10 Commandments for Great Patient Flow

Follow these rules to improve patient flow, quality, and efficiency. We made most of the list in a recent ED meeting, but it applies anywhere patients present.

1. Add value for patients first, always, and without compromise.

2. Never make patients wait unless it adds value for them.

3. Triage means sorting, not primary nursing assessment (see 1 and 2 above).

4. Time is Quality for most care.

5. Nurses and physicians must pull in the same direction at the same speed: ED team = 2-horse chariot.

6. Professionals must do what they do best: RNs do RN work, not clerical work.

7. Remove or unload bottlenecks.

8. Always design parallel processes, not sequential.

9. Design for unlimited capacity; you cannot turn people away.

10. Patients need humanity with every encounter, especially when ‘there’s nothing wrong’.

Do you have any to add? Please share them in the comment section. Thanks!

(image credit: http://blog.cachinko.com/)

How to Lead Using Complexity Theory in Healthcare

Healthcare fails when good people apply the wrong kind of solutions to the healthcare system.

This post highlights concepts that will improve your leadership using complexity theory. (see Edgeware: lessons from complexity science for health care leaders by B. Zimmerman, C. Lindberg, and P. Plsek)

Use a New Metaphor

Military and machine metaphors dominate healthcare thinking (e.g., cog, mesh, direct, follow, limit, leverage, tune, ramp up, etc.). These metaphors shape our solutions. Complexity offers something different:

Simple is like following a recipe to bake a cake: anyone can follow the instructions and get a good result.

Complicated is like sending a rocket into space: a team of smart people, improving process with each attempt, can figure out the best way to fly in space.

Complex is like being in a romantic relationship or raising a child: success with one is no guarantee of success with another.

Features of Complex adaptive systems:

Non-linear
Adaptive
Distributed control (central control slows system’s ability to react)
Size of input produces unpredictable effect (small input might create huge impact)
Large numbers of connections between a wide variety of elements

Leadership Principles

1. Focus on Minimum specifications / Good Enough: Don’t even try planning all the details before you start; it’s impossible. Get a clear enough sense of the minimum needed and get started.

2. Find Attractors: Learn which patterns or areas draw the energy of the system. Imagine how to attract a bird to leave your room vs. How to roll a marble down a track.

“Complexity suggests that we create small , non-threatening changes that attract people, instead of implementing large scale change that excites resistance. We work with the attractors.” p. 11

3. Get Comfortable with Uncertainty: Solutions need to be rapidly adaptable. They must be comfortable with both data and intuition, planning and acting, safety and risk.

4. Use Paradox and Tension: lead by serving, keep authority without having control, give direction without directives

5. Tune to the Edge: Don’t be afraid to stray from the centre. Go to the fringes for multiple actions ; let a direction arise.

6. Be Aware of the Shadow system: Gossip, rumor, informal relationships, hallway conversations

7. Use Chunking: Grow complex systems by connecting simple systems that work well

8. Mix Cooperation and Competition: don’t think either/or

(photo credit: www.nytimes.com)

Emergency doctors demand seven-day primary care support | GPonline.com

This headline comes from Britain (see the link at the bottom).

Many Canadians think they can stop “inappropriate visits” to emergency departments by educating the public. They assume people need more information.

Patients need more access, not more information.

Until we design the system to offer great ways to access care that fits into patients’ lives, we will continue to have patients accessing emergency departments for concerns that could possibly be handled in private offices.

But, we can’t just demand longer office hours. We need to support physicians in the community with acute lab and X-Ray support and attract physicians to work unsociable hours. (We wouldn’t need to attract physicians to work unsociable hours if MDs had to compete for patients.)

Emergency doctors demand seven-day primary care support | GPonline.com.

P.S. If hospitals changed from their current Monday-Friday, 9-4:30 schedules to a 7 day/week approach, we would increase patient flow and patient access, too.