By Briana Krewson, Student Professional Development Support Fund Recipient
The US healthcare system is, at the end of the day, a business. Because of this, there is a belief that patients feel more like statistics than individuals, and doctors seems to be driven more by profit than morals. The idea of quality improvement in healthcare is to fix all the small, broken parts of the healthcare system to make it workable and functional for both patients and providers.
I had the privilege of attending Dartmouth-Hitchcock Medical Center’s conference called “Health Care Quality Conference: Tools and Takeaway for Your Journey” with the help of the Dartmouth Graduate Student Council. The conference was 7:00AM - 4:30 PM on a Saturday, and I was one of the youngest people in attendance.
The conference was geared toward DH employees, healthcare organization managers, and really anyone who wanted to learn about better managing workspace operations, encouraging QI projects, and co-producing healthcare. As a public health student at The Dartmouth Institute, I fit right in.
The conference opened with Robert Shumsky, PhD and Professor at Tuck School of Business. He presented on operations and patient flow by doing a simple, hands-on activity. Each row of conference attendees acted as a hospital unit, and the object was to move as many patients through your hospital as possible. Each participant in the row had to draw six smiley faces on an index card before passing it to their left for the next person to add six more smiley faces. By the end of the row, the card was filled up of all sorts of shapes and sizes of smileys, and placed down as “complete”. Every time the first person in the row passed their card to the left, they picked up another blank card, pulling in as many “patients” into the system as possible. The quality of the smileys did not matter too much; the speed of getting the cards complete was the priority. We were were smiling and laughing at the lightness at the activity, while Professor Shumsky amicably sprinted around the room counting stacks of cards to determine an average.
After that first two-minutes, Professor Shumsky altered the activity, so that each person now had to draw the number of smiley faces of their birth month. My birth month is May, so I only had to draw five smileys. Others in my row were born in November and December, meaning they had a lot more work to do compared to January and February babies. I found myself waiting for cards, feeling pressure and impatience in watching them work, knowing I was not permitted to help them draw, and simply had to wait. The process slowed down and we had significantly less patients successfully compete the system (less completed cards).
Shumsky used the activity to demonstrate Little’s Law, saying that based on our WIP (average number of items in the system) and throughput (average arrival and departure rate) from our first round to the second round, our overall lead time (time of item in the system) went up, so the patients had to stay within the hospital a lot longer.
In the afternoon, Paul Bataldan, MD, a world-famous doctor and professor of quality improvement in healthcare, presented on co-production in healthcare in his chat with DHMC’s CEO Joanne Conroy. Coproduction is the idea that patients should have a primary role in their healthcare, so that providers and healthcare teams are not the only ones make decisions about care plans. Dr. Bataldan stated that we cannot “outsource” or “delegate” our health, that we need to change healthcare culture in America so that patients take the driver’s seat and are active and comfortable in engaging and leading their treatment plans. The patients are, after all, the experts in their individual health statuses. Dr. Bataldan emphasized the idea of patient-centered care in coproduction; physicians should be asking patients what “what matters to you” instead of “what is the matter with you”.
This conference was a great complement to my TDI education and coursework in QI. I have been working this term on understanding microsystems and how QI projects work similarly and differently on the macro and micro system levels. I am honored that I had the opportunity to listen to Dr. Bataldan speak, and I am excited to think more about design of operations within healthcare. I am grateful for the Dartmouth Graduate Student Council’s assistance with my engagement in this opportunity!