Absence of data – a blessing in disguise?

My first scientific research was in 1999 in one of the major hospitals in The Hague. I worked there for about 6 months doing my Master thesis research. I studied the process of Gynaecology patients and more specific the patient file processes. Patient files, still on paper at the time, were often missing. Besides solving this problem, my main question was whether computer simulation added value in the problem solving process.

My main memory of this experience was that I spent 3 months collecting data and that it was, in Trump terms, a total disaster. Instead of knowing the patient and the administrative processes in detail after three months I only collected fragments but could not put them together. There were data on patients being in the outpatient department and there were data on patients being in the nursing department, but the time in between visits or steps was unknown. The same applied for the process of patient files. It was impossible to describe and quantify the processes from start to end in an objective way.

My last resort was to go to one of the gynaecologist and ask him. He was most helpful and we worked together for some weeks describing the patient processes and quantify these. It turned out that there were 8 patient types with more or less the same process. A process consisted of a number of activities that took place in a certain order and in an often predictable rhythm. In the process of making the model it became clear that patient files underwent activities in a rhythm that was not synchronized with the patient process. In other words, it was almost a miracle if the file was present at the right location when the patient showed up for an appointment.

Many people in the hospital already knew this. The patient file was often on the doctor’s desk, waiting to be processed. But assistants and other administrative staff did not feel comfortable to address this issue with doctors. The gynaecologist that helped me was quite happy to see the bigger picture and impressed by the fact that with his help we were able to make a ‘fancy’ computer simulation model. Besides it seemed like a useful exercise, it was fun for him. He accepted the analysis without any hesitation and was willing to change his own habits and behaviour to solve the problem. I was happy with the result, knowing I had solved the problem and wrote my thesis. But then the main lesson was still to come.

I presented my research to the entire group of gynaecologists. They listened politely but discarded the story as ‘organisational chit chat’, not really an issue that was of their concern. Then the gynaecologist that I worked with stood up and started a monologue to his colleagues about what needed to be done and that their own way of working needed to change. From then on I knew that making simulation models in a hospitals is only effective when the people working in the processes provide the data input themselves. They need to be involved in the making of the model, otherwise they won’t accept the outcome.

To be able to  work together with doctors and nurses it is important to understand the medical profession and what the ways are of doctors and nurses. To learn more about the doctors two thesis are worth reading: Doctors Orders by Karen Kruijthof and, only available in Dutch I think, Doctors in Charge by Yolande Witman. Both books provide an inside look on how doctors think, behave and what their beliefs are. Facts and evidence based measures are important factors in making a change that includes doctors and nurses. Simulation models could be a useful tool, if not merely made and presented by the outside analyst or data engineer, but developed and used by the people involved.

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