Comments on Lean Insider: Paging the Doctor: Sorry, Wrong Number

I've been a physician for 40 years, though happily...

2009-06-18T17:46:18.768-04:00

I've been a physician for 40 years, though happily only a few of them in academic medical centers (grin).

A significant underlying issue is segmentation of on-call rotations across the multiple subspecialties in an academic medical center. Now combine this with the trading of on-call days/shifts and it can become hideously complex. No published schedule can keep up. The default organizational culture of specialty silos also adds to the problem. Eliminate handoffs -- yeah, right.

The academic medical center I retired from a few years ago had an operating rule that whoever was carrying a pager for a particular service was on-call for that service. This had the practical advantage of people being very conscious of turning over call at the right time and if the operating rule was strictly followed, you answered the page even if you were not technically on-call any longer but still (sadly) had the pager on your belt.

All this explanatory hoo-hah aside, the problem can be addressed and solved if the appropriate academic chiefs can be trained to solve problems rather than "study" problems and publish journal articles. This is what the healthcare lean transformation culture is all about, though as Dean Bliss rightly points out above, it cannot begin until there is recognition that a problem exists.
/Dr. Pete

Before proposing solutions, best to understand the...

2009-06-18T15:13:53.659-04:00

Before proposing solutions, best to understand the problem. Why was the whiteboard incorrect, for example?

Was there not a good process for updates? Unclear ownership of that responsibility??

Standard work? Less handoffs? Error proofing? Y...

2009-06-18T09:44:53.374-04:00

Standard work? Less handoffs? Error proofing? Yes, yes, and yes. I've seen examples of all three. The big issue, though, is helping nurses, clerks, and others recognize that there is a problem to solve, and that we have ways to address the situation. Once we get there, the solutions can be developed and maintained. Easier said than done, but certainly doable.