Monday, May 11, 2009

Emergency Room Visit – A Model of Individualized Care -- Lessons for Education

An unplanned trip to the hospital on May 7th, 2009 gave me some insight as to how an organization can be optimized to meet the needs of individuals. This is in contrast to the organizational model of educational organizations, and the cultural inertia that resists full support of individualized learning.

What I noticed first from my emergency room experience was the number of people involved in my care. I was served directly by nine different care providers in just the first half-hour or so. The actions of each care provider were informed by the work the others had done, coordinated, and focused on my individual needs just long enough to provide the needed care.

I was amazed at the efficiency with which multiple ‘specialists’ each provided just the right care at just the right time with just the right information to support their decisions and actions. My time was limited with each specialist, but each encounter added personalized value to my care. And each did so in a way that made my experience as comfortable as possible.

The multiple care providers did not need to spend a lot of time talking about my case, or debating decisions, the criteria for key decisions had been pre-established within standard processes and informed by best practices. For example, the triage nurse didn’t have to think twice about calling for an electrocardiogram. The decision had already been made that the EKG would be done based on the circumstances. The decision was built into a well-thought-out, well-established process, that has been trained upon, and has become part of the organizational culture. I am convinced that if I entered that hospital on a different day, with different staff on duty, the decisions made, and the care I received would not have been different.

The cost in time and money for doing the EKG had been minimized by assigning a specialist with a mobile cart able to move quickly to the patient, do the test, and move on. While the technician did the test, the triage nurse was able to finish entering comments in my record then shift focus to another case.

In this case, person-time is more valuable than the equipment and consumables. The efficient system makes it easy to reduce risks, the risk of not doing the test, missing or delaying a diagnosis, or wasting the time of a (higher paid) physician if the test wasn’t available when needed later.

My quality of my care was dramatically improved because someone, somewhere, figured out that employing a separate EKG technician, and assigning that person to device on a mobile cart, is more efficient than that triage nurse or someone else doing that job at a different location. And not only did someone come up with the idea. The practice of having a roving EKG technician has been tested, measured, and proven to be an effective practice. That EKG technician may have been cross-trained to perform other duties but was available at the moment the triage nurse called.

I was served directly by the following health care professionals during my brief four-hour emergency room stay:
1. Triage registration desk clerk (with desktop computer)
2. Triage nurse (with desktop computer)
3. EKG technician (with mobile cart)
4. Aide, for transport to room
5. ER intern for initial diagnosis/ test (with wall-mount computer in hospital room)
6. ER nurse assist with test sample
7. Registration clerk (with mobile cart)
8. X-Ray technician (with mobile cart)
9. Medical technician (training to be an EMT) for blood sample and to set up I.V.
10. Aide, for comfort ...blanket, ice chips
11. Room attendant for trash and biohazard removal
12. RN to administer medication via I.V.
13. Doctor to confirm diagnosis and treatment plan (used in room computer)
14. Nurse for discharge (computer at nurse’s station to print discharge instructions and patient sign-out)
15. Emergency waiting room information desk clerk -- provides service to waiting family members (desktop computer to look up patient admittance info) …and parking validation.

I realize that there are countless others that I didn’t see that made it possible for me to receive the care that I did. Even though these many professionals may not see each other, they were all able to focus on my care informed by a common information system and common set of procedures and professional practices.

It is worth noting that I felt like I was being better cared for by many professionals in short intervals than I would have if I had one jack-of-all-traits person with me for extended periods of time. More importantly, the actual quality of my care was better because specialists were employed and because the processes established made it easy for those specialists to use effective practices for each step in my care.

There is a critical need to transform institutions of learning into organizations optimized to meet individual learner needs. The medical model is a good place to start in defining the “Learning Care System” to replace our outdated education system.

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