This year has been an eventful one for my family. We had the regular COVID restrictions and wished we could all be together celebrating life’s many milestones. This year also brought unanticipated opportunities of spending time with loved ones as inpatients (non-COVID) in several different hospitals. This is the kind of Gemba you never want to visit, but the view makes for new perspectives with the patient at the center of care. Fortunately, everyone is doing well and back home, but I would like to reflect for a moment on some learning and yes, opportunities from the patient and family perspective.
Many years ago, I was part of a value stream event that focused on the patient and caregiver experience on the inpatient units. As we collected data from the patient, we heard that they were concerned about not knowing who their caregivers were by discipline and could not remember their names. The staff was concerned about the number of patient calls and their inability to get to the patients fast enough. Administration was concerned about patient discharge and length of stay.
The event included caregivers, patients and family members and the solution approach they wanted to try was to create visual management by using a white board in each patient’s room. I remember the excitement of running experiments and coming up with what we thought was a near perfect white board. It included the names of current caregivers, working diagnosis, scheduled tests with times, and meds with the time of next dose and expected discharge date. After this event, we worked with the staff on each unit to use the board to increase customer satisfaction and to reduce the calls to the nurse’s station. We measured the results and were quite proud of the effect this work had on patients and caregivers. Over the next couple of years, as I rounded each day, I was sure to check on a couple of boards and ask both patients, families and caregivers – Is this helpful? What can we improve?
As in all improvements we needed to reflect over time and improve the process. This study and adjust part of the cycle assures the process we improved is still relevant over time and yes, can be changed and further improved or even stopped for a new better process.
Now back to my experience in Gemba this year. I think it may be time for us to engage in the reflection and adjustment of these learnings. The use of these boards varied by organization and by shift. Sometimes the use was spot on. When they are not used, they become confusing wallpaper. The patient wonders why they are on the wall. The family feels like something is missing.
When white boards are used, they are very helpful to patients and families. It’s great to know who your caregivers are and when they are leaving. When this update is part of the end of shift hand off it’s even better! It feels more personal. The use of this board for medications, especially pain medication is invaluable. The patient and family have realistic expectations and are less confused by the process. They are less likely to call for their meds in the interim. Having the working diagnosis on the board helps communicate with the family and allows them to consider questions and thoughts they want to ask or share. And lastly, having an expected discharge date and time allows them to prepare for the transition back home in timely manner.
I missed having effective white boards. How are your teams using white boards?
Catalysis Healthcare Value Network