Does your hospital have a system to ensure nurses have working equipment or they know how to get them fixed?
I recently visited a hospital where the answer would be “NO”.
Last week, a family member needed a day surgery procedure done at a local hospital. There were signs in the prep/recovery room touting their move to electronic medical records and no longer needing paper charts. The problem for the nurse was, the Computer On Wheels (C.O.W.) did not work. The nurse was unable to access or update the electronic chart!
A second nurse came in during the morning before the procedure to try to troubleshoot the malfunctioning C.O.W. It was decided to grab a C.O.W. from another room and use it instead. I am not sure if other nurses had to search for the missing C.O.W. now that it has been moved into our room where it sat there for four hours. A third nurse eventually pulled it away to put back where it belonged.
The first nurse came back in and tried to access the original C.O.W. in our room and commented “This still doesn’t work yet?”
I looked at the C.O.W. and there was no signage about how to troubleshoot or who to call. I do not know if a nurse tried calling their helpdesk out of my view but it looked like nobody knew what to do with the broken computer. It seemed like nobody knew who was to take charge in fixing it. One can almost infer they expected it to magically fix itself!
Three nurses spent time reacting to faulty equipment that could have been better used providing care to patients. Instead of spending their creativity solving patient issues, they use it creating workarounds.
Lean thinking can help hospitals put systems into place to ensure equipment always works. Procedures can be created for what to do when something is broken and how to handle. Make things visual so staff doesn’t have to rely on memory or look up procedures because instructions are attached to the item being used.
Helping remove waste and frustration from those giving care with make a better experience for those receiving care.
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5 responses to “A C.O.W. Tale”
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It’s something how often it’s assumed that going paperless = lean (or at least, more efficient). It certainly wasn’t in this case you described. I had an older nurse on a team a couple of months ago who participated on a team with me who was facing pressure from younger nurses to go paperless on a process, insisting it was “leaner.” The older nurse was relieved to learn that it’s not whether or not it’s electronic – it’s about what results in the best flow – what WORKS.
Nice post and example, Brian.
Great post. The jump to technology being lean is a long one to make. Technology should be there to support the process and help make it efficient. The C.O.W. example is no different than buying a piece of equipment for the plant to automate some handwork. Then the equipment is always down.
A simple visual sign about who to call on each C.O.W. would be a good example of lean thinking. Sorry to hear about all the waste it created.
Visual signs or instructions (or knowledge about the process) is one thing. It’s an important point.
I think your scenario, being a very common one, highlights the lack of a help chain in healthcare. If the nurse is struggling with broken equipment, there’s no “andon cord” to pull (or parallel way) to report the problem and get immediate help from a supervisor.
And if that supervisor didn’t know how to get equipment fixed, where is the help chain for them to get an answer??
I’ve seen this in many hospitals – broken equipment of all kinds and people don’t know how to contact bio-med or they don’t even know what the name of the department that fixes stuff is called…
Huge opportunity for improvement.
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