‘Nice job colleagues, but does it also work in theory?’ – part 1

A hospital moves into a state-of-the-art new building, in which all processes are supported by advanced ICT. Short after the opening of the new hospital both the building and the ICT do not seem to support the way patients and staff use it. Waiting rooms are empty – which sounds like great news – but it is not because there is no waiting. People are sitting in other places than what is the idea and doctors searching for their patient, have to shout along the corridor for the next one. Administration staff working in front offices complain that they have lost communication with their backoffice colleagues.  Not long after, due to financial deficits,  the hospital is forced  to reduce the staff. 

Another new hospital opens its doors. In the first weeks working at the new Operating Theatre Complex (OR) there are serious issues: by lack of storage space, materials get stuck in hallways and expensive operating space is used as storage room. The logistical processes have not been organized to deliver materials just-in-time. The operations and safety of the OR are at stake. The hospital needs to rebuild the entire OR.

Yet another hospital needs rebuilding and renovation as some facilities do not meet modern standards. Rebuilding the entire hospital is not feasible, financially and the local authorities are not very cooperative with permits. It is decided to leave the outpatient and daycare in the existing facilities and to rebuild the clinical parts in the same region. From a logistical perspective this will lead to substantial increase of operational cost. Doctors oppose as travelling daily between two locations costs time. After years of designing the new hospital and preparing it to be built, the plans are put on hold.

Two hospitals merge into one hospital, while both hospitals are rebuilding their facilities. Their plans are discussed by the banks: why build two complete hospitals with everything new in the same region and one organization? It is decided that the two hospitals will be serviced by one sterilization facility. The hospital that lost its ‘own’ sterilization department, suffer from failures in the delivery of sterilized medical equipment by the central sterilization facility. Staff experience a lot of stress and failure costs are high. After a few years of improvement attempts one hospital location decides to outsource the sterilization of their equipment to a commercial sterilization company, while the other hospital sticks to their own sterilization department. Economies of scales are nowhere to be found.

Having seen these situations between 2006 and 2016 I went from curious, amazed, sometimes cynical on a bad day. Why is it that we rebuild or transform hospitals into something logistically worse? What is behind that, if anything? To me, the link between what was aimed for strategically and the operational outcome was unclear. Research on hospital mergers seem to set the same diagnosis; they do not seem to result in better hospitals. And every new hospital building seemed to lead to newspaper headlines of a hospital in financial need.

Inspired by all this? That is not the right word. But to blame it to anything or anyone, that was too easy. The issues seem to occur in so many hospitals. The people who work there are intelligent and devoted people. What was going on then? At some point I cleared my agenda for a couple of days and started writing down what I had seen, what was puzzling me and how I thought that a logistical perspective would be useful.




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