Parker Hannifin, Cleveland Clinic partnership focus of Dec. 2 keynote

Being a top hospital in the country, Cleveland Clinic is home to countless great ideas poised to transform into life-altering, even life-saving, medical advancements.

Getting those ideas out of the heads of its top-ranked physicians and onto the market has been the focus of a remarkable collaboration between the hospital and one of its neighbors in the Cleveland economic scene: Manufacturer Parker Hannifin Corp.

pete buca
Pete Buca

This partnership, which began quietly nearly a decade ago and was formally announced in 2014, is the focus of the afternoon keynote at the Center for Operational Excellence’s Dec. 2 seminar. At the event, Parker Hannifin VP Pete Buca will share details on the Cleveland Clinic collaboration, which has become a bustling pipeline of medical device ideas the company is working to bring to life using its own product development process, dubbed “Winovation.”

Recently ranked the No. 2 hospital in the country, Cleveland Clinic sees more than 5 million patient visits a year and employs more than 3,000 caregivers. That same U.S. News & World Report ranking called it the No. 1 hospital in the country for cardiology and heart surgery and one of the top five for diabetes and endocrinology, gastroenterology, orthopedics and pulmonology, among others.

Parker Hannifin, meanwhile, is an $11 billion-a-year maker of motion and control technologies that spent about $360 million on research and development in its latest fiscal year. It’s a supplier to more than 400,000 customers that span just about every significant manufacturing, transportation and processing industry in the economy: Food and beverage, life sciences, renewable energy, agriculture and aerospace, just to name a few.

Parker and Cleveland Clinic began collaborating several years ago in an effort to connect the engineering and product development prowess of the former with the critical insights into health-care challenges at the latter. To translate these two capabilities into action, Parker employees sat in on surgeries and communicated with surgeons, leaders told Crain’s Cleveland Business. Interactions like these spawned the 100-plus ideas that initially populated the partnership’s pipeline.

One product seeking to eventually make its way to the market is what’s called the Cleveland Multiport Catheter (CMC), a bold attempt to advance the treatment of brain cancers. Gliomas – a type of tumor in the glue-like supportive tissue of the brain – are resistant to radiation and other common therapies, largely because of the natural barrier in the body that keeps circulating blood out of the brain.

Surgical catheters that pump cancer drugs directly into the brain have been used on a trial basis for the past few decades, according to an October 2015 article by a CMC inventor, but have key limitations. Two in particular, according to the article, must be used in a special operating room, and left in only for several hours. The CMC, which began development in 2009, can be implanted in any neurological OR then be left in place for several days, ultimately delivering more cancer drugs, wrote inventor Dr. Michael Vogelbaum.

Cleveland Clinic partnered with Parker Hannifin to manufacture the CMC and treated its first patient with the device about two years ago. A March update revealed seven patients have undergone treatment with the CMC, which now has an Investigational New Drug application formally on file with the U.S. Food and Drug Administration. Dr. Vogelbaum said in a CMC update video that the device ultimately could help treat other neurological conditions such as Alzheimer’s Disease, Parkinson’s Disease and epilepsy.

At COE’s Dec. 2 seminar, Buca will share other exciting developments with Cleveland Clinic and detail how other organizations can learn from their collaborative innovation efforts. The featured keynote at the seminar’s morning session is Fisher College of Business Prof. Aravind Chandrasekaran, an award-winning researcher who will be sharing keys to collaboration.

Head to COE’s website to read more about this members-only session, or register now.

Do we really understand lean deployment in health care?

by guest author Aravind Chandrasekaran, associate professor of management sciences, Fisher College of Business

Anyone who has taught lean principles grounded in the famous Toyota Production System (TPS) to organizations outside the manufacturing industry has – at least once – heard this common refrain: “(Insert industry here) isn’t cars on an assembly line. This doesn’t apply to my work.”

A. Chandrasekaran
A. Chandrasekaran

Leading lean thinkers, of course, have learned how to work with individuals and teams to move past this roadblock and garner buy-in – that’s why the practices and tools intrinsic to TPS have made their way into countless industries. Lean still can be a target for criticism, though, and one need look no further for proof than an article published earlier this year in the New England Journal of Medicine – and the debate it ignited.

The January issue of NEJM featured an article called “Medical Taylorism” where authors and physicians Pamela Hartzband and Jerome Groopman assert that lean principles “cannot be applied to many vital aspects of medicine. If patients were cars, we would all be used cars of different years and models …” This tipped off a flurry of rebuttals, including one from Lean Enterprise Institute CEO John Shook boldly titled “Malpractice in the New England Journal of Medicine.” In his piece, which itself attracted widespread attention, Shook writes that the foundational lean principles of continuous improvement and respect for people are critically important in the health-care system.

Shook is right, but I’d like to approach this discussion from a different angle, namely that this line of criticism has emerged elsewhere – and it’s rooted in a lack of understanding of lean deployment.

One of my initial research areas sought to understand how standardization and “smart application” of Six Sigma principles can aid R&D and innovation efforts. I pursued this as a number of business press publications and industry practitioner blogs lamented the damage Six Sigma does to creativity and praised the need for variation for innovation. Several years of research with my colleagues in Fortune 500 companies made us realize such sentiments don’t hold much water. We found, in fact, that principles of Six Sigma – when applied to the innovation process correctly (hence the “smart” in “smart application’) – can help reduce unnecessary variation and stop worthless innovation activities that consume R&D funding.

Credit: bostonmagazine.com
Credit: bostonmagazine.com

I’ve more recently collaborated with researchers and physicians to tackle similar questions in health care. Once again, the findings – published in several academic and practitioner outlets – are very similar: The smart application of lean and continuous improvement principles can help develop a safe and patient-centered health-care system.

In arguing that patients aren’t cars, the NEJM’s authors are absolutely right – but they’re dead-wrong in concluding there’s no place for lean in “many vital aspects of medicine.” As with our R&D research, we’ve found that lean deployment in hospital settings minimizes unnecessary variation that comes from care providers, not patients. In fact, it frees up time and effort to cater to the necessary variability in a population diverse in its illnesses, economic backgrounds, languages and more.

As an example, I spent years with other researchers – including some physicians – looking at Ohio State University’s Wexner Medical Center, specifically a lean deployment effort in its kidney transplant discharge process. Medical research has found that transplant recipients after discharge must drink at least three liters of fluid a day – failure to do so can spike creatine levels, elevating blood pressure and increasing the likelihood of readmission. In our study, we found variations in how nurses delivered these instructions to patients: One nurse, for example, recommended drinking “a lot of fluids” while another suggested 100 ounces. Interestingly, nurses varied their wording across patients, while one patient would receive different instructions from more than one nurse. This wasn’t a matter of intentional deception, but the inconsistencies confused patients as they took in a tremendous overload of instructions.

Overhauled through the lean deployment via standard work design, nurses in our medical center now clearly explain the specific volume of fluid, use a jug to visually illustrate, and discuss the consequences of not following the instructions. Preliminary findings show this approach soothes patients’ anxiety levels and has reduced the chances of readmissions in the first month after transplant.

This isn’t just a lean approach to a problem – it’s a smart lean approach. And in an environment that, yes, isn’t cars on an assembly line, that matters more than ever.

Fisher, Cardinal Health collaboration driving results

A new healthcare-efficiency collaboration between The Ohio State University Fisher College of Business and Cardinal Health Inc. is driving results for participating hospitals just months into its launch.

The Academy for Excellence in Healthcare recently released two “white paper” reports from hospital systems that have participated in the program, which started early this year and offers a “boot camp” of sorts for cross-functional teams at hospitals nationwide seeking to implement operational excellence principles. The reports show major improvements under way for Zanesville, Ohio-based Genesis Healthcare System and the Harvard University-affiliated Beth Israel Deaconess Medical Center as a result of the program, now heading into its fourth cohort.

healthcare academy
The Academy for Excellence in Healthcare is gearing up for its fourth cohort of students.

Building off of Fisher’s reputation as a key thought leader in operational excellence and COE member Cardinal Health’s remarkable track record as a lean organization, the Academy helps organizations identify and solve their greatest operating challenges, ultimately driving results that can significantly reduce costs and improve patient outcomes.

It’s a major challenge for an industry undergoing historic change, but one many hospitals already have committed to tackling through the Academy. Here’s a look at the two projects highlighted recently:

A new patient model

A cross-functional team from Beth Israel attended the Academy in the spring in an attempt to solve a problem that plagues many hospitals: Disconnected round schedules between doctors and nurses that resulted in redundant work and, worst of all, repetitive and even conflicting information for patients and their families.

When the team at Beth Israel committed to driving a more patient-centered model for physician and nurse rounds, they found doctors and nurses in a 24-bed general medicine unit were together in a patient room less than 1 percent of the time, while the in-room whiteboards – a crucial element of visual management for the hospital and patient families – seldom were updated.

Working with faculty at Fisher and leaders from Cardinal Health, the Beth Israel team devised what they called a Team-Patient Model that emphasized a standardized rounding routine that brought physicians and nurses together more and resulted in regular whiteboard updates. Coaches in the Academy wisely helped the team tackle a small piece of the problem and then scale it, applying the new model first to one patient and then spreading it to all of a single resident’s patients.

By the late summer, following Beth Israel’s experience in the one-week Academy program, the model was rolled out to all patients in the GM unit, with time spent on rounds dropping by 15 percent but physician/nurse “face time” with patients increasing a remarkable 55 percent.

Download the white paper here.

A pharmacy inventory conundrum

In contrast to Beth Israel’s patient-care challenge, it was a behind-the-scenes one that brought a team from Zanesville-based Genesis Healthcare System to the Academy. The two-hospital system found itself readying to merge into a single, renovated facility with a conundrum on its hands: How can the two separate pharmacies be combined into one and become more efficient in the process?

At the outset, the data didn’t speak to an optimized inventory management process: The Genesis team calculated that inventory levels had increased while patient volume itself had gone down. This created an on-hand inventory level of more than 3,000 drugs worth about $1.6 million, heading out to the two hospitals and other ancillary facilities.

Coaches and faculty from Fisher and Cardinal through the Academy once again helped the team tackle the problem by drilling down and seeking efficiencies that later could be scaled. The team found, notably, that only about two-dozen of those 3,000 drugs accounted for about half of its inventory, creating a perfect, small target for optimization.

Working with tools sharpened at the Academy, the Genesis team value-stream mapped the pharmacy inventory flow process and devised a “kanban” system for each of the drugs, specifying minimum and maximum inventory levels that better tied ordering methods to current – rather than past – activity.

The Genesis team, according to the report, is aggressively rolling out the kanban system to other drugs and by the fall had realized nearly $350,000 in savings for that $1.6 million inventory haul.

Download the white paper here.

Learn more

Interested in bringing your team to the Academy or know of someone who is? Head to go.osu.edu/aeh for more details on the program and application information.

Op-ex principles drive design, processes at new Wexner Med Center emergency department

A Columbus Dispatch story this week on The Ohio State University Wexner Medical Center’s new emergency department set to open this weekend includes a few discouraging statistics on the operation’s current state.

wexner medical centerWait times for patients eventually admitted, according to the article, exceed 6 hours, the third-longest rate among Ohio hospitals. And about 4 percent of patients leave before they’re treated, double the national average.

The steps Wexner Medical Center is implementing to combat these problems, however, are extremely encouraging.

Here are just some of the new features of the new emergency department, the first part of its new $700 million hospital tower to open:

  • An increase in beds;
  • Mobile computers that allow registrars to go to ailing patients;
  • Relaxing décor touches instead of stark white light;
  • A physician available on visitor-heavy weekdays ready to treat quick and easy problems, such as wounds needing stitches;
  • And a 16-bed unit focused exclusively on cancer patients, which Wexner Med Center claims is the first of its kind in the nation.

It’s a sharp focus on process and a drive to improve the patient experience that underlie all of these changes. These also show that Wexner Medical Center’s commitment to operational excellence is alive and well.

Read more at the Columbus Dispatch.

Wexner Medical Center ranked among best by ‘U.S. News’

Congratulations to Center for Operational Excellence member Wexner Medical Center for ranking among the nation’s best hospitals and cracking the top five in Ohio in the latest ranking from U.S. News and World Report!

wexner medical center
Wexner Medical Center’s main campus. Pictured center: Rhodes Hall.

Among Ohio’s 225 hospitals, U.S. News ranked The Ohio State University’s medical center fourth, the highest ranking among Columbus-area hospitals and just behind Cincinnati’s Bethesda North Hospital (no. 3), University Hospitals Case Medical Center of Cleveland (no. 2), and the no. 1-ranked Cleveland Clinic. Wexner Medical Center was one of only 11 nationally ranked hospitals in the state.

The nearly 1,000-bed Wexner Medical Center received its highest specialty ranking at no. 15 nationally for Ear, Nose and Throat. Four other specialties made the national rankings: Cancer, Cardiology and Heart Surgery, Nephrology and Urology. A scant 3 percent of hospitals nationwide had even one of 16 specialties rank nationally.

Patient satisfaction rankings for Wexner Medical Center exceeded the national average this year, with 80 percent of patients giving the hospital the highest or very high rankings, compared with 70 percent across the U.S. Patient experience is an increasingly important component of government reimbursements and incentives , which were tied largely to clinical outcomes in the past.

The annual U.S. News rankings are calculated using a combination of hard data on patient safety, mortality rates and other factors in addition to a reputational survey of physicians. Visit the U.S. News site to learn more about the national or Ohio rankings.

Leadership development, innovation lead roster of April summit’s breakout sessions

With less than four weeks to go before we kick off our second-annual Leading Through Excellence summit, we’ve unveiled the full list of breakout sessions you’ll have the chance to experience throughout the day on Thursday, April 10, and Friday, April 11, in Columbus, Ohio.

The full list is available at our website, but here’s a quick look at some of the sessions available:

leading through excellence logoBehind the scenes at GE Aviation – It’s tough for many organizations to keep a fresh pipeline of leaders with the right problem-solving skills and cross-functional capabilities. Rick Guba, a Master Black Belt at GE Aviation, will offer an inside look at the company’s successful accelerated development process, which links skills and hands-on experience for a best-in-class learning model.

Kaizen 101 – Looking for a crash course in hosting a kaizen event week? Whitney Mantonya, owner of Collaborative Lean Solutions, will walk attendees through the purpose, flow, and structure of one, offering up a primer on basic tools and concepts applicable to all such events.

Leading from the middle – True lean success needs support from the top, but few organizations start out with this luxury. Ted Stiles, a partner with lean executive recruiting firm Stiles Associates, examines how creative mid-level leaders can navigate this landscape and the skills they must employ along the way to boost leadership engagement and influence without authority.

‘Buying’ a lean culture – Harvard University’s Beth Israel Deaconess Medical Center was showered with 90,000 employment applications annually, but they needed a new, efficient way to determine which potential hires would thrive in a lean environment and be an integral part to its ongoing success. Alice Lee, vice president of business transformation at Beth Israel, will share the pre-employment assessment tool that was developed and implemented.

Innovation and the element of surprise – Award-winning Fisher professor and researcher Aravind Chandrasekaran will share his research with more than 30 high-tech organizations into the “disruptive innovation” that has dealt a blow to some companies (Polaroid) and, with the right strategy, allowed others (IBM) to thrive.

Paper or plastic? – Through an interactive game that challenges preconceived notions about the environmental sustainability of products in our everyday lives, Fisher Asisstant Prof. Gökçe Esenduran will introduce the concept of the life-cycle assessment (LCA), a powerful tool to evaluate a product from the cradle to the grave.

And there are a dozen more where that came from. Register now before pricing increases April 1!

Study: Top-ranked hospitals not immune to bottom-line pressure

The health-care institutions perched atop U.S. News and World Report’s annual best hospitals ranking are known as the leaders in their field, the place to be for their specialties, well-staffed and highly regarded.

New research from a Fisher College of Business professor found those accolades don’t, however, mean operating margins aren’t often razor-thin – or in the red.

W.C. Benton
W.C. Benton

Featured in the December 2013 edition of the Decision Sciences journal is a nearly decade-long glimpse at top hospitals’ profitability from W.C. Benton Jr., Edwin D. Dodd Professor Management Sciences at Fisher. The study, “A Profitability Evaluation of America’s Best Hospitals, 2000-2008,” is a follow-up to similar analysis conducted in 2000 and 2007.

It’s an attempt to answer a question Benton says nagged him for years:

“If they’re the best, are they sustainable? Are they liquid?” he asked. “You can be of the best quality in the world, but if the lights aren’t on, you won’t survive.”

The numbers

The hospitals Benton analyzed in the latest research are the scant 3 percent of the nation’s 5,000-plus that make it on the U.S. News ranking, thanks to favorable scores on patient survival rates, structural resources, staffing levels, and reputation. In the second part of the research, Benton also conducted a more detailed analysis of the “honor roll” hospitals on the list, those that find at least six of their specialties ranked near the top of 16 sub-rankings.

While two in three hospitals are designated nonprofits, Benton’s research uses the metric to gauge how much revenue remains each year to reinvest into the organization.

The results paint an intriguing picture of how the financial state of the nation’s best hospitals changed throughout the last decade. Average net income among these hospitals rose from about $10 million in 2000 to more than $58 million in 2008, while net income per bed spiked to $115,000 from about $18,000.

Profit margins tell a different story. In 2008, they ranged from a high of 71 percent to a deficit of 19 percent among 123 hospitals, but the average fell closer to break-even at 4 percent, up slightly from 1 percent in 2000. That means even though average profit at these hospitals rose at a frenzied pace in those years, it remained only a tiny slice of the revenue received, indicating overhead and fixed costs in the form of technology, advertising, and brick-and-mortar investments were moving nearly as quickly.

Indeed, across all hospitals nationwide, the number of beds in those eight years shrank to 951,000 from 984,000, but expenses ballooned to nearly $700 billion, up from $400 billion in 2000, according to Census Bureau data. The total number of hospitals, meanwhile, was virtually unchanged.

Juggling these heavy investments amid an increasingly complex financial ecosystem of public and private dollars means that in order to keep the lights on, Benton said, “hospitals are getting smarter.”

“In some cases, they’re even trying to ‘game the system,’” he said. “But some won’t survive.”

Making do

How these best-in-class hospitals are surviving was the focus of Benton’s deep dive into the “honor roll” pack of institutions in the second part of his research. What emerged was no clear-cut formula for financial success.

One honor roll hospital tightened bed capacity, improved occupancy and took on a more complex caseload, only to see its profit margins take a hit over the nine-year period. Another increased bed capacity and reduced caseload diversity, flipping from a shortfall to a surplus.

“These (honor roll) hospitals are trying to adjust to a new environment,” Benton said. “They’re trying to size themselves the right way.”

With no silver bullet to slay the challenge of operating in this rapidly changing, Affordable Care Act era, the notion of segmentation will become even more critical, according to the research. In short, hospitals can’t continue to be all things to all patients, pumping resources into pricey or, worse, redundant technology. New changes to reimbursements through the health-care law might lead to more cooperation among hospitals, but Benton said survival ultimately will be a question of leadership.

“Hospitals are going to have to decide what their core competencies are and try to provide the best care per dollar spent,” he said. “They should keep an eye on the external environment, but in the end, what decides whether you’re going to be successful is you.”

This article appears in the March 2014 edition of COE’s Current State e-newsletter. Have a colleague who should be receiving this e-newsletter? Contact Matt at burns.701@osu.edu.

Management Sciences prof wins ‘Outstanding Early Career Scholar’ award

Featured on the homepage of Fisher College of Business this week is Aravind Chandrasekaran, assistant professor of management sciences, who recently took home a first-ever honor at the Decision Sciences Institute’s annual meeting.

Chandrasekaran

Chandrasekaran was honored with the inaugural Carol J. Latta Memorial DSI Emerging Leadership Award for Outstanding Early Career Scholar, which will be given each year to a scholar who received his or her last degree within the last five yeras and shows excellence in published research, teaching, and service.

We’ve written about Prof. Chandrasekaran’s research twice: Once in 2012 on research he co-authored about the link between the quality of hospital care and patient satisfaction, and earlier this year, when that same research won the annual Best Paper Prize from the Institute for Operations Research and the Management Sciences.

You can read more about Chandrasekaran’s latest honor in Fisher News.

Health care: Too much on the plate?

Earlier this month, Shingo Prize-winning author and Master of Business Operational Excellence instructor Beau Keyte wrote a fascinating article on the Huffington Post titled “The Silent Killer of Health Care Transformation: Being Overburdened by Too Many Choices.” This addresses a key concept in lean called “muri,” or overburdening.

Keyte defines overburden a phenomenon where equipment or people are pushed to run at a harder pace and with more effort than is appropriate.  Using the analogy of going to a Brazilian steakhouse faced with multiple choices, with an eager waiter waiting for a signal from you to bring more varieties of meat, Keyte makes the point of how health-care organizations are laden with a vast range of priorities. As a customer at the steakhouse you can choose what you want to have on your plate but leaders in health-care organizations do not have the choice. Multiple stakeholders, internal and external bombard the leadership with ideas that are important to them with a very restricted timeline. The executives take on the burden of execution of these great ideas to the employees in the organization that are already overburdened with a previous task list.

Similar to the customer in the steakhouse who leaves half-eaten good food on the plate to try the new kind of meat, the employees leave projects halfway to bite on the new initiatives. Due to lack of time and resources, the new initiatives do not get the kind of attention they need and this nips the possibility of transformation in the bud. How do you address this problem? Keyte emphasizes that it is the leaders in the organization who can LEAD the organization on a path that reduces the burden – but how?

The first thing is to focus on the real stakeholder, the patient. Think about how the initiatives suggested by the other stakeholders impact the patient. Would the initiative result in the right outcome for the right patient at the right time? Do the initiatives align with the strategic goals? Do you have the human resources to work on these initiatives? Do you need to do all the initiatives? What are the few things that you NEED to get done to meet the three to five most critical goals this year? Could you drop or delay some? By answering these questions, leaders can dedicate the available resources to only the critical projects. This way, employees can spend their time wisely while providing patient-centered care.

The second thing the leaders can do is to think long term instead of saying yes to all the projects and trying to instantly gratify the stakeholders.  However, it is important to think forward and pick three to five strategic initiatives to work on in future and plan on carving out capacity to take these on.

Keyte puts it well in the last paragraph: “Like all silent killers, overburden sneaks up on you and your organization. Learn to sense it, see it, analyze it, and deal with it to help your organization not only survive, but thrive.”

The waiting game: Dispatches from urgent care

After spending years as a practicing physician and later working with others to improve processes in health-care delivery, it’s still refreshing to spend some time on the other side of the exam table.

urgent careI recently lacerated my toe when a blender jar fell from the counter top and, bleeding profusely, went with my partner to a nearby urgent care, my toe tightly wrapped in a bandage. We entered a large waiting room with 20 chairs and only one other patient only to spend 10 minutes waiting for a medical technician to enter my information into a computer. This is after I spent five minutes completing the form on paper. This made me very, very pessimistic about how long I might have to wait to see a physician. The television playing a History Channel documentary showing bridges falling and the destruction of surrounding areas didn’t help.

The registration process triggered my lean thinking: Many hospitals are spending a lot of money installing kiosks for self-registering patients. The idea is great but the cost ultimately isn’t justified. Filling out the forms, I thought of how efficient it would be if the registrar had turned her own computer screen to me and asked me to enter the information directly on the computer. With a quick confirmation of some key information, that would save 10 minutes. Small change, big benefit.

Patient intake is only one challenge, though. Patient variation is an entirely different issue.

While in the waiting room, I saw a female patient in her late 60s arrive with her daughter. At least another 15 minutes passed as the new arrivals scrambled to find an insurance card and driver’s license and another patient in the waiting room was called back. Eventually, we were called back to sit in an exam room, where my mind was still lingering, thinking about the fate of the older patient and her daughter.

What transpired in the waiting room over a half-hour is nothing but patient variation: I was signed in within 15 minutes, while another lady waited for more than 30. So how do you apply lean/six sigma to the business of health care with so much variation? The answer: With empathy! Some experts in the field tend to downplay the very existence of patient variation, which only evokes defensiveness from health-care professionals who treat patients day in and day out. Ultimately, it’s important to examine data on the number of times events deviate from the normal and develop an improvement plan that incorporates that variation.

On our way to the exam room, my partner asked if I’ll need an X-ray. The answer: “I can take your X-ray if you want.” I was shocked. When I practiced medicine, patients weren’t entertained this way. I’d always have a reason for any labs or X-rays. In turn, I responded that I didn’t want an x-ray unless there was a reason for one. She shrugged her shoulders and said: “If you don’t want the X-ray, we won’t do it. It’s up to you.”

Once in the exam room, my vitals were taken and I asked to unwrap my bandage but was told “Not yet.” It’s essential to take vitals, but I was getting desperate for the provider to open my bandage, examine the wound and treat me.

We waited some more. I flipped through a WebMD magazine labeled “complementary waiting room copy.” This made me realize how much we’ve built waiting into providing care.

A half-hour later, my toe was finally examined but I waited another five minutes for the doctor, who went directly to the wound and got down to the suturing business. He explained what he was going to do, but didn’t say whether I should continue to sit or lie down. Four painful stitches later, he took off his gloves and left the room with the instruction to take painkillers on and off and change the bandage every day. But I realized that he hadn’t put any bandage on my toe. After waiting for about 10 minutes, my partner went out to get someone to bandage my toe. Five minutes later, someone arrived, put on a fresh pair of gloves and dressed my wound.

The doctor came after 15 minutes and handed me a two-page document, asking me to come back in a week to 10 days to get the stitches removed.

There are a multitude of problems here. The doctor didn’t put a bandage on my wound, but he had gloves on and it only would have taken a few more minutes. He preferred to leave me without a bandage and type out a two-page document, which, frankly, I still haven’t read. A physician’s assistant in scrubs had to waste a pair of gloves to do the dressing. Here, we’re providing more assistants and nurses so doctors can focus on clinical work – but a patient really doesn’t really care how or how much a physician writes notes. A hospital doesn’t benefit from wasting supplies, and a doctor isn’t doing clinical work when he or she is documenting.

The solution here is to help physicians by slashing the amount of documentation and keeping only value-added information. When I practiced, I used to take the vitals and history. I sutured and dressed the wound myself. There were almost no handoffs. I also documented with the patient sitting with me in my clinic. I could finish a regular visit in fewer than 15 minutes.

We’re asking providers to document a bit too much. And even though we are providing them additional resources to “save” them time, that savings isn’t benefitting who it truly should: Patients. This is never more apparent than when you’re the one on the exam table.