February 11, 2008 12:01 am

Process oriented or deviate a little bit?

Filed under: Communication,Medical,Process Improvement,Project Management — ramsblog @ 12:01 am

How best is the process oriented, step-by-step methodical execution of a project or a task would be? 
How about liberalizing, although existing great working process, a little bit to assess the impacts up-front and eliminate any unnecessary project costs?
How about clear communication ahead of time to reduce any possible project impacts?

I am having these and many more questions lingering in my mind in past 2 days, since I learned a lesson in another industry. I used to have these in software development project management past several years, but my new experience was with medical. Here is the recent instance, although thought of a short one, but became a bit longer text here, that taught me much more. 

I had a surgery appointment for yesterday at the local hospital. A day before the surgery appointment, I seemed to develop cold and cough in the morning. Around Noon, I also had a temperature up to 100 deg. So called the Surgeon’s office and left a message about my situation asking if it was ok to keep the surgery appointment or postpone it to some other time until cough,cold,fever goes away. I received the call back from the doctor’s office later in the afternoon, saying the situation will be assessed by an anesthesiologist once I get there. I had a similar conversation with a pre-Op nurse as well.

Anyways, there I go to the hospital the following day with 102 deg fever. I was asked lie on a bed, a lab person came in to draw my blood sample. I said, I have fever, cough and cold, would you want to check the vitals first. She said, there will be another nurse to do so. There goes 2 tubes of my blood. 20 minutes later, a nurse comes in, confirms my name and date of birth. Asked her the same question that I appear to have cold and fever would that be checked first. She says – yes, we need to do your weight first – got myself weighed, she noted the number. I was then asked to dress up with hospital outfit – well obeyed that. 15 mins later, she comes in and checks my Blood pressure, temperature and pulse. She says, oh 39.4 in right ear and 39.1 in left ear, that’s not good for a surgery. I was like “(wink), I have been asking this since yesterday.” She was just about to inject an IV into my veins, but then went back to check with the surgeon upon checking the temperature again to make sure. 5 minutes later another nurse comes back and says, “Surgeon says we cannot perform the procedure now, this will have to be rescheduled”

Now, if only one of them had heard me and checked the temperature even before I got onto hospital bed? *sigh*

This shows, that the professionals following their scripted process would tax most around. Why not liberalize a bit and do the key steps first?


cons of not checking temperature when we asked for (after arriving at the hospital)
a. I didn’t have use the Bed/stretcher and other paraphernalia (a pair of socks, head cap, gown, bed spread, etc)
b. I could have saved my blood (2 tubes were drawn for electrolytes panel test). This will be repeated if I reschedule my appointment for later time
c. two or three nurse staffs didn’t have to spend their 60-90 minutes on me
d. Lab work could be eliminated
e. Now, all these will be of course billed to my insurance. I don’t know how much money that is going to be.

Cons of not taking the decision the previous day:
a. I was not supposed to eat since the previous mid-night. also having the fever the previous day, wasn’t able to eat much – so it was pretty much 24hours between my first call to the doctor’s office till my visit to the hospital
b. I was very very tired when I arrived at the hospital – I could have at least consulted a family doctor to cure present situation
c. my wife had to take a day off to take me to the hospital
d. inconvenienced our neighbor to pick up our daughter from her school
e. plus all the above after arriving at the hospital

So, at times, it is better to take the decision ourselves instead of consulting the professionals. I could have canceled the appointment saying I wasn’t ready and uncomfortable with cold and fever, but I did not and waited professional advise, not knowing about fever and surgery.

Where was the problem?
After talking to the doctor personally, we realized, the information that was communicated from medical assistant to the doctors the previous day did not include my fever at 100’s that I mentioned to the person I talked to. *sigh – Communication!*

I have been in projects as a developer a decade ago where we had an application requirements (from a client) put together by another team, and we designed and developed an application accordingly. Once tested, we both went to the client with a close to finished product (yes, we did not do the prototyping back then; we used dbaseIII+; application was going to be installed on a machine with 20mb hard drive and 16mb RAM, I think). Looking at the screen shots, the business said, their requirements weren’t met – our product management translated the requirements differently to us. We had to re-design our database to get back to what they asked for, within a short span of time.
a. Resources used up in building for wrongly understood requirement
b. Trust factor reduced with the Customer to some degree (owner of that company told me in one of my visits to deploy that application)
c. repeated visits to the customer at the last minute to re-design
d. etc…

(Disclaimer: for privacy, I have not mentioned the name of the hospital or the place. I will not disclose any names in this aspect. I have used this long story as a lesson learned and how this can be used in other situations, and to keep things in mind for assessing impacts in my other roles; and not point fingers )


1 Comment »

  1. […] the process for quite sometime and finally had decided to go for it this year. I was sent back 2 weeks ago since I had cough and high fever. We had it rescheduled for last week. Doctor had explained to me […]

    Pingback by Laparoscopic Surgery « RamsThoughts — February 27, 2008 6:11 am @ 6:11 am | Reply

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