I had made a commitment to you, the readers of this blog series to try and post a new segment every Friday. So far in 2017 I have gotten away from that to some degree and I promise to be better through the rest of the year.
At the end of Part 76 of the TLS Continuum Blog series, I stated that here is how my new lens looked at the situation. The best way to begin is to layout the time line that we are considering. My wife and I arrived at the emergency room at 11:45 PM on New Year’s Eve. After the usually evaluation processes it was determined that my wife needed life saving surgery. She was wheeled into the operating suite at 5:45 am and the surgery began approximately 6:25 am. Four hours later I was able to visit her in the Cardio Surgical Unit (ICU) and this is where my explanation of a changed view of the environment come to play.
In the CSU highly trained medical personnel, who are each responsible to two patients each, staff the unit. If the medicine machine sounded an alarm it appeared on their computer and they were there immediately. Each shift was 12 hours in duration and there was a half hour overlap between shifts where the ending shift and starting shift compared notes but were there in case of an emergency. My wife was in the CSU from Sunday until Thursday. The plan as to discharge her on Saturday or Sunday so we asked based on the care we were receiving could we remain in the unit for the extra couple of days but were told they needed the bed for critically ill cases.
Once the decision was made to move her upstairs to the nursing floor we were confronted with a situation very similar to the one discussed in Bon Sproull’s Focus and Leverage. In the book Bob talks about the improvement project that took place between the emergency room and the nursing floor. The examples talked about the in plain sight difficulties of moving someone from the ER to an available bed. So we were told we were number four on the waiting list for a bed in the ward we were supposed to go to. We had an extensive discussion with the head of critical care about our concerns with the lower level of care and asking to be left in the ICU for the three days.
We then late Thursday afternoon was moved to the nursing floor where we found that instead of two patients per nurse we now had a situation where they were responsible for six patients. Now if the alarm went off on the medicine machine the only way the nurse knew was if we hit the assistance button. The everyday patient most likely would have complained that the staff was not watching out for their needs. I however looked at it not as a people problem but a process problem.
The primary nurse on the floor and the one responsible for my wife’s care stated that the hospital had recently cut staff to the floor resulting in less backup for the medical personnel who were delivering medical care. I suggested he looked at a TLS Continuum tool called TAKT time and see what it told him about the efficiency of the unit. Just for comparison, if each shift is 12 hours in length the nurse has to check vitals four times one ach patient in his or her prevue it means they have a total of 26 minutes to spend with each patient. Consider if the hospital was not a 100% private room set up. The question then becomes are we saving money or making money.
Let me explain that more in detail. The explanation I received from one of the nurses was that the hospital had recently reduced staff, despite being one of the most profitable hospitals in the chain, they were trying to save money. Most organizations behave in this manner. Every action or decision is based on either the expenditure of funds to purchase materials or it is processed through the view of cost accounting. But there is another way that is more suited to the TLS Continuum.
The model for the different view is based on Dettmer’s IO Map and the TAKT time calculations. So let’s begin. From the use of the TAKT time example above we know that the goal of the hospital is to get the nursing floor operating in a manner that is as close as possible to the level of service in the Cardio Surgical Unit. We want to be able to provide timely complete service to the patients on the floor. The first ting we must do is to determine what is a reasonable service time for the floor. If we determine that 26 minutes per patient is not reasonable then what is the correct timing for service? So using the new takt time calculation, we then need to determine what is necessary to reach that new goal. The best way to do that is use the three metrics of throughput accounting and determine what is the rate of flow of patients through the hospital and what do you need to investment to reach the goal and finally what is the resulting operating expense.
The danger of the TLS Continuum is then we see everything from the perspective of the process flow rather than from a blame perspective. The new view of the world is how we get where we need to be not saying the result is to replace human capital. It is not from wholesale cost reduction but rather the reallocation of funds to make the system more efficient and effective. The result is that the organization will make more money rather than looking at how to reduce costs.