The Human Factor in Healthcare

Several times recently, I've been asked by manufacturing folks about the challenges of making the move to healthcare as a lean coach.  The one challenge that I always emphasize is the human factor.  The human factor exists in every industry, but it's magnified in healthcare.  This is partly due to the manual nature of the work, partly due to to the fact that the product is the patient, and partly due to the unique cultural aspects of working in an organization that directly saves lives on a daily basis.

As a lean coach in healthcare, one must adjust both his or her expectations and tactics.

Adjust Your Expectations

Expect a lot of variation.  I mean a lot of variation.  Even with a calibrated, properly maintained, properly operated piece of machinery, we expect a level of variation.  Now take away the calibration, maintenance, and proper operation and see how much variation you get.  Now take away the machine altogether, replace it with a person, and see how much variation you get.  I could go on, but I think I've made my point.  Expect a lot of variation!

Adjust Your Tactics

As for our tactics, we must adjust them to take into account the human factors.  We have to design around the needs of not only the patient, but also the family of the patient.  We might have to make choices we don't want to make to accomodate the teaching needs of an academic hospital.  We have to define value in terms of not only the patient, but also of the payer.  There are so many layers of complexity that prevent us from getting to an optimal future state, but we can't let that stop us from moving towards at least a better future state.  We have to adjust our tactics and be much more agile.

Shock Absorbers in an ER

In an Emergency Room, it's pretty hard to control the volume and acuity of patients coming in the door.  Variation is inevitable.  It's like riding down an old dirt road--you have some smooth spots and some bumpy spots.  That's why our cars come with shock absorbers.

What is our shock absorber in an ER?

How do we mitigate the effect of variation in patient volume and acuity?  Sometimes, we take the wasteful but safe approach of over-staffing.  Or, we might look at the measures of central tendency and variability in our patient volumes and acuity, and come up with a staffing model that is both statistically reliable and much less wasteful than blunt force over-staffing.

Being able to absorb the shock of uncontrollable patient volumes and acuities is especially critical if an ER is attempting to go to a cellular flow model.  In this model, you might try to even out the variation by distributing patients to the multiple cells evenly.  This works well as long as the cells are equipped for all patient types.

If, however, a certain type of patient can only be seen in a certain cell, and a bunch of those patients come in at the same time, then we have a big problem.  In this circumstance, we need a different kind of shock absorber, perhaps flex resources (doctors, nurses, etc.) that are not assigned to a single cell, but that can flow to where they're needed.  Of course, in the long-term, we should try to even out the capabilities of the cells so that this whole issue is moot.

Whether it's through blunt force over-staffing, statistically sound staffing, level loading to cells, flowing flex resources to unleveled cells, or evening out of cell capabilities, we absolutely must have a way to ride over the bumpy spots in the road.  We have to have a shock absorber.