I had quite a warm-up period before I went into PhD research. Not that I was aware of that at the time. Over the years, working in hospitals, I learned bits and pieces of the puzzle. I analyzed many outpatient processes, some in general, some in detail like those of eye patients, gynaecology and oral surgery. People gave me several tours of the Operating Theatres, the morgue, the laboratory, the Central Sterilization Department. I observed cardio vascular surgery. I visited a supplier of ready made dinners for patients, I spent a couple days with Oncologists talking to cancer patients every 10 minutes. I studied planning schemes of all sorts of departments, I talked and observed to logistics staff working in the central storage and internal transport. I guess I had more than 100 interviews and a similar number of workshops with pharmacists, doctors, nurses and managers. For over 3 years I worked on the logistics of the OR in several hospitals and in my Master thesis I spent 9 months in the Gynaecology related deparments. I understood that all these processes are connected somehow. But how?
I learned that hospital processes are extremely diverse and there are many flows going round. I once did a study of a hospital with two locations and at some point I had modelled 18.000 unique movements per week, including patients, materials and staff. These 18.000 flows consisted of 36 different flow types, mainly goods, but also, for example, bed patients. The flows crossed, they arrived on the same day on the same nursing deparment, sometimes even 30 (!) times a day. Flows were, whether it be Cardiology patients or linnen, all (if at all) managed individually. Data on these processes was often not available or hard to find, mostly in the head of the experts: the doctor, planners and the people who do the job. The fragmentation seems so obvious and the optimization options endless but at the same time it’s crazy to even get started with that. My laptop even crashed trying to calculate stuff with these data.
Not surprisingly some people simply groan by the sight of such complexity. Me too I must admit. Data collection was like Sisiphus labour. It made me think of other ways to do it though. In my Master thesis research I did three months of data collection – only to conclude that that was a dead end road. Very frustrating. But I then discovered something I had not really thought of initially: the hospital is full of work process experts. Doctors, nurses and other staff know how things work and flow. Let’s use that. That turned out to be fruitful in several ways. More on that in my next blog.