Archive for December, 2011|Monthly archive page

Shop Floor Management in the E.D.

In Uncategorized on December 22, 2011 at 14:30

Emergency Medicine is a growing and developing specialty. It is unlike any other, in that it gets more complicated as it evolves. Society relies more on the Emergency Department every day of the year, to keep people from getting worse, or evaluate whether the chance for this to happen is bigger than one would think.
This results in a wider array of tasks and processes that are expected of the E.D. every day.
Still, most other disciplines consider Emergency Medicine as a not-so-well-defined specialty, with a very vague context, aura and atmosphere around it.
And they are right in a way, as it is a very blurry situation down there sometimes. Only, the main difficulty is exactly that chaotic blurry atmosphere, in which just being a good medical doctor or nurse, does not warrant an overall success.
The E.D. is the (only) place where the operational needs of managing the place is just as important to the outcome of the patient as the medical attention this patient gets or will get. Because bad operational management in the E.D., means no medical attention!
In most other areas of the hospital, the operational component does not have the same amount of importance towards the patient’s health. E.g. if you start an elective operation later, that usually won’t harm anybody (more). In the maternity ward, many things can start to happen, but usually the array of things that can happen there are limited to a certain number. (Child birth, a breach, a cesarean section …). And so on.
But you never know what’s going to happen in the E.D., nor how many it will happen to, or how many others you will be confronted with.
From an operational point of view, it’s a nightmare. To say the logistics are chaotic is mild.
But only a number of people seem to grasp that how we organize ourselves, has almost as much importance as what we do when we’re with the patient.
In short, in Scandinavia, people seem to grasp the importance of operational “shop floor management” of the E.D. far better than in the rest of the world.
And it is very clear that people elsewhere rather apply what has been tried before (in a different surrounding, such as car manufacturing plants) than to radically put urban emergency medicine back on the design table from an operational and tactical point of view.
I consider it a mission to analyze our needs and design our strategy from the bottom up.
It might become very interesting, if we keep an open mind.