Friday, January 7, 2011

In Action: Creating a Culture of Improvement at GBMC

Anyone who knows me knows that I love to eat. In fact, when I was in medical school in Italy, I thought that I was in heaven! A good friend of mine, Pino Mauriello, recently reminded me of an interaction he had with a mutual acquaintance who didn’t remember my name. After speaking with Pino, the acquaintance said, “E quell’ Americano che mangia!” Translated: “He’s that American who eats!”
So I got the message when at one of my initial introductory town hall meetings last summer, a nurse gently confronted me on the notion of bringing more joy to the practice of taking care of patients. She told me that it was hard for her to stay focused on the patient when she was feeling constantly rushed. On top of this, on the days she was able to get to the cafeteria to eat a quick lunch there were frequently long lines of people waiting to pay. She reminded me that with only a few minutes to eat, the wait in the line was a pure waste of her precious minutes. She often went back to her unit without eating.
I heard her message loud and clear. I had been talking about change and improvement and a member of our GBMC family was identifying a system that was in need of improvement that was outside of her control.
I discussed this issue with Keith Poisson, our Chief Operating Officer and Mike Forthman, our Vice President for Facilities, and they told me that significant improvements were in the planning stages. We met with Matt Tresansky, our Director of Food Services so I could learn about the design changes.
Matt educated me on how the operations in the cafeteria work and the measurements that were in place to gauge efficiency. It was good to see he was measuring how many people were served on a daily basis but I didn’t see evidence of measuring the cycle time from when I’m ready to pay to when I actually finish paying. I noticed that there were four cash register stations but only two were open at the height of the lunchtime rush. Matt explained that a big part of the problem was that the cash registers were too slow and outdated. In order to be able to flex to five register lines, we had to upgrade the equipment and the new registers were on order.
The cafeteria received the new, state-of-the-art Point of Sale cash registers in November and since then the lines during the busiest times of the day have been much shorter (see the photos) and we open up to five checkout lanes as the demand requires during peak times. 
The proof of improved efficiency is in the evidence, of course, so consider some of this initial data and future plans provided by Ryan O’Hara, Retail Manager:
  • Credit cards now process in three (3) seconds, versus 30 seconds with the older credit card processors; Credit cards are also accepted in all five checkout lanes
  • Cashiers currently process on average eight (8) transactions per minute versus four (4) transactions per minute with the old register system
  • Total transactions increased from 35,322 (December 2009) to 36,287 (December 2010)
  • Barcode scanners help to control inventory and speed up the check out process
The GBMC cafeteria photographed at the height of the lunchtime rush - 12:30 p.m. on January 5...
Short lines, new registers, improved flow and all register lanes open allow staff more time to enjoy lunch!

Ryan has received a lot of positive feedback so far from employees who are pleased with the almost “non-existent” checkout lines and with having more time to enjoy their lunch time rather than wait in line for most of it.

“Nurses have been very appreciative that at least four checkout lanes are open during lunch, and have given several compliments on how their wait time has dramatically decreased.  They also like that credit cards are accepted at all five registers,” says Ryan.

My point is this: We got it. An area for improvement had been identified and we took action. We heard what this nurse and others were saying and we designed a better system and achieved measurable improvements.   
People often talk about an organization’s culture. The way I see it, the culture at any hospital is one of two ways – you either have a culture of inaction, where individuals focus on a problem, place blame and make excuses; OR you have a culture of ACTION, where people focus on the solutions to a problem. Our culture at GBMC is not to look the other way when there is a problem, but to find a solution.
On the issue of wait times…Long patient waits and delays should be looked at as nothing more than a characteristic of our systems for serving patients in need, whether it be in a physician’s office, the Emergency Department or somewhere else. We need to apply the same scientific approach to reduce waits for our patients that we apply to waits for our staff in the cafeteria. We will embark in February on a hospital wide assessment of patient flow. Thanks for getting in action on this with us!
I had another experience this week that did not make me feel good about GBMC’s ability to get in action to fix a problem. I was in one of our patient waiting rooms where I had been told that most of the table lamps had no light bulbs. I went to find out if this were true. When I saw this for myself, I asked a staff member if she had known about this and she responded: “Oh yeah, we’ve been trying to get that taken care of for a while.”
I wondered what she meant by this? I don’t expect individual staff members to buy light bulbs and bring them in from home, but I am too proud of GBMC to let a day pass knowing that family members (who might want to read while they are waiting for one of our patients) are “in the dark.” If it were my area, I would not rest until we got the bulbs. If our process for replacing light bulbs is not reliable, let’s get in action and redesign our system!
What it comes down to is this – You don’t want to hear excuses. Patients don’t want to hear excuses. Whether it is something as simple as putting light bulbs in the lamps, or helping the busy nurse who only has a few minutes to grab lunch to eat, we can’t be complacent. We need to be an organization that takes action to achieve our vision of being the healthcare system where everyone, every time is treated the way we would want our own loved ones treated.
One of my mottos is: control what you can and expect that your colleagues will do the same. In the end, the nurse at the town hall meeting was essentially saying to me, “How can I take good care of the patients when I can’t even get something to eat – you, Dr. Chessare, can control that.”
Are you getting in action on what’s within your control to improve? Have you witnessed a colleague going above and beyond and taking action?  I’d love to hear about it and welcome your thoughts on this important topic.

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