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October 6, 2009

Process Improvement in Hospitals

This week I went to hospital (in the UK) for day surgery. I arrived at the appointed time of 11am. A nurse took my blood pressure and confirmed my answers to questions that had been asked at the pre-assessment clinic. I then sat and waited in the corridor for four hours. Finally the anaesthetist talked me through the procedure for a general anaesthetic. Half an hour later the consultant came round and decided my operation could be done under a local anaesthetic. I was taken to theatre after waiting a total of five hours. The procedure took about 40 minutes, followed by half an hour for cleaning me up and recovery.

Thus the total process time for this procedure was 370 minutes, of which less than 100 minutes was actually necessary for the operation and recovery. Nevertheless it is difficult to see how the process flow could be improved – for two reasons:

Firstly, the nurses need to be sure that the patient has indeed fasted for at least six hours. It seems that patients do not always fully understand what this means – during my wait one man arrived for an operation having just had a cup of tea and a biscuit: he didn’t seem to understand that this counted as food !.

Secondly my operation was delayed by about 2 hours because the previous operation had taken longer than expected. It must be difficult to predict with much accuracy how long an operation will take when each patient is different and there are a number of possible complications.

It would be interesting to convene an improvement team comprising the nurses, theatre staff and surgeons to see how the process could be improved. Perhaps a test can be developed to gauge whether the patient has fasted for the required time; perhaps nurses could do the anaesthetic briefing. However, both of these ideas place additional burdens on already busy nursing staff.

I would welcome other people’s comments on how such improvements might be made. How could lean help this situation ? What performance metrics would we use ?

I am now resting at home recovering from my leg operation. Apart from bruising, I am in remarkably little pain (I’m told it might start to hurt a lot between four and six days !). I must commend the nurses, theatre staff and surgeons on their good work and good humour throughout a fairly long day.