A well reputed hospital in Thailand had developed a mysterious problem. They were not able to discharge their patients when the patients were ready to leave.
The hospital policy required that patients should be transported to the lobby in Wheelchairs. But there never seemed to be a wheelchair when needed. In fact transporting patients anywhere within the hospital was difficult, owing to missing wheelchairs.
The immediate conclusion was that there was a shortage of wheelchairs. But the records indicated an abundance of wheelchairs. A new stock had been procured nine months earlier. So where had the wheelchairs vanished?
We established a quality improvement team to address the problem of the missing wheelchairs. Members included the CEO (German), head nurse (Chinese), Head of patient transportation (Thai), Chief administrator (British), Senior accountant (Indian), and a transporter (Thai).
As a first step, the team flow charted 42 as - is discharge processes, distributed over a week, as well as three shifts a day. This brought about a common understanding of the actual process to a multi-lingual argumentative team.
The transporter also tracked the actual time for each activity or task. They collectively, further analyzed the variability of each discharge journey. Numbers, rather than language, catalyzed consensus building.
To every member’s surprise, the root cause turned out to be a shortage of laundry hampers! This was nowhere on any ones radar at preliminary meetings. Much to the embarrassment of the head nurse the nurses were using the wheelchairs to tote the laundry.
As remedial action, the CEO ordered a replenishment of laundry hampers, nurses were happy.
Even with an increase in availability of wheelchairs, patients were quite often delayed for their journey to the lobby, resulting in irritated patients. Why because patients discharges occurred at fixed hours, thrice a day. Demand exceeded supply in these concentrated hours.
The team then suggested that the hospital policy of mandatory wheelchair trip for all patients be replaced by a policy that dictated the use of wheelchairs exclusively for non-ambulatory patients. The new policy eliminated the traffic jams on the wheelchair highway. All stakeholders were happy.
Lessons Learned:
- Patient Focus is non-negotiable
- Policies are guidelines; riot diktats
- Anyone impacted by the problem, should’ be represented in the quality improvement team
- Vital few problems should be solved by the Vital few managers
- Flowcharting is a good facilitation tool
- Numbers are more effective
CREDITS: Suresh Lulla, Founder & Mentor, Qimpro Consultants Pvt. Ltd.