Radical thought – put patients first

Now here’s a radical thought – Dunedin Hopsital’s emergency department wants to put patients first.

The simple premise of putting the patient first may help to fix Dunedin Hospital’s emergency department woes and save up to 50% wastage at the hospital, the Otago District Health Board was told yesterday.

Emergency specialist Dr Tim Kerruish asked the board not to make any radical changes in the emergency department until a pilot project to increase efficiency and optimise “patient flow” through the hospital had been given a chance.

The project is based on car manufacturing company Toyota’s way of thinking, which involves putting the customer – or in the hospital’s case, the patient – first, as well as looking at how the entire hospital system works and getting everybody working together.

Aiming for perfect patient care should underpin how and why everything was done at the hospital, Dr Kerruish said.

Wastage in hospitals was also “extraordinary” and common estimates of 40% to 50% wastage were probably applicable to Dunedin Hospital, he said.

Otago is one of two district health boards which are trialling the “Optimising the Patient Journey” project in their emergency departments.

I spent a lot of time in Dunedin Hopsital, sometimes more than a week at a time,  when my children were young. That is now a couple of decades ago, however more recent experiences of family and friends indicate that some things haven’t changed: the staff are wonderful but the system needs radical surgery.

Wary as I am of catch-phrases, the thinking behind “optimising the patient journey” sounds like a good idea for staff and patients. Especially as Dr Kerruish said it would come from staff generating ideas and solutions and did not require more resources.

Similar projects adopted in hospitals in United States and the United Kingdom had shown incredible achievements, Dr Kerruish said. Getting everybody working together would be crucial to the success of the project.

“The emergency department cannot fix its problems without help from the rest of the system. This includes GPs and other hospitals.”

For example, emergency department overcrowding was often the result of patients not being able to be transferred to wards which were full because ward patients had not been discharged early in the day.

My baby son had been a patient for about 10 days when I was told he’d be discharged “tomorrow”. When tomorrow came we waited all day for the consultant to come so we could go. By the time he got to us it was early evening but it was the middle of winter and we were 120 kilometres from home so he said it would be safer for us to stay another night. It was early afternoon the following day before we finally left – so we spent nearly a day and a half longer than we should have and the hospital had incurred the extra cost of that.

Another common problem was the way things were done often went back “years and years” and had never changed.

“We never take anything away . . . we just add it to it. We end up with this very complicated system and a lot of the time people don’t know why they’re doing stuff.”

Overseas experience showed staff bought into ideas when they could fix the “Why do I have to do this?” frustrations, Dr Kerruish said.

Putting patients first, simplifying the system, improving co-operation between departments, GPs and other hopsitals and allowing staff to fix the problems doesn’t sound difficult or expensive. I’m sure the friend’s daughter who spent all yesterday afternoon waiting in the emergency department would think it’s worth a try.