Suggested visualization for the SÖS Children Emergency

Posted by Marcus Hammarberg on February 22, 2013
I have small children (5, 3 and 3 years old). During the winter half of the year that means that they are sick. A lot. No really: like you wouldn't believe. Ok... like this: last year we had a cold outbreak in october and the next time all three of them was well again was in august.
This means that I have from time to time spent some time at the hospital. No - you cannot go during the day since the kids mostly becomes much worse when they have lied down for a couple of hours. Like after sleeping for about 3 hours for example.
The people working at SÖS children emergency room is amazing! I very rarely met people that isn't cooperative and want to do their best, even 0430 in the night. Thanks a bunch for taking care of me and my kids when we have been in dire straits.

However ... I miss some visualizations on my waiting progress. Last time I was there I started to think and I came up with something really, really simple that could help me as a patient a lot. Who knows - the nurses and doctors might find it useful too.

In this blog post I wanted to share my thoughts, from a pure client perspective. I known nothing about the inner workings and process at the ER, other than having been there about 15 times the last 2 years.

What are we solving here?

In true kanban fashion, the visualization doesn't impose any change at all. It's just visualize the current workflow. For me as a patient this would provide invaluable information since that's about the only thing I think about when in the ER: when is it my turn? How many are before me?

These are the problems I want to focus on... for now. If I get excited I might suggest some ways to improve on this in a later post, but that's really getting ahead of myself as well as thinking that I really know how to improve. I leave that for later.

The focus is instead: visualizing the flow of the patient during the whole time he or she is in the ER, in order to provide information for the patients so that they know where they are in the process.

The current process

This is my description of what happens to me as a patient from when I enter the ER to I leave it:
  1. I walk through the front doors and take a queuing ticket to the registration booth
  2. I'm instructed (by a sign) to be seated in the waiting room
  3. When it's my turn (a electronic sign and sound tells me) I go to the registration booth. 
  4. Here i meet a nurse that take some basic controls (pulse, saturation and temperature). I also talk about the condition and tells her WHY I'm here. This is information is written down and put into a plastic folder. 
  5. I'm then instructed to wait to be examined. 
  6. We then wait in the waiting room. 
  7. After a while we get called and get to meet a doctor, that examines the kids more thoroughly and decide on some treatments. I suspect that you can often be sent home from here with a recipe, but let's stay on it for a little while more.
  8. A treatment is decided and we are sent to the waiting room or, if it's not that busy we can wait in the examining room.
  9. After a while a nurse comes and do the treament or take some samples.
  10. We then wait for the treament to take effect  or the samples to be analyzed
  11. We then get to meet the doctor again. This is basically point 7 and sometimes points 7-10 is repeated. 
  12. Finally it's decided on if we can go home or need to stay over and have more check-ups in the morning. 
  13. We leave the ER
Again: there are truly amazing people working there! I make no claim to know any better on how to do this. The process I described is just what usually happens, based on my experience with 10-18 visits during the last years. This is how I perceive what's going on, from the perspective of the customer (or patient if you want). It might be wrong. 

Visualization of the process

This is a first step. My goal here is to change nothing - but simply visualize what's going on, to get more transparency for the patient.

I thought about this for a while and a real simple thing would be that each patient just as now pull a number as you enter the door. The system for that is already in place so there's no real change for patients. 

When you are called to the registration booth the nurse do the same thing as before (registration, simple examination and check-up) but also create a post-it with the number on my ticket. This ticket is then posted on a simple board that looks like the following:

Some comments on the board:
  • This should be visible for all patients in the waiting room. The glass wall into the nurses room is an excellent place.
  • The column-names, number of columns and how you move stuff around is merely my suggestions: change as you see fit. I would love to help you (marcusoftnet at gmail).
  • Not that the order of handling should be the order the stickies are sitting in columns. The top one is the next up and the last one in the column is last. 
  • You're of course allowed to reorder as need see fit. Nothing changes there. This is merely showing what is going on. 
  • In some cases the stickies will travel "backwards". For example when a patient have been treated another examination might be in order, to see how the treatment went. This is perfectly ok, just move the stickie into the right column and right priority order. We see an example of this on my example board, in the examination column patient 24 is back waiting to be examined. 
  • In the same manner the patient can be sent home if they get well (or sent to a another department of the hospital). Just move the sticky to the "Left ER"-column and we're done. 
  • You don't need to show anything about the patient except the number on the board. There's nothing revealed about the condition or who he or she is.  

Conclusion and ideas

For me as a patient (or parent to one of your patients) this would add massives amount of value: I would see what's happening and that something is actually moving at all. I suspect that no-one would object being side-stepped for another, more urgent case. As long as you show it. Right now that's just more waiting and I knew nothing about what happend. 

Here are some extension and augmentations that you could do, still without changing anything about how you work, the order in which you do stuff etc. :
  • Make the board fun. Have someone do drawings instead of the boring names I came up with  for example. Have the kids pick out an animal that you move around rather than the number. There's much that can make this more fun for kids.
  • Start measuring time (you're doing that already - I've seen you excellent "average waiting time stats"). Example of very simple measurements:
    • Number of patients treated today = number of stickies in the "Left ER"-column each day
    • Average time in ER = write the time you put the sticky on the board on the sticky. Note the time that you put the sticky in the "Left ER" column. You can now calculate the total time. With the help of Excel or a spreadsheet you could do the average waiting time. 
  • Add an emergency lane on top of the board. This is things that is prioritized above everything else and shows that other patients will have to wait for now. 
I would love to help you set this up and get it going. You have been so great to me and my kids in time of need, so I'm more than willing to put in a day or two to help you. Please, please contact me on marcusoftnet at gmail or on twitter @marcusoftnet.

We're not changing anything - we're just showing what's going on. I'll write you another blog post that show how this can be the foundation for improvements and make you even greater!



Published by Marcus Hammarberg on Last updated