Consider the differences in the two stories below.
Speedy Medical Center, recognized regionally and nationally for performance improvement continuously monitors process and outcome measures in it organization. Their Director of Perioperative Services boasts proudly when sharing key process measures across their service line, “Our average wait time in the Admissions office on the day of surgery is only 8 minutes and that helps us achieve our 90% compliance rate with on-time starts in the operating room.” Additionally, publicly reported measures for Speedy Medical Center indicate a 97% compliance rate with providing preventative care for blood clots during/after surgery and they score in the 90th percentile for patient perception of pain management. In fact, 9 out of 10 patients would recommend Speedy Medical Center.
Armed with this important data, a 54 year old male, “Al” elects total knee replacement at Speedy Medical Center. His surgery is scheduled for 7:00am and following his pre-admission evaluation three days prior, he is told to arrive in the hospital’s Admission Department at 5:00am. “Al” thinks, “Getting there at 5:00am seems like a long time if it only takes 8 minutes…” Al and his wife are in Admissions the morning of surgery for 34 minutes before going upstairs to Pre-Op. Around 7:25, “Al” is rolled back to the operating room and his wife sees on the visual tracking board that his surgery begins at 7:47. Following recovery, “Al” is transferred to the med-surg nursing unit. His nurses and patient care associates come in to check on him every hour. At shift change, he receives a new nurse and patient care associate. He begins experiencing pain and his wife tells him, “No worries, someone comes in every hour, we will just wait to tell them next time, it should be in about 10 minutes.” An hour and a half later, after not seeing anyone round in the room, “Al” presses his call button and requests pain medication. Another hour passes and the nurse arrives with his medication. “What took so long?” Al’s wife asks the nurse. “Not sure, our average turnaround time from Pharmacy is only 30 minutes.” “We were told you round hourly on patients, we haven’t seen anyone since 7:00pm,” Al’s wife expresses. To which the nurse very kindly replies, “Yes ma’am, we are supposed to round on each patient every hour, but that doesn’t always happen around shift change, but if you need anything at all, please don’t hesitate to press your call button.” Three days later, “Al” is getting ready to be discharged, when he suddenly becomes short of breath upon standing. Al’s wife hears the nurse call a “Code Blue” and a team of caregivers rush into the room. “Al” is transferred to the Intensive Care Unit and his wife is told that he developed a blood clot after surgery which traveled to his lungs. He will be okay but will need to stay in the hospital another 4-5 days.
Speedy Medical Center randomly samples 75% of its population with a patient satisfaction survey…..I wonder if “Al” is the 1 out of 10 that would not recommend Speedy Medical Center?
Does this story resonate? Sadly, healthcare organizations often boast about “nearly perfect” data. We win awards and celebrate achievement for 90th percentile and 95% reliability. Would anyone board a plane if we knew the airline was 95% reliable upon take-offs and landing? What about purchasing a vehicle that started 95% of the time? You see, for every average we calculate in healthcare, there is a lower and a higher value. For example, a patient waiting 5 minutes and a patient waiting 25 minutes yields an average wait time of 15 minutes, although one patient experienced nearly double that amount. And for every “percent reliable”, there are patients who avoid a complication (“the lucky ones”) and real patients who experience harm. Patients don’t feel our averages, they feel the variation in our processes. The application of Six Sigma has transformed the way many hospitals view high reliability. Is 95% really good enough? Or can we actually design processes that produce only 3.4 defects per million opportunities instead of 5 defects out of 100? Contact A3 Healthcare to discuss how we can help you transform your culture to one of high reliability and ensure the safety and satisfaction of your patients…..ALL of them!