A visit to gemba at Royal University Hospital

Regular readers know of my practice of going to gemba when I am visiting a hospital.  It is my way of looking at work processes in different places.  If you are interested in process improvement, you can never see enough examples of this.  In turn, I like to present summaries to you, my readers, not to draw negative conclusions about the institutions involved, but rather to demonstrate the common need for process improvement across the hospital world.

This week, while I was in Saskatoon for the Health Care Quality Summit, my hosts graciously arranged for me to spend some time shadowing Therese, a unit clerk in the emergency room of Royal University Hospital, an excellent institution operated by the Saskatoon Health Region.  The SHR, along with the rest of the province, has made a strong commitment to the Lean process improvement philosophy.  Lean will be rolled out over the coming years.  Given the early stages, it has not yet been fully adopted everywhere, and so I got to see the "before" view of things in the ER.

Therese is a dedicated and hard-working person who faces a large variety of tasks in the ER.  She handles telephone inquiries of all types.  She helps coordinate the collection of specimens and their delivery by pneumatic tube to the laboratory.  She compiles patient records.  (These are paper records, as an electronic system has not yet been put in place.)  She also takes care of linen changes and wiping down of the patient care bays in her section of the ER.

As I sat with Therese, I was amazed at her energy and sense of organization.  She truly holds the place together in many ways.  And yet the underlying work flows that she must carry out offer prime examples for the kind of redesign that will surely come when Lean arrives.

Here's an example.  When a patient is discharged from the ER, a copy of the patient's record -- known as the back copy -- is kept in the ER for two weeks in the event the patient returns.  If and when the patient returns, Therese flips through the accumulated stack, looking for that record, and then attaches it to the current patient file.  Also, if a bacterial culture has been taken for a patient, the lab result generally is returned after the patient has left.  Therese has to find the back copy, onto which she attaches the lab report, leaving it for a doctor to review in the event a change in treatment (e.g., a new anibiotic) is called for.

If Therese cannot find the back copy, she has to call to the medical records department and ask them to fax a copy to her.  The problem is that the back copies are stacked up in an unpredictable order, so Therese has to flip through them to try to find the correct patient record.  This ends up taking an inordinate amount of her time -- 2 to 3 minutes each time -- unless she is interrupted by a phone call or something else, at which points she has to start over again.  This little video gives you a sense of the current process.


When you add up those multiple 2-3 minute tasks and calculate how much cumulative time is spent on this alone, you can see how -- some Lean day in the future -- this and other parts of Therese's life in the ER will be improved.

If you cannot see the video, click here.