Jun 28, 2007

Doctors don't need admins to show them how to do their job....

First of all, I need to say that I have no business or knowledge to comment on the stuff below, but this is my blog, so I'll do it anyway. I am just a software developer and a health care administrator wannabe... I will likely find other ways to fill my life before I'll ever get there anyway.

I mentioned a few weeks or months back that I like Dr. Wes's blog. I love his posts and I also learn new things about hearts (real ones). As with other people that I like, I find it very disturbing to read that there are things that we do not agree on. I need to work on this, but this post is a commentary on one of his posts that I don't agree with.


I don't know enough about the exact details of the deal to be able to disagree with the entire post, but here's what I didn't like

Once again, it appears that hospital administrators would rather turn to
non-medical auto-industry "efficiency" and "safety" experts, rather than asking
health care professionals to recommend the best way to improve care.
Do we really need yet another company or administrator to tell us how to do
our job? Is it all about safety and efficacy? Or might providing a better
nurse-to-patient ratio be far better at improving care?

I am sure we are all frustrated with the health care status: patients, doctors, nurses, etc. But I think that a big part of the problem is the administration. If administration is telling doctors and nurses what to do, it is wrong, administration should empower them to do their jobs and take care of all the non-medical stuff so that they can do their jobs.

In software development, we say that the modern project manager is no longer a supervisor, but a partner that helps developers to do their jobs without needing to care about budget, time constraints, getting approvals, having the right hardware or software to do their jobs, etc. They just tell us what to do in what order and when and ask us what we need to get this accomplished in terms of time, and resources. Then they make that happen: they supply the resources and let us do our job.

That's what hospital administration should do, no more, no less. From my perspective as a patient, it's not the doctors or nurses that I am complaining about, it is the administration. I think that medical office staff is shortsighted, I think they don't get it, I think they perpetuate the idea of doctors as "Minor deities" (BTW, wonderful post, Paul! Yes, I too love my doctor but hate the system). They act as if they don't care about our time or our pains. Customer service is so poor. I doubt that I am the only one that is more annoyed about trying to get an appointment or try to get a doctor to call back then it is to actually talk to the doctor. In Romanian we have an expression: "on the way to God you get eaten by the angels"... I can't think of a better metaphor for what's going on.

So why not let the administration learn more from other industries? They do need to learn. They can't do it from their peers, most of them seem stuck in the same hole.

Just this week I went to the hospital to have a procedure. I love to look around and see what's good and what's bad. So while looking around I see a chart: customers satisfaction surveys for nurses: 100% ... my, my, these guys are already perfect, there's nothing better to be done.
(I think that the book "If Disney Ran your Hospital" - by Fred Lee is wonderful and right on target on this). And, of course, the poster with: if you can't give us a 5 just call the nurse manager and she'll fix it for you - guiltying us into giving them only 5s. Oh, well!

The hospital is wonderful and the nurses and doctors were great. It was a good experience, not a memorable one, but good enough. I don't have complaints about doctors or nurses.

But they call the patients one hour and a half before the procedure is scheduled... Why? Why not 30 minutes, maybe even 15 minutes? After all, all there is to do is to sign a bunch of papers, and get undressed. They take a medical history and they put in an IV, but all this stuff is done in L&D in less than 15 minutes.

I didn't get the impression that there were too few nurses... maybe they are overworked, I don't know. They do plan the same number of patients, so what difference does it make to them that we stay there an additional hour? All I can think of is that if someone cancels or comes late they want to be sure that the doctors and nurses stay occupied. But is it worth? Shouldn't administration ask and find a solution to this particular scenario without inconveniencing the patients? Maybe this is what "lean" should mean?

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