We call it a health system, and there are times when it works with an incredible life changing, interconnected fluency.
But far too often what it is….is a complex bundle of separate silo-systems.
Every day there are hundreds of episodes of asynchrony within the patients journey as discrete silo-systems bump and scrape and snag up against each other. Some are minor annoyances that test a patients, well…..patience.
Others are truly exasperating experiences for everyone, demonstrating poor design, a lack of respect for our patients and a lack of advocacy by, well …….us.
Here is one very simple example of the health system at work
Mrs Fleck is a 45 yo female who presents to the emergency department after impaling her foot on a large 4cm splinter of wood whilst walking barefoot in her back garden.
She presents at around 7PM on a public holiday Monday.
The emergency department is experiencing access block, resulting in overcrowding and very long waiting times.
She is finally seen by an ED doctor at around 11PM.
The splinter is removed and the wound is cleaned and dressed.
There is however, some concern that a piece of wood has broken away and remains lodged in her foot.
The doctor books the Mrs Fleck in for an ultrasound, but as this service is not available this late, the patient is asked to present to the medical imaging department first thing in the morning.
Mrs Fleck leaves the ED at 1240 AM.
She presents as requested the next morning at 9 AM.
And gets her ultrasound at 1030.
Indeed, a piece of wood remains lodged in her foot.
Mrs Fleck is told to re-present to the emergency department for follow-up. There are no other management options available to her within the system at this point.
She presents to the Triage desk at 1145 AM.
Again the ED is extremely busy. Mrs Fleck is given a triage category 5 (non-urgent) and queued to be seen with other lower acuity patients in a Fast Track section of the department.
At 3.30PM Mrs Fleck angrily storms (well more of a hobble really) out of the department stating that “I’m sorry, but I cannot wait here any longer, I will sort out this problem myself”.
After presenting with a splinter of wood in her foot, she has spent well over eleven hours in the system. She has left the system with a splinter of wood in her foot.
Despite coming in contact with professional, hard-working staff she has been let down by the asynchrony of the system. It was a relatively minor outcome in the scheme of things. Mrs Fleck eventually went and saw her GP….who of course referred her straight to the emergency department, where it was eventually all sorted out.
As I said, this is an example of a simple problem that did not go smoothly.
How then, does the health system manage problems with more complexity and severity?
And how can we improve cross-links and flow design between the separate systems?