{"id":4319,"date":"2015-10-17T10:07:20","date_gmt":"2015-10-17T09:07:20","guid":{"rendered":"http:\/\/www.saasoft.com\/blog\/?p=4319"},"modified":"2015-10-17T10:07:20","modified_gmt":"2015-10-17T09:07:20","slug":"a-case-of-chronic-ae-pain-part-6","status":"publish","type":"post","link":"https:\/\/hcse.blog\/?p=4319","title":{"rendered":"A Case of Chronic A&E Pain: Part 6"},"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 chronic pain in their A&E department<\/em>.<\/p>\n

The story so far:\u00a0The history and examination of St.Elsewhere’s\u00ae Emergency Flow System have revealed that the underlying disease includes\u00a0carveoutosis multiforme<\/strong>. \u00a0StE has consented to a knowledge transplant but is suffering symptoms of disbelief – the emotional rejection of the new reality. Dr Bob prescribed some loosening up exercises using the Carveoutosis Game. \u00a0This is the appointment to review the progress.<\/em><\/p>\n

\n

<Dr Bob><\/strong> Hello again. I hope you have done the exercises as we agreed.<\/p>\n

<StE> Indeed we have. \u00a0Many times in fact because at first we could not believe what we were seeing. We even modified the game to explore the ramifications. \u00a0And we have an apology to make. We discounted what you said last week but you were absolutely correct.<\/em><\/p>\n

<Dr Bob><\/strong> I am delighted to hear that you have explored further and I applaud you for the curiosity and courage in doing that. \u00a0There is no need to apologize. If this flow science was intuitively obvious then we we would not be having this conversation. So, how have you used the new understanding?<\/p>\n

<StE> Before we tell the story of what happened next we are curious to know where you learned about this?<\/em><\/p>\n

<Dr Bob><\/strong>\u00a0The pathogenesis of carveoutosis spatialis<\/em>\u00a0has been known for about 100 years but in a different context. \u00a0The story goes back to the 1870s when Alexander Graham Bell invented the telephone. \u00a0He was not an engineer or mathematician by background; he was interested in phonetics and he was a pragmatist and experimented by making things. He invented the telephone and the Bell Telephone Co. was born. \u00a0This innovation spread like wildfire, as you can imagine, and by the early 1900’s there were many telephone companies all over the world. \u00a0At that time the connections were made manually by telephone operators using patch boards and the growing demand created a new problem. \u00a0How many lines and operators were needed to provide a high quality service to bill paying customers? In other words … to achieve an acceptably low chance of hearing the reply “I’m sorry but all lines are busy, please try again later<\/em>“. \u00a0Adding new lines and more operators was a slow and expensive business so they needed a way to predict how many would be needed – and how to do that was not obvious! \u00a0In 1917, a Danish mathematician, statistician and engineer called Agner Krarup Erlang<\/a> published a paper with the solution. \u00a0A complicated formula that described the relationship and his Erlang B equation allowed telephone exchanges to be designed, built and staffed and to provide a high quality service at an acceptably low cost. \u00a0Mass real-time voice communication by telephone became affordable and has transformed the world.<\/p>\n

<StE> Fascinating! We sort of sense there is a link here and certainly the “high quality and low cost” message resonates for us. But how does designing telephone exchanges relate to hospital beds?<\/em><\/p>\n

<Dr Bob><\/strong> If we equate an emergency admission needing a bed to a customer making a phone call, and we equate the number of telephone lines to the number of beds, then the two systems are very similar from the flow physics perspective. Erlang’s scary-looking equation can be used to estimate<\/em> the minimum<\/em> number of beds needed to achieve any specified level of admission service quality if you know the average rate of demand and average the length of stay. \u00a0That is how I made the estimate last week. It is this predictable-within-limits behaviour that you demonstrated to yourself with the Carveoutosis Game.<\/p>\n

<StE> And this has been known for nearly 100 years but we have only just learned about it!<\/em><\/p>\n

<Dr Bob><\/strong> Yes. That is a bit annoying isn’t it?<\/p>\n

<StE> And that explains why when we ‘ring-fence’ our fixed stock of beds the 4-hour performance falls!<\/em><\/p>\n

<Dr Bob><\/strong> Yes, that is a valid assertion. By doing that you are reducing your space-capacity resilience and the resulting danger, chaos, disappointment and escalating cost is completely predictable.<\/p>\n

<StE> So our pain is iatrogenic as you said! We have unwittingly caused this. That is uncomfortable news to hear.<\/em><\/p>\n

<Dr Bob><\/strong> The root cause is actually not what you have done wrong, it is what you have not<\/strong> done right. It is an error of omission. You have not learned to listen to what your system is telling you. You have not learned how that can help you to deepen your understanding of how your system works. It is that information, knowledge, understanding and wisdom that you need to design a safer, calmer, higher quality and more affordable healthcare system.<\/p>\n

<StE> And now we can see our omission … before it was like a blind spot … and now we can see the fallacy of our previously deeply held belief: that it was impossible to solve this without more beds, more staff and more money. \u00a0The gap is now obvious where before it was invisible. It is like a light has been turned on. \u00a0Now we know what to do and we are on the road to recovery. We need to learn how to do this ourselves … but not by guessing and meddling … we need to learn to diagnose and then to design and then to deliver safety, flow, quality and productivity. \u00a0All at the same time.<\/em><\/p>\n

<Dr Bob><\/strong>\u00a0Welcome to the world of Improvement Science. And here I must sound a note of caution … there is a lot more to it than just blindly applying Erlang’s B equation. That will get us into the ball-park, which is a big leap forward, but real systems are not just simple, passive games of chance; they are complicated, active and adaptive. \u00a0Applying the principles of flow design in that context requires more than just mathematics, statistics and computer models. \u00a0But that know-how is available and accessible too … and waiting for when you are ready to take that leap of learning.<\/p>\n

OK. I do not think you require any more help from me at this stage. You have what you need and I wish you well. \u00a0And please let me know the outcome.<\/p>\n

<StE> Thank you and rest assured we will. We have already started writing our story … and we wanted to share the that with you today … but with this new insight we will need to write a few more chapters first. \u00a0This is really exciting … thank you so much.<\/em><\/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

Part 1 is here<\/a>. Part 2 is here<\/a>. Part 3 is here<\/a>. Part 4 is here<\/a>. Part 5 is here<\/a>.<\/p>\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 chronic pain in their A&E department. The story so far:\u00a0The history and examination of St.Elsewhere’s\u00ae Emergency Flow System have revealed that the underlying disease includes\u00a0carveoutosis multiforme. \u00a0StE has consented to a knowledge transplant but … <\/p>\n

Continue reading “A Case of Chronic A&E Pain: Part 6”<\/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":[8,12,20,32,35,38],"tags":[],"class_list":["post-4319","post","type-post","status-publish","format-standard","hentry","category-bobles","category-carveout","category-flow","category-productivity","category-reflections","category-safety"],"_links":{"self":[{"href":"https:\/\/hcse.blog\/index.php?rest_route=\/wp\/v2\/posts\/4319","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=4319"}],"version-history":[{"count":0,"href":"https:\/\/hcse.blog\/index.php?rest_route=\/wp\/v2\/posts\/4319\/revisions"}],"wp:attachment":[{"href":"https:\/\/hcse.blog\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=4319"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/hcse.blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=4319"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/hcse.blog\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=4319"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}