The Invisible Disease in Hospitals

Start of a shift

Let’s have a little fun for a moment… with a serious angle.  The root of the term organisation is, obviously, organ, and the terminology used in health care often refers to organisational improvement efforts: for example, symptoms, fitness, process, root cause or remedy. Let’s push the metaphor by proposing that large, multi-faceted hospitals “suffer” from an invisible “disease”. Its symptoms are easily recognisable but go “undiagnosed” and, worse, are accepted as “natural” and “untreatable”.  Once you understand the disease’s nature and the tacit acceptance of its reality, by professionals and the public, and the fact that its symptoms and effects are neither invisible nor negligible, you’ll wonder why we accept it so passively. Hence, it is not only invisible, but pernicious. However, there is a “remedy” that reduces the frequency and negative impacts of this “disease”, and offers a method for effectively managing its effects.

Let’s start with the most common symptom of this “invisible disease” in hospitals: appointments and procedures rarely start on time. Everyone accepts this, including patients. It’s so common that it is “invisible”, tolerated because health care access is so important.  Would we accept the same symptoms from other service providers, or professionals such as lawyers?  Would you continue using an airline who was consistently late for flights (especially if you had an alternative choice)?  Yet, we all show up for health care appointments on time, and invariably wait.

This “invisible disease” is, of course, variation.

We tested this hypothesis with hospital managers, who were amused by the name “invisible disease”, but who also confirmed that they had never questioned the “reality” of variation. Across all activities in the hospital, it is common, accepted, inevitable, and very predictable. I’ve asked hundreds of people to estimate how often their health care appointments are on time, and not one person gave a figure higher than 5%.  Interestingly, an associate and I recently talked with a logistics manager who revealed that on-time performance of trains to their facilities was about 20-22%, and his organisation had to accept it… imagine the impact on their operations!

As you can imagine, the flow-on impact of this “invisible disease” — of accepted variation to appointments — is significant: long wait times, stress for patients, health care practitioners and support staff, ineffective utilisation of expensive assets, overtime, peaks and troughs of demand and supply and an inability to plan effectively for future requirements (and often significant buffering of resources and assets to cover for this disease).

One of my mentors, Dr. Donald Burwick, founder of the Institute of Health Care Improvement in the U.S., made a statement that has since become my professional mantra:

Every system (organisation, policy, process, etc.) is perfectly designed to achieve the outcome it gets.

This has proven valid for over 30 years. FedEx and DHL are designed to achieve 99.9% on-time delivery of packages overnight. The rail operation cited above is designed to achieve 20-22%. What outcome does your business get? The simple, and critically important corollary to this is: if you want better outcomes, then you must redesign your system.

The “invisible disease” in any organisation needs to be acknowledged and challenged to begin the “healing” or “remedial” process.  Start by looking at current symptoms and outcomes.

Let’s make one more important point: appointment making is not the same as scheduling. You can see this difference clearly in hospitals: appointments are made in silos.  Every doctor, department and lab makes appointments with no, or limited, visibility of all the other departments.  When a doctor recommends for a diagnostic, for example, getting a blood test, X-ray, or a heart stress test, the nurse/administrator is not scheduling these activities to minimise effort and ensure all tests and procedures.  In fact, they simply make appointments without seeing potential impacts on other departments.

More importantly, there is no visibility or connection when variations or disruptions affect appointments. A late start of one appointment can mean missing future appointments, or cascading across the entire hospital. Even a common scheduling system can only provide visibility, but can’t handle variation.

A truly integrated and optimised scheduling system like DELMIA Quintiq’s visualises the entire service chain, with all its unique constraints, business rules, variables, processes and behaviours. It can optimise scheduling (in real-time) across the entire service chain for all patients, staff activities, departments and assets, as variation affects the service chain. In this way, everyone can be notified of changes which affect them and optimally re-schedule for maximum service, utilisation and patient satisfaction.

This post was previously published on LinkedIn.

Lee Hochberg

Senior Advisor - Supply Chain Planning & Optimization, DELMIA Quintiq, Dassault Systèmes