My wife and I are excitedly expecting our first son around the beginning of April. I am getting a first hand experience of what it is like to be a “customer” of a hospital experience and it makes me realize how Lean can really help.
- Effects of on-call: My wife’s OB advised that she can not guarantee she will be the one to deliver our child due to the fact that the little boy can arrive at any time of the day (understandable). There are 4 other doctors that would be covering for her if she is not available and we would have to schedule appointments if we wanted to meet them prior. As a customer, this adds a complexity and I would prefer a reduced number of on-calls. It would waste the other doctor’s times to meet with us if they did not end up being on-call on birth night. Design the pathway to be simple for the patient.
- Potential rushing: One thing that concerns me is the notion of doctors pushing the birth faster to fit their schedules. I am not sure how true it is, but from interviewing doulas and recent moms, some C-sections are given because the provider has other things to do or wants to go home (two cases as described to me). Our OB said the other day she might do a procedure “to speed things up”. If the patient chooses options to make things faster or it is needed for the health of the mom & baby – go for it. If the hospital system is not flexible enough to allow births to take a natural course (if patient chooses) and requires speeding up artificially, improvement is needed for staffing and room utilization to ensure you are providing value to patients.
- Unpredictability and non-standardized: From conversations it appears as though every experience changes greatly on which nurse you get that day and your provider. Babies and the human body are unpredictable and cause variation but some things CAN be standardized. As a customer, I would feel more confident if it was explained to me that the hospital has a generally predictable practice and have plans in place if the mom shows specific signs. Unpredictability is problamatic too from an insurance perspective since the hospital can not tell us who the expected roles will be to ensure each are covered so we can make an informed choice. As a customer, I would chose a hospital with standardized work over an organization who just tells me “it depends”.
As a hospital customer, are my demands unreasonable? If you work at a hospital, what are your customers wanting? Do you agree or disagree with me that Lean thinking can help the hospital meet my needs?
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Hi Brian,
Congratulations and best wishes as you anticipate the birth of your son! It’s a magical, dizzying, life changing experience.
I know that we had our “favorite” OB doc and wanted her to be there for the birth of each of our three children, but it did not work out that way. As you mentioned, labor and delivery timing is a difficult thing to accurately anticipate, unless you’re talking planned C-sections. Accordingly, you kind of have to roll with the punches. Chalk it up to demand variation relative to mix and volume. No supermarket here. Having the doc available 24/7 would introduce some serious muri or overburden to an already stressful profession.
One thing that did bother me was the lack of nurse standard work, most specifically how they informed or did not inform the parents (to be) as to what was happening (i.e., baby heart rate decelerations), the procedure/countermeasures and what was going to happen next. This is especially important for first-time parents (the classes can only prepare you so much).
Here we’re talking about a portion of a value stream within which the “product,” (the patient(s) a.k.a. the customer) talks, thinks and emotes. I think standard work that approximates TWI’s job instruction (first list the important steps, then describe key points) would be very beneficial to the patient and their understanding as to what the heck was/will be going on. Of course, there was other variation between the different nurses (you’ll see if the labor is long and spans multiple shifts) relative to steps and sequence, but that’s another story.
Best of luck,
Mark R. Hamel
Congratulations!
Not having gone through this (having no children), I don’t have first-hand experience. Seems like there is not a good alternative for guaranteeing you have “your” doctor unless you’re willing to work around their schedule – being available 24×7 doesn’t seem realistic, I guess.
John Toussaint’s upcoming book about the ThedaCare lean journey has some details about improvements they made in the delivery process and how they involved a mother in the rapid improvement event (direct, and sometimes surprising, feedback from her).
Toussaint has shared data (don’t have it handy) about improvements to the % of babies born after the threshold of X weeks…. see his journal article, which you can access for free if you get there via the link on this page:
http://www.healthcarevalueleaders.org/displayobject.cfm?id=1132
Thanks to Mark and Mark for your comments.
I know it is pretty unrealistic to expect our OB doctor due to the 24×7 possibility of our boy arriving, but it would be nice to limit the on-call back-ups to at least 3! Our real problem is the possibility of not knowing our delivery doctor. Maybe the counter-measure should be a meet & greet on the day labor starts. As patients we would pay for that if available and it would reduce the number of doctors delivering to 2!
At our hospital, we involve parents and patients in our improvements also. Their feedback have really helped the teams create positive change for those we serve.
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