{"id":4578,"date":"2016-02-27T11:07:03","date_gmt":"2016-02-27T10:07:03","guid":{"rendered":"http:\/\/www.saasoft.com\/blog\/?p=4578"},"modified":"2016-02-27T11:07:03","modified_gmt":"2016-02-27T10:07:03","slug":"the-cost-of-chaos","status":"publish","type":"post","link":"https:\/\/hcse.blog\/?p=4578","title":{"rendered":"The Cost of Chaos"},"content":{"rendered":"

\"british_pound_money_three_bundled_stack_400_wht_2425\"<\/a>This week I conducted an experiment – on myself.<\/p>\n

I set myself the challenge of measuring the cost of chaos<\/em>,\u00a0and it was tougher than I anticipated it would be.<\/p>\n

It is easy enough to grasp the concept that\u00a0fire-fighting\u00a0to maintain patient safety amidst the chaos of healthcare would cost more in terms of\u00a0tears and time …<\/p>\n

… but it is tricky to\u00a0translate that concept into hard numbers; i.e. cash.<\/p>\n

\n

Chaos is an emergent property of a system.\u00a0 Safety, delivery, quality and\u00a0cost are also emergent properties of a system.\u00a0We can measure cost, our finance departments are very good at that.\u00a0We can measure quality – we just ask “How did your experience match your expectation”.\u00a0\u00a0<\/em>We can measure delivery – we have\u00a0created a whole industry of\u00a0access target\u00a0monitoring.\u00a0 And we\u00a0can measure safety by\u00a0checking for things we do not want – near misses and never events.<\/p>\n

But while we can feel the chaos we do not have an easy way to measure it. And it is hard to improve something that we cannot measure.<\/p>\n

\n

So the experiment was to see if I could create some chaos, then if I could calm it, and then if I could measure the cost of the two designs – the chaotic one and the calm one.\u00a0 The difference, I reasoned, would be the cost of the chaos.<\/p>\n

And to do that I needed a typical\u00a0chunk of a healthcare system: like an A&E department where the relationship between safety, flow, quality and productivity is rather\u00a0important (and has been a hot topic for a long time).<\/p>\n

But\u00a0I could not experiment on a real A&E department … so I experimented on a simplified but realistic model of one. A simulation.<\/p>\n

What I discovered came as a BIG surprise, or more accurately a sequence of big surprises!<\/p>\n

    \n
  1. First I discovered that it is\u00a0rather easy to create a\u00a0design that generates chaos and danger.\u00a0 All I needed to do was to assume I understood how the system worked and then use some averaged historical data to configure my\u00a0model.\u00a0 I could do this on paper or I could use a spreadsheet to do the sums for me.<\/li>\n
  2. Then I discovered that I could calm the chaos by reactively adding lots of extra capacity in terms of time (i.e. more staff) and space (i.e. more cubicles).\u00a0 The downside of this approach was that my costs sky-rocketed;\u00a0but at least I had restored safety and\u00a0calm and I had eliminated the fire-fighting.\u00a0 Everyone was happy … except the\u00a0people expected to foot the bill. The finance director, the commissioners, the government and the tax-payer.<\/li>\n
  3. Then I got\u00a0a really big surprise!\u00a0 My safe-but-expensive design was horribly inefficient.\u00a0 All my expensive resources were now running at rather low utilisation.\u00a0 Was that the cost of the chaos I was seeing?\u00a0But when I trimmed the\u00a0capacity and costs the chaos and danger reappeared.\u00a0 So was I stuck between\u00a0a rock and a hard place?<\/li>\n
  4. Then I got a really, really big surprise!!\u00a0 I\u00a0hypothesised that the root cause might be the fact that the parts of my system were designed to work independently, and I\u00a0was curious to see what happened when\u00a0they worked interdependently<\/strong>. In synergy.\u00a0And when I changed\u00a0my design to work that way the chaos and danger did not reappear\u00a0and the efficiency improved.\u00a0A lot<\/strong>.<\/li>\n
  5. And the biggest surprise of all was how difficult this was to do in my head; and how easy it was to do when I used the theory, techniques and tools of Improvement-by-Design.<\/li>\n<\/ol>\n
    \n

    So if you are curious to learn more … I have written up the full account of\u00a0the experiment with\u00a0rationale, methods, results, conclusions and references and I have published it here<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"

    This week I conducted an experiment – on myself. I set myself the challenge of measuring the cost of chaos,\u00a0and it was tougher than I anticipated it would be. It is easy enough to grasp the concept that\u00a0fire-fighting\u00a0to maintain patient safety amidst the chaos of healthcare would cost more in terms of\u00a0tears and time … … <\/p>\n

    Continue reading “The Cost of Chaos”<\/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":[14,15,17,18,20,22,24,26,31,32,38,40,41,42,45,46],"tags":[],"class_list":["post-4578","post","type-post","status-publish","format-standard","hentry","category-delivery","category-design","category-examples","category-finance","category-flow","category-healthcare","category-improvementology","category-isp","category-papers","category-productivity","category-safety","category-sfqp","category-stories","category-how","category-what","category-teach"],"_links":{"self":[{"href":"https:\/\/hcse.blog\/index.php?rest_route=\/wp\/v2\/posts\/4578","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=4578"}],"version-history":[{"count":0,"href":"https:\/\/hcse.blog\/index.php?rest_route=\/wp\/v2\/posts\/4578\/revisions"}],"wp:attachment":[{"href":"https:\/\/hcse.blog\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=4578"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/hcse.blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=4578"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/hcse.blog\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=4578"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}