Recently I started doing some work with a major hospital and in preparing my first intervention I reviewed some of the earlier work I did in the health care industry, which included working with executives from the Alexandra Hospital in Singapore. To update myself I also explored their website and found out that they are using a publicly accessible webcam for their Emergency Services waiting room. Why would you want to do that?

Before I explain that, I should tell you that Alexandra’s management team, under leadership of Mr. Teng Lit Liak, was always serious about continues improvement. They had done some amazing things including analyzing and improving the flow of patients from the moment they leave their house for a same-day procedure to arriving at the hospital and going back home again. This was in 2002. When I visited Mr. Liak 2 years ago, he was still at it with his management team, now using insights from Toyota, very carefully translating them with his people into possible applications that would help improve the patient’s experience at Alexandra Hospital.

Apparently one of the ideas that emerged was putting up a web-cam in the emergency room that would provide every 5 minutes an update on the average waiting time for patients and the absolute number of patients waiting to see a doctor. The hypothesis is that people who have a minor injury and would like to be treated in a hospital would first check the waiting time on the internet before they would go to Alexandra hospital. Based on what they see on the webcam they might make a more informed decision, e.g., go to Alexandra Hospital, or go to another hospital or clinic. This idea is based on the so called “Hejunka” principle derived from the Toyota Production System. “Hejunka” means to level or make smooth and in the emergency room context could potentially lead to better management of the relative unpredictable peaks and surges that occur. Possible advantages might include that patients are served more timely and a better match of people resources (number of doctors and nurses to patients).

The whole idea is based on a self-organizing patient flow, i.e. the patient making decisions based on one extra piece of information that could influence the actual demand of patients at Alexandra hospital.

The question is, will it work? It was decided to just try it. In October 2005, the average waiting time was 1 hour and 43 minutes and in October 2006, a month after implementing this system, the waiting time for 95% of the patients had fallen to 1 hour and 12 minutes. The implementation team agreed that it was not clear that the webcam contributed to this result, in other words the cause-and-effect relationship was not apparent, but they decided to continue the use of it and of course the real benefits will come when other hospitals also adopt a similar system. The decision making process for the patient then becomes easier.

Guess what, to date Alexandra hospital offers you links to four other hospitals who have a similar system. With the usual publicity in newspapers and other media, the emerging system is beginning to do its work.

I think this is a classic example where cause-and-effect relationships are unclear, the adoption by other hospitals was unpredictable and a new system of patients making more informed decisions about where to go is emerging. The outcome is unpredictable. You are dealing with a complex system with so many actors that your best bet is to send in a probe. In this case the cost was minimal, some S$ 400 for a webcam! Call it a probe or an experiment, do some careful sensing and move forward. Simple and Complex!

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I will be in Australia (Sydney and Canberra) shortly for some projects and an accreditation ...


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