The Shifting Landscape for Healthcare
The healthcare community has been changed forever due to the COVID-19 outbreak. As news began to spread of the seriousness of the virus and businesses started to close their doors, society began to experience significant disruption. Many industries are facing tremendous challenges, and healthcare facilities and hospitals are faced with a future filled with uncertainty. However, they do have a unique opportunity to navigate this disruption and examine their existing strategies and workflows to ultimately improve operational efficiency.
First-Order and Second-Order Responses
While there are a variety of strategies healthcare facilities can use when faced with disruption, there are a few approaches to problem solving and improving operational efficiency worth noting. First-order problem solving involves finding short-term solutions to long-term problems.[1] For example, if a nurse is in need of supplies for a patient but cannot find them, going to a storage closet on another floor may temporarily solve the problem, but the actual cause of the shortage is still unknown. Evidence suggests these practices are common in the healthcare industry, and medical supply issues will continue to be a factor for the foreseeable future.
Conversely, second-order problem solving would still involve finding the appropriate supplies for the patient, but the nurse would also engage in a series of workflow processes, or “metactions,” that attempt to uncover the root of the problem. In this particular scenario, the nurse would have evaluated the supply ordering and storage protocols for potential issues. There must be a baseline understanding of existing workflows and procedures to encourage hospital employees to resolve similar problems efficiently. Understanding why a problem occurred and the process for resolving the issue is far more beneficial than consistently finding short-term fixes.
How Poorly-Integrated Policies Affect Routine Performance
Hospitals are complex organizations with many departments that must coordinate their efforts carefully to achieve high levels of patient care. Unfortunately, establishing a mutual understanding of policies and procedures across multiple departments is often overlooked as a priority for healthcare facilities managing disruption.
In many cases, departments have a wide variety of objectives and conflicting interests. In a study of one hospital setting, a nurse who was questioned about lost charges on medical supplies stated it was due to “policy” and the process that caused the error had been in place for many years.[2] In another scenario, a transport manager had little idea as to why there were delays in transporting patients. In evaluating their responses, researchers found that the idea of a practice being “policy” was a commonly held belief throughout the hospital and there was a clear lack of knowledge and understanding of the purpose of various procedures and how they were to be completed. While it would be unfair to suggest that a lack of communication and baseline understanding of common policies and procedures is common among all hospitals, it does suggest that these issues are prevalent.
Implementing Solutions Sustained Through Leadership
Healthcare facilities and hospitals must begin to evaluate how well they communicate their policies and procedures, and conduct training. The creation of a streamlined process for training and development more often than not results in a greater mutual understanding of policies. Researchers for many years have concluded that relying on standardized problem solving procedures improves workflows in healthcare settings.[3] Hospitals looking to improve operational efficiency can review existing protocols and incorporate standardized training as possible solutions to navigating disruption.
Hospital leadership teams can play a pivotal role in improving operational efficiency as well. Fostering an environment that encourages second-order problem solving and standardized training are both viable solutions, but the fundamental characteristics of leadership must still be present. Healthcare facilities are comprised of highly educated individuals with expertise in a variety of areas. Standardized training and a review of existing workflows is only beneficial or productive when leaders are able to clearly communicate the purpose. To achieve this, leaders must begin by displaying expertise and a commitment to improvement. Physician leaders are most influential when they have “enough training to know what questions to ask, what they’ll need from others, and what potential strategies they can use.”[4]
A Comprehensive Approach to Abate Disruptions
The world of healthcare will continue to evolve, and the future is always uncertain. While managing disruption is never an easy task, there are viable strategies to navigating periods of uncertainty in healthcare facilities which have been proven to be effective. Hospitals can look to the use of second-order problem solving, standardized training, and a commitment to strong leadership as solutions to current disruptions and to mitigate future issues.
[1] “A Problem-Solving Routine for Improving Hospital … – PubMed.” https://pubmed.ncbi.nlm.nih.gov/25800336. Accessed 2 Jun. 2020.
[2] “A Problem-Solving Routine for Improving Hospital … – PubMed.” https://pubmed.ncbi.nlm.nih.gov/25800336. Accessed 2 Jun. 2020.
[3] “A Problem-Solving Routine for Improving Hospital … – PubMed.” https://pubmed.ncbi.nlm.nih.gov/25800336. Accessed 2 Jun. 2020.
[4] “From Physician to Physician Leader: Developing Your Skills ….” 24 May. 2018, https://www.hsph.harvard.edu/ecpe/physician-leader-skills-success/. Accessed 2 Jun. 2020.
