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Improving Work Flow, Both at Medical Practice and at Home


An exercise at work to improve quality patient care might just benefit from my spouse-communication system at home.

My organization excels in continuous quality improvement. When a problem is identified, the organization conducts week-long improvement events. They are impressive organizational feats. They are also costly to run, I am sure. However, without fail, I always find the events to be a great use of my time and the team’s time when I see how much progress we’re able to make in four days.

This week, I am working on an event to fix a very small part of patient care that is very broken. When a baby is born, the process to notify the attending physician is extraordinarily complex. It seems simple and straightforward - something that should be able to be negotiated in 10 minutes or so. It turns out, though, that there are a staggering number of different ways that physicians in our organization choose to be notified about a new baby waiting to be seen. Add to this that some doctors see newborns in the hospital and some do not. There are family physicians and pediatricians and they do things differently. There are also two hospitals, each of which does it differently.

This complex and broken system highlights the difficulties I face in work-life balance as well. Even things that seem easy - checking the kids’ homework, following a predictable call schedule, and making sure there is toilet paper in every bathroom - can get broken. There are few things my husband and I do well that also could be applied to our newborn notification problem and a myriad of other issues at work and at home.

First, as we are finding out in our improvement event, someone needs to be responsible. We constructed a flow diagram to layout the current process from a newborn’s birth until the time they are seen by a physician for their newborn exam. There was a big blank along part of the diagram in which we discovered that no one is responsible for making sure the message about the new baby’s birth is conveyed to the doctor. In my own home, we never run out of toilet paper because there is a responsible person - my husband. He’s the TP man and we know who to ask when the supply is running low. This is in contrast to gym shoes or more specifically making sure the kids have new gym shoes before the first day of school. When we went to the school open house, we looked at each other when it came time for our kids to put their gym shoes on the shelf and realized that neither one of us had taken care of the shoes.

Similarly, at work, when I really need something done, I need to identify the responsible person. I don’t just send out vitally important phone messages. I walk over to let a specific nurse know that the issue needs to be taken care of.

Other things that we do well that make the easy things easy include clear communication - not just a note left on the kitchen counter but a face-to-face, "Are you really listening to me?" kind of conversation. We try not to place unreasonable explanations on each other - we are flexible and try to make it easy for the other person to meet our needs. And finally, we have a clear goal in mind - what it is we’re trying to accomplish.

I’ll see if any of my success at home can be brought to my improvement event.

Find out more about Jennifer Frank and our other Practice Notes bloggers.

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