Wednesday, April 6, 2011

10 Complexities in Hospitals

Having worked in a hospital as a Lean Coach for about a year now, I've grown accustomed to dealing with a wide range of complexity related to healthcare, and hospitals in particular.  Here's a list of some of the types of complexity I've seen in the hospital (it's not an exhaustive list by any means, and is in no particular order)...

  1. We often have no ability to control/level the volume going into the system, especially in an ER setting
  2. We have seasonal, weekly, and daily volume fluctuations
  3. We often have a wide range of acuity levels, which are high-mix, low-volume in nature
  4. Clinical workflows are often controlled by complex computer systems, which makes some processes more inflexible that we'd prefer
  5. The most highly-trained and often most powerful people in a hospital are the physicians, who are also the "touch labor" for our front-line processes
  6. We have 24/7/365 business hours, making cross-shift collaboration a challenge sometimes
  7. In pediatric hospitals, we have to design processes that accommodate the needs of both the patient and their family
  8. In academic hospitals, we often have to design processes with educational needs in mind
  9. The customer and the payer (insurance companies, Medicare, etc.) are often not the same entity
  10. In places like Texas, we have huge language barriers that our processes have to accomodate
Every industry has its own sources of complexity.  Healthcare, and hospitals in particular, bring special types of complexity that are pretty challenging.  I personally love the challenge, but I also realize that I have a long way to go if I want to be a Lean Coach who is capable of overcoming the complexity found in hospital systems.