A Guide to Implementing the Theory of
Delay Emergency Department – Not On-Line
I have made a conscious
decision not to put this solution on-line, and that certainly is at odds with
the rest of the site but the exception stands. A close colleague who is well aware of the
content thought that I had finally come to my senses; “the content is priceless
and you were going to give it away!”
But that isn’t my reasoning.
is that when something is free, it is very rarely truly appreciated. It is too easy for healthcare management
and clinicians to read the solution, actively agree with it, and then do
nothing. It is the “do nothing” part that I have so much trouble with.
To write a
cogent solution, with all of its underlying logic marked off, is orders of
magnitude more difficult than “just doing it” based upon knowledge,
intuition, and experience. There is
just one “writer” who must meet the expectations of many critics and that can
only happen by addressing the underlying fundamental issues. This has taken longer, and with more
effort, than I could have first imagined is possible. The outcome has to be that something is
done, rather that “do nothing.”
In other “free
market” commercial enterprises to which the rest of the website applies to,
the customers or consumers at least have some freedom of choice between
suppliers. Whether the suppliers
choose to be more efficient and effective in supplying value really is up to
them, and the customers can play an active part by way of their consider
support or lack thereof.
Of course this
is a bit of a fantasy about the free market, and I prefer to subscribe to the
notion that the free market in fact is only truly effective in the very
limited act of culling-off the very ineffective, and even then that can be
somewhat circumscribed if you can argue that you are “too big to fail.”
healthcare is different, and it is different because there is, in general, a
monopoly supplier. This shouldn’t be a
problem of itself. Indeed it should be
the maximal solution, the cost of the “risk” is spread over the entire
population. The cost-per-head should
be the lowest due to economy of scale and economy of scope (large populations
can support one or two very specialized specialists for example). However, by virtue of monopoly, the patient
is locked out of this process and can’t vote with their feet. And for all the discussion about Lean in
healthcare, the patient seems to be the very last person to be asked about
In my country
we “sample” every discharged patient for their experience in hospital (did
you like the food, were the staff friendly?) and we call this “quality” but
it is a perversion of statistics and we are singularly careful never to ask
patients waiting at home, depressed and in chronic pain, what they think of
the situation. Is this a travesty or
not? I happen to think that it is.
The people who
can address this are, together, the
management and the clinicians. The
patients can demand action, but only the management and the clinicians
together can put this into effect. So
the question is, what do we do for emergency department then? Let’s have a look.
in an emergency department ought to be lack of patients. So seldom is this now achieved that we have
probably forgotten what it was once like.
However, it need not be like this.
If we were to look at the current constraints in emergency department
we would probably find that they are many and varied, and changing all the
time. But this is misleading. There are a few, maybe just one or two
which are prime candidates at any one time, and which must be addressed and
removed. Of course this will uncover
further issues that must also be addressed and removed, but suddenly we have
a process of on-going improvement.
missing at the moment are some very basic “tricks of the trade” of the
operations specialist that can bring order to chaos in a very short
time. I guess the question is whether
you are really “up for it” or not?
Which is it?
is here, but it is locked.
This Webpage Copyright © 2008-2009 by Dr K. J.