I See Systems

Working in enterprise software has changed my perspective on the world around me... I see everything through more of a systemic lens.

My wife recently had knee replacement surgery.  World-renown surgeon performing the surgery.  But being done at his 2nd choice of hospitals due to limitations of our health insurance policy.  Good hospital, but not his hospital of choice.  Like everything else involving health care in the U.S., it's a money thing.

The surgery was originally scheduled for Friday, December 13th but postponed until Monday, December 16th.  On the 16th, we were requested to arrive at the hospital at 11 am for a planned surgery of 1 pm.  But the surgery did not begin until 6 pm.  At this point, I'm thinking that these guys have no idea about linear programming and managing their supply chain.

While my wife was in surgery, I was directed to a "Surgery Waiting Room".  The room allegedly had an attendant and a television screen for monitoring patient status during surgery.  When I entered the waiting room, I immediately noticed the attendant's desk was unoccupied.  Seems that the attendant's shift ends at 5 pm - those waiting on surgeries beyond 5 pm are asked to answer the phones on a volunteer basis.  The idea being that surgical staff will call the waiting room to update family and friends when surgery is completed, and to alert those waiting that the surgeon is on the way up with a more detailed debrief.  So, being the volunteering type, I sit at the attendant's desk and start answering the phone.  After about three incoming calls, I notice a trend - no friends or family in the room to receive the updates.  And I'm also noticing surgeons coming into the room looking for friends and family who are not there.  I put the phone to use and make a few inquiries within the hospital - and discover that there are three surgery waiting rooms in this tower alone (the hospital in question has seven towers).  Neither the surgical staff nor the surgeons have any idea which waiting room contains friends and family for any particular patient, as they have no waiting room check-in function.  So they're literally hunting for the pea under any one of three shells as they go from waiting room to waiting room searching for friends and family of a particular patient.  Low-key chaos.

Another observation from the surgical waiting room:  the status screen showing patient status is listed by case number rather than patient name.  I did not have a case number for my wife's surgery.  And a quick survey of the folks in the waiting room indicated that none of them had a case number either.  So the status screen was useless to those of us waiting on surgical outcomes.  During the next few incoming calls from surgical staff, I asked for case numbers.  But the surgical staff had no idea of the case numbers either.  What in the world?

Fortunately, the surgery went well, the outcome was positive, and Marlene is now home working through the long recovery process.

After rolling the surgical experience over in my head, I decided to view this experience as a systemic failure for this particular hospital.  Lots of good people with lots of energy all trying to do the right thing, but nobody has tied it all together.  So how might I suggest improving things from a system point of view?

First, I'd establish personas:  the patient, the family member/friend of the patient, the surgical staff member, the attendant, the pre-op nurse, the surgeon, and so on.  Then I'd walk through the entire process, from the time a patient walks in the door until they leave post-op recovery.  And I'd do it for each persona.  Essentially build a systemic "As Is" flow.  Then design how we want things to work, review the changes with the people doing the work, then implement.

Sounds a bit like an enterprise applications implementation project, doesn't it?  Well, enterprise applications are all about implementing systems.  Like I said, working in enterprise software has changed my perspective of the world around me...

How about you?  Ever have a similar experience?  Healthcare?  The DMV? Retail returns?  Sound off in the comments about your experience and how you'd approach a fix.