5.05.2008

Hospitals Need a Team-Based Approach

Much of what has been written about applying lean to healthcare focuses, appropriately, on the inefficient, error-prone processes at hospitals.

A
good article put out by H&HN (Hospitals & Health Networks) offers a different but equally important focus, on the need to change the structure and culture of hospital operations.

The article is written by Dr. Charles Shaney, SVP and chairman of surgical services at William Beaumont Hospital in Royal Oak, MI, and by David Ellis, corporate director of planning and future studies at Detroit Medical Center and publisher of Health Futures Digest.

They begin by discussing another article, published in the January/February issue of Health Affairs, and written by a nurse involved in the treatment of a critically ill infant.

The baby’s doctor had left instructions for the infant to be weaned off a ventilator, according to well-established protocols. The nurse, Ray Bingham, thought the infant needed to be weaned more slowly than the protocols dictated. Bingham used subterfuge – such as bathroom breaks – to do it his way.

When the doctor returned in the morning, he was angry, though no action was taken against the nurse. The baby survived.

Shaney and Ellis, while agreeing that no healthcare professional should blindly follow instructions they believe may be harmful, take the position that Bingham was wrong. They note that the baby might have done just as well if the doctor’s instructions were followed.

More importantly, Shaney and Ellis see this incident as an example of what is wrong with the way hospitals operate.

As Bingham’s article illustrates, the physician-centric, hierarchical delivery model is seriously flawed…

Our challenge to Mr. Bingham is to share the steps that he has taken to ensure that a nurse in his unit will never again have to resort to a similar strategy to ensure effective communication and the best quality care for his or her patients…


The postmodern health care reality will require a cadre of physicians who not only recognize and value the judgment, skill and experience of other increasingly autonomous and interdependent health care professionals, but also physicians who willingly depend upon such skill to safely and effectively execute life-saving and evidence-based treatments in a patient-centered manner.

The postmodern reality also demands longitudinal and continuous professional evaluation and improvement processes, as well as meaningful incentives that recognize and reward physicians and other members of the caregiving team based on their ability to interact collaboratively. Much as will be the case for health care information technology, we argue that it may be only with a new generation of physicians and other care providers—educated in a team-based and contextual milieu, and for whom no other reality is logically consistent—that we will begin to see truly transformational change in health care delivery.

While the authors don’t use the word “lean,” their discussion of team-based operations and strong communication go to the heart of what lean is all about. I hope they are right that the new generation of professionals will embody this kind of thinking.

1 comments:

Ian Furst http://www.waittimes.blogspot.com said...

There is a recent New England Journal article about the basic etiquette for doctors. The sad truth is that it's easier to get doctors to act in a team approach than to try and change a bad attitude. There will always be doctors that think that everyone else is an idiot and nurses that think that every doctor is an egocentric absentminded fool. Team work needs to be built into the day to day activities (rounds, etc..) by great leadership. Otherwise animosity will prevail.