Designs on assembly-line care
IF you want improved healthcare for less money, get rid of the 20% of health and support personnel who work against the other 80% delivering services.
Flashback to earlier this month: the patient before me was very sick. I knew her history well. I had a gut feeling as she walked through the surgery door, panting, that she might have pulmonary embolism (PE), on top of hepatitis.
I rang the pathology service that was accumulating her abnormal lab results and chatted with one of their consultants. He independently settled on the same diagnosis: possible PE.
I called for an ambulance, stating I was a doctor ringing on behalf of a patient with PE. As in Victoria on bushfire days, 000 in South Australia is code for “zero priority”. If you really want something to happen quickly, forget to re-register your car.
I expected to be asked where the patient was located. But then I was ushered into Torture Room 7 of the Respiratory Inquisition wing. I assume similar hellish suites exist for other acute health problems.
“Has the patient ever had asthma?”
“Yes, she had mild asthma in the past, but I’m worried she might have PE now.”
“Well, is she on an asthma management plan?”
“I’m her GP and I’m managing her asthma, but I think we need an ambulance for her PE, now.”
“And when exactly did the patient last have Ventolin?”
“Look, how many of the 20 questions do I have to get right before this patient qualifies for an ambulance?”
Clearly I didn’t score highly enough. I got a paramedic in a sedan. Later, an ambulance arrived.
The patient stayed four days in hospital, which was a major achievement, because this hospital has had a program running for years called Redesigning Care.
The hospital is attempting to model itself on the efficiencies of an assembly line, because treating patients is just like manufacturing cars. And, as we have seen, nothing could be sounder than the car industry.
A gigantic spreadsheet on the ward maps where each patient is on his or her hospital journey. Most importantly, it lists barriers to discharge.
One would think that being seriously sick would rate as a barrier, but not necessarily. Indeed, I have heard rumours that social workers are required to attend discharge-planning meetings for patients who have just hit the ward.
The patient has not been diagnosed yet, but plans for their eviction are progressing nicely.
I would argue that not all discharges are equal. A discharge may be either honourable or dishonourable. I’m not sure if that concept has entered the consciousness of the Redesigning Care team.