{"id":4303,"date":"2015-10-03T09:16:41","date_gmt":"2015-10-03T08:16:41","guid":{"rendered":"http:\/\/www.saasoft.com\/blog\/?p=4303"},"modified":"2015-10-03T09:16:41","modified_gmt":"2015-10-03T08:16:41","slug":"a-case-of-chronic-ae-pain-part-4","status":"publish","type":"post","link":"https:\/\/hcse.blog\/?p=4303","title":{"rendered":"A Case of Chronic A&E Pain: Part 4"},"content":{"rendered":"

\"Dr_Bob_Thumbnail\"<\/a>Dr Bob runs a Clinic for Sick Systems<\/em> and is sharing the Case of St Elsewhere’s \u00ae Hospital which is suffering from\u00a0chronic pain in the A&E department<\/em>.<\/p>\n

Dr Bob is presenting the case study in weekly bite-sized bits that are ample food for thought.<\/p>\n

Part 1 is here<\/a>. Part 2 is here<\/a>. Part 3 is here<\/a>.<\/p>\n

The story so far:<\/p>\n

The history and initial examination of St.Elsewhere’s\u00ae Emergency Flow System have revealed the footprint of a Horned Gaussian<\/em> in their raw A&E data. \u00a0That characteristic sign suggests that the underlying disease complex includes one or more forms of carveoutosis<\/em>. \u00a0So that is what Dr Bob and StE will need to explore together.<\/p>\n

\n

<Dr Bob><\/strong> Hello again and how are you feeling since our last conversation?<\/p>\n

<StE> Actually, although the A&E pain continues unabated, we feel better. More optimistic. We have followed your advice and have been plotting our daily A&E time-series charts and sharing those with the front-line staff. \u00a0And what is interesting to observe is the effect of just doing that. \u00a0There are fewer “What you should do!” statements and more “What we could do …” conversations starting to happen – right at the front line.<\/em><\/p>\n

<Dr Bob><\/strong> Excellent. That is what usually happens when we switch on the fast feedback loop. I detect that you are already feeling the emotional benefit. \u00a0So now we need to explore carveoutosis. \u00a0<\/em>Are you up for that?<\/p>\n

<StE> You betcha!\u00a0<\/em><\/p>\n

<Dr Bob><\/strong> OK. The common pathology in carveoutosis<\/em> is that we have some form of resource that we, literally, carve up into a larger number of smaller pieces. \u00a0It does not matter what the resource is. \u00a0It can be time, space, knowledge, skill, cash. \u00a0Anything.<\/p>\n

<StE> Um, that is a bit abstract. \u00a0Can you explain with a real example?<\/em><\/p>\n

<Dr Bob><\/strong> OK. I will use the example of temporal carveoutosis.<\/em>\u00a0 Do you use email? \u00a0And if so what are your frustrations with it … your Niggles?<\/p>\n

<StE> Ouch! You poked a tender spot with that question! \u00a0Email is one of our biggest sources of frustration. \u00a0A relentless influx of dross that needs careful scanning to filter out the important stuff. We waste hours every week on this hamster wheel. \u00a0And if we do not clear our Inboxes by close of play on Friday then the following week is even worse!<\/em><\/p>\n

<Dr Bob><\/strong> And how many of you put time aside on Friday afternoon to ‘Clear-the-Inbox’?<\/p>\n

<StE> We all do. It does at least give us some sense of control amidst the chaos.\u00a0<\/em><\/p>\n

<Dr Bob><\/strong> OK. This is a perfect example of temporal carveoutosis<\/em>. \u00a0Suppose we consider the extreme case where we only<\/strong>\u00a0process our emails on a Friday afternoon in a chunk of protected time carved out of our diary. \u00a0Now consider the effect of our carved-out-time-policy on the flow of emails. What happens?<\/p>\n

<StE> Well, if we all do this then we will only send emails on a Friday afternoon and the person we are sending them to will only read them the following Friday afternoon and if we need a reply we will read that the Friday after. \u00a0So the time from sending an email to getting a reply will be two weeks. And it does not make any difference how many emails we send!<\/em><\/p>\n

<Dr Bob><\/strong> Yes. That is the effect on the lead-time … but I asked what the effect was on flow?<\/p>\n

<StE> Oops! So our answer was correct but that was not the question you asked. \u00a0Um, the effect on flow is that it will be very jerky. \u00a0Emails will only flow on Friday afternoons … so all the emails for the week will try to flow around in a few hours or minutes. \u00a0Ah! That may explain why the email system seems to slow down on Friday afternoons and that only delays the work and adds to our frustration! We naturally assumed it was because the IT department have not invested enough in hardware! Faster computers and bigger mailboxes!<\/em><\/p>\n

<Dr Bob><\/strong>\u00a0What you are seeing is the inevitable and predictable effect of one form of\u00a0temporal carveoutosis<\/em>. \u00a0The technical name for this is a QBQ time trap\u00a0<\/em>and it is an iatrogenic<\/em> disease. Self-inflicted. (QBQ=queue-batch-queue).<\/p>\n

<StE> So if the IT Department actually had the budget, and if they had actually treated the ear-ache we were giving them, and if they had actually invested in faster and bigger computers then the symptom of Friday Snail Mail would go away – but the time trap would remain. \u00a0And it might actually reinforce our emails-only-on-a-Friday-afternoon behaviour! Wow! That was not obvious until you forced us to think it through logically.<\/em><\/p>\n

<Dr Bob><\/strong>\u00a0Well. I think that insight is enough to chew over for now. One eureka<\/em>\u00a0reaction at a time is enough in my experience. Food for thought requires time to digest. \u00a0This week your treatment plan is to share your new insight with the front-line teams. \u00a0You can use this example because email Niggles are very common. \u00a0And remember … Focus on the Flow<\/strong><\/em>. \u00a0Repeat that mantra to yourselves until it becomes a little voice in your head that reminds you what to do when you are pricked by the feelings of disappointment, frustration and fear.\u00a0 Next week<\/a> …<\/p>\n

\n

St.Elsewhere’s\u00ae is a registered trademark of Kate Silvester Ltd.\u00a0And to read more real cases of 4-hour A&E pain download Kate’s:<\/em>\u00a0The Christmas Crisis<\/a><\/p>\n

\n

\n

\n","protected":false},"excerpt":{"rendered":"

Dr Bob runs a Clinic for Sick Systems and is sharing the Case of St Elsewhere’s \u00ae Hospital which is suffering from\u00a0chronic pain in the A&E department. Dr Bob is presenting the case study in weekly bite-sized bits that are ample food for thought. Part 1 is here. Part 2 is here. Part 3 is … <\/p>\n

Continue reading “A Case of Chronic A&E Pain: Part 4”<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8,12,20,35],"tags":[],"class_list":["post-4303","post","type-post","status-publish","format-standard","hentry","category-bobles","category-carveout","category-flow","category-reflections"],"_links":{"self":[{"href":"https:\/\/hcse.blog\/index.php?rest_route=\/wp\/v2\/posts\/4303","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/hcse.blog\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/hcse.blog\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/hcse.blog\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/hcse.blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=4303"}],"version-history":[{"count":0,"href":"https:\/\/hcse.blog\/index.php?rest_route=\/wp\/v2\/posts\/4303\/revisions"}],"wp:attachment":[{"href":"https:\/\/hcse.blog\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=4303"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/hcse.blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=4303"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/hcse.blog\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=4303"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}