and make sure that coronavirus doesn’t spread from sitting around in waiting rooms.

“Let’s go and improve something this week.”