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Bad Processes Beat Good People

About 3 years ago, I had to take my wife to the ER when we were living in Texas.  That night really tested me on living up to the quote, “Good processes beat good people.”  This means we should always look at the process.  Don’t blame the people, blame the process and fix it.  Well, on this night, in extreme circumstances, I failed to live up to it.  Even getting upset with a nurse at one point.  Below is a recount of the night that I posted on the Lean Blog the week after it happened.

Can you see all the improvement opportunities that lean could help with in this hospital?

Saturday night, I had to take my wife to one of the local ERs. We got there at 9:40pm. When we got there, I filled out paperwork to register her with all the basic information (name, symptoms, SSN, address, etc…….). Then we had to sit there and wait……..and wait…….and wait. This was especially frustrating since wife was curled up in the fetal position in extreme agony and no one evened seemed to care.

The maddening part was there was no privacy (except chest pain). Everyone else in the ER had minor things (sprained ankle, minor headache, etc……..). After we checked in a mother with a baby that could not have been older than 1 came in. The baby was green! It freaked me out. It was the one person I thought should get bumped in front of us, but they didn’t. They waited in the FIFO line too.

After 30+ minutes we got called into the triage room where half the questions that got asked were repeat questions that I filled out earlier. I found this frustrating since the data from our registration sheet was put into the computer and that is how triage got our name and called us in. Where did the rest of our data go? Why ask again? The triage nurse said this was part of registration.

Then we went back out into the waiting room and waited for another hour before they called us back. As they were taking us back they stopped me and said that I had to register to go back with my wife. I had to register at the same desk as the first registration an hour and a half earlier. So, my wife is in agony and can barely walk and I have to stay up front to have my ID scanned and a sticker badge given to me. Then I get let in and I have to search for her room. I finally find her and we wait for a third person to come in and ask the same registration questions again. She is even wearing a badge that says “Registration” on it. My wife asks why this wasn’t done in the waiting room where we have been for that last 1.5 – 2.0 hrs. The lady replies that “this is just the process.” We could’ve had all the registering done in the waiting room up front. This seems to be a little more batch (“batching all the paperwork up front”), but I would argue two points: 1. there isn’t as much batching as one might think because we are getting all the same questions over and over with a couple of new ones, and 2. this would be more customer focused because my wife is in pain and we wouldn’t be separated plus she wouldn’t be getting upset about answering all the same questions over and over again.

At this point, my wife looks up an me and says, “This isn’t very lean is it?” I was glad to see her smile through the pain.

We wait for a long time and finally see a doctor who orders a CT scan, so we wait for the scanner to be setup and then we wait for the results and then we wait for the doctor, etc………….. During all this waiting I speak with some of the nurses. At this point it is about 1 or 1:30am. The nurse tells me this is a real slow night. Usually the halls are lined up with patients. I notice that they can’t find their electronic thermometer and go borrow one from another area, the supply area is labeled but is very messy and can’t tell how much is supposed to be there. The nurses can’t find things and quite a few times are just sitting around talking about their lives outside of work. They spent a lot of time doing this. Not because they don’t care but because they are waiting on doctors and information and whatever they need to treat the patients.

The most disheartening thing I heard all night was about a computer. I heard that they had test results back on the baby that was green (and I literally mean green) but nobody has been able to view them for an hour. They were having problems getting the computer to work so they called IT. There was no manual override or way to get results so the baby couldn’t be treated until they got the computer working. WHAT!!!!!!!!!?????????? I couldn’t believe what I was hearing. I don’t know what happened to the baby and the test results but I hope everything turned out alright.

At 2:30am, we finally left the ER with pain medicine in hand nearly 5 hrs after walking in the door. I figure only about an hour was value added. This is being generous too because it includes the walk time to the CT scan and the 20 minutes we had to wait after receiving the pain meds before we could leave.

I was thinking about lean stuff all night and trying not to blame the people but at times I would even find myself getting upset with the people “just sitting there” and not helping. My emotions would just take over as I watched my wife in pain.

I have always believed that lean is for everyone and every place because it is the mindset. Saturday night was just one of those “hit home” experiences that brought it to light.

What do you see that the hospital could have done from a lean perspective?  Do you have a story to share?

It was a very enlightening experience that has still stuck with me today.  I try my hardest to always remember that no matter how positive the intent of the person is, if the process is designed poorly, eventually the process will beat the people.

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