Tuesday, April 25, 2006

Toyota at UI

Toyota at UI

Here is a story from my alma mater, The University of Iowa Hospitals and Clinics. Good old UIHC has hired an automotive expert to bring lean manufacturing concepts to the hospital. The first project in the ED has reduced wait times and increased patient satisfaction.

This is a great example of a hospital using knowledge from another industry to improve care. While it is generally recognized that we should use “cross-industry fertilization”, I haven’t seen it used extensively in healthcare. I think part of the problem is that we don’t necessarily know where to look. Everyone knows that Toyota (and other manufacturers I am sure) have come up with processes that are extremely efficient. We also know that the banking industry has standardized data, so that ATMs across the world can securely access our account and dispense money. But where else should we look? What does the retail or marketing or shipping industry know that we can learn from? Which industry has better practices in customer satisfaction or rapidly applying research or increasing safety? If we took a broad and systematic look at other industries, we could find opportunities to learn and in turn improve healthcare.

Starbucks makes a great latte, but does it do something else that we could use to lower mortality rates. I think we should find out.

A note to regular Healthcare Tomorrow readers. Sorry about missing my post last week. The well was dry on Monday night. Hopefully it won't happen too much in the future.

Monday, April 10, 2006

EHRs in the Exam Room

I found a perfectly wonderful study and resource this past week. It was a study published in the Annals of Family Medicine entitled, "Physicians, Patients, and the Electronic Health Record: An Ethnographic Analysis." The researchers observed how physicians interact patients while inputing to an EHR. Basically, the researchers found that physicians aren't very good at interacting with both the patient and the EHR at the same time.

So why am I so excited about this study? Besides the fact that I get to write "ethnographic" in my post (making me look very smart), it is bcause EHRs are coming and we better figure out how to integrate them into the doctor/patient relationship. This study is a first step in figuring out what our new healthcare world will look like and how we can "humanize" a system that is becoming increasingly driven by technology. Wonderfully, instead of bemoaning this fact, the authors have taken a very practical approach to managing this coming trend. Along with the article, the authors have produced a handy guide with tips for physicians on how to successfully integrate an EHR into the patient encounter.

I hope that we will see many more studies like this.

Finding this study made me so happy that I won't even quip...if their typing is as bad as their handwritting, then...

Monday, April 03, 2006

Baby Thomas - Part 3

Last week I introduced Baby Thomas and his truly brave and frank mother, Sara Bickle. Sarah shared some more comments with me about Thomas's care. Their experience continues to reinforce how important it is for hospitals to attend to the total expereince of care.

Here are Sara's comments:

I mentioned before that the Children's nurses and doctors had been so motivated about pain and so proactive about preparing me to be the "care manager" for little Thomas. When we moved to the oncology floor Monday, I was disappointed by a difference in the way we were treated there, and this change brought to my attention the practices that had made my stay so positive on other floors.

The first change I noticed was that, out of about 14 people who came into our room in two days, just three of them introduced themselves and told us what they were doing (one was a housekeeper - I must say, Children's housekeepers rock). I never realized what a gift this had been until I didn't have it. Knowing someone's name, department, and what they're doing to your kid is particularly important in a teaching hospital like Children's, where about 20% of the doctors and nurses you see aren't allowed to do much for your baby without calling someone else in. Talking to the wrong person while your trached baby is wretching and writhing feels a lot like being put on hold when you've called 911.

The other big change I noticed was that people assumed I knew a lot of things that I didn't know. Nurses would ask me if my son was on such-and-such a medication and a doctor looked miffed when I couldn't tell her precisely what kind of medicine I was asking for on Thomas's first night of chemo. I got pretty frustrated, but later I realized that on the oncology floor, all the families and patients really are professional patients. Thomas was the newest and youngest patient on the floor and we just didn't have the comfort level and information that everyone else apparently had.

Those are really some of the only negative experiences we had with Children's, and it didn't seem like that big of a deal once I said to myself, "It's just a different culture." But I wonder how I would feel about it all if this wasthe beginning of our hospital expereince, and not the end. The good news is, at Children's, I could probably talk to a floor manager and get a sign on our door telling staff to introduce themselves, and Lord knows, I am way more informed about meds today than I was three days ago.

You can read more about Baby Thomas at The Official Thomas Bickle Blog.