knowquestion :: Stephen Bounds

There's a great story in The Boston Globe about work being done to improve a children's hospital's capacity to help people without a single additional dollar being spent.

The thing that really struck me was that I'm sure everyone in the hospital was genuinely trying to deliver the best service to their patients:

Many doctors and nurses just don’t care about "efficiency" for its own sake. They got into the business to help people, and tend to cringe when administrators start going on about cost-cutting.

However, staff were only considering their little piece of the puzzle

The problem [was] actually quite simple ... Nearly every department [was] run separately, making [the] hospital a nest of competing kingdoms rather than a smooth-running, cooperative organization.

The result was blockages that stressed staff, doctors and patients, further exacerbating process delays:

... hospitals [can] think they’re overcrowded [when] they [just] have a chronic problem managing their flow. Patients simply pile up at certain times ...

... Backups in one part of the hospital [caused] backups in others, leaving, for example, patients sitting for hours in the waiting room or highly trained surgical teams cooling their heels with no patient.

My takeaway from this story is that even good local intentions in an organisation can have bad global outcomes.

The hospital brought in an expert (Eugene Litvak), who applied a top-down approach known as queuing theory to optimise processes.

Now, I think Litvak's work has been a fantastic boon to the hospital. However, the question arises of why all these staff thought they were doing the right thing. And what will stop Litvak leaving and then have all of these problems creeping back in?

I believe that knowledge management provides an alternative and supplementary path to continued self-optimisation within an organisation. With the effective use of distributed problem solving and knowledge integration by staff, it should be possible to spot problems sooner and take corrective action before the crises hit critical mass once again.

Toyota is the classic master of this kind of whole-of-organisation process evolution. When dealing with long process chains like car assembly lines and hospitals, people in organisations need to consider not just their immediate work, but the work being done as far up and down their chain as possible.

It's a lesson I dearly hope the hospital has learnt, but unfortunately we may be hearing about the next "efficiency expert" returning to the hospital in 10 years' time.