Every organisation, including the NHS, has shrinkage.
Note: This article appeared in a public sector publication in October 2014.
Recently, Jeremy Hunt claimed that:
“basic mistakes in hospitals in England cost the NHS up to £2.5bn a year and the NHS could afford to hire more nurses if the errors were cut out”*. He’s right of course. However, he went on to say that:
“More resources should be invested in improving patient care rather than wasted on picking up the pieces when things go wrong”*.
Which is not right?
You need to pick up the pieces when things go wrong. And when things are going wrong a lot, you have many pieces to pick up. You can’t stop wasting money on picking up the pieces until you spend some money figuring out why the pieces needed picking up in the first place.
And has the Government done this? Have they figured out the root causes of poor patient care through a dedicated Lean improvement programme? Have they designed and implemented improvements to eliminate the root causes of poor patient care that is costing loads of money?
What they are doing though, is spending money on a poster campaign warning staff about the financial problems basic errors cause*.
Let’s think about that for a moment. Are we suggesting that nurses are making mistakes because they fail to realise that this costs the taxpayers money? That by somehow letting them know it costs money (with shiny posters!) that will make them less likely to make a mistake?
So the next time a nurse decides to fit a catheter incorrectly, they’ll think twice. All because of our shiny new posters advising them that mistakes cost money.
It’s this kind of management thinking that does precisely nothing. The reason this does nothing is that you haven’t correctly identified the root cause of the issue and therefore you haven’t fixed the problem.
The root cause of poor patient safety is most definitely not ‘because nurses are unaware this costs us money.
The counter-point to this line of thought was offered by Dr Peter Carter from the Royal College of Nursing who said:
“the government needed to invest in more staff before patient care can be improved”.
They argue that mistakes were the result of understaffed wards*. This is also not right.
Dr Peter Carter makes the assumption here that we don’t have enough staff and that this is the cause of the problem. But this line of thinking assumes that the staff we do have are working efficiently and effectively.
In the business world, high performing operational environments will measure something called ‘shrinkage’. This is broadly defined as the percentage of time colleagues spend NOT doing the productive work they are there to complete. In a call centre, this would be all the time spent not taking calls. In a retail shop, this might be all the time spent not serving customers.
Every organisation has shrinkage.
In the case of nurses, this would be any and all activity not spent directly on patient care. It includes discharges, admissions, report writing, one-off projects, chasing authorisations, fetching supplies, chasing doctors and supervisors, care plans, incident logging, appointment making, checking others work, rostering, timesheets… I could keep going.
How much time is lost to these activities? How much more time could be invested indirect patient care if less time was spent on the above?
Then there are all the policies that create waste. For example, when my wife and I were expecting our first child we called up the hospital to book in our 12-week appointment. We were speaking directly to the nurse responsible for booking these appointments. But could we make an appointment?
No. We had to wait until a referral had been received (via the post!) from our GP. The very same GP who we told we were pregnant. The GP who didn’t perform any tests or check to see if we were actually pregnant. They simply accepted our word for it. But the hospital wouldn’t accept our word for it – the policy was to wait until they heard it from the doctor (who heard it from us).
This is waste. In the time the nurse was speaking to us to tell us they couldn’t make an appointment, they could have just made the appointment. Instead, we needed to waste the doctors time writing a referral. The GP surgery staff wasted time sending the letter to the hospital. The hospital wasted time receiving that letter and delivering it to the correct person. The person wasting time processing the letter and making a booking. The hospital then wasting time contacting us to advise the time of the appointment.
There are literally thousands of poor policies like this that drive waste into our hospitals. Waste that is more often than not, absorbed by our wonderful nurses who could better spend the time doing what they do best – caring for all of us.
I love the NHS. I’m proud that we have a service like this available to all of us here in the UK. It frustrates me that despite the huge amount of money we spend on it, it’s not as good as it could be.
Silly hospital policies waste time which means we don’t have enough time to look after patients properly.
Maybe THAT should go on a shiny new poster, Mr Hunt.
*Source – http://www.bbc.co.uk/news/uk-29639383