May 22, 2012

More healthcare experience: a timed visit to urgent care

Sometimes you test the healthcare industry by mishap. On Friday I came home with a trunk full of flowers to plant. I went through the garage into the house to enlist Mike's aid in unloading them, walked back into the garage and found myself falling.

As I looked back at the dangerously placed step, I thought about putting "fluorescent tape" on my shopping list when we bought this house, and thought about how I never  had followed through. I wasn't looking at my feet, however, and I'm still pondering how to render the hazard safe.

I hobbled into the house, took off my sock, and found a big blue goose egg blooming below my ankle. Sprained? I could move all my toes, so I decided it wasn’t broken and I didn’t need a trip to Urgent Care -- which is many times less expensive than Emergency, I’ve learned. I figured the first sunny weekend in May would mean a crowded waiting room, not an attractive prospect. Mike made me an ice bag, and Ace bandage, and got me some naproxen, while I made a bid for sympathy on Facebook. (I was kinda proud of remembering from Girl Scouts how to properly bandage a sprained ankle. I did get that First Aid badge.)

I spent Saturday on the couch with a book, and went to a play we had tickets for, limping. It didn't hurt much, just swollen. By Sunday morning, Facebook comments were in favor of getting my foot checked out. It was even fatter than it had been before -- not a good sign.

St. Joseph Mercy Hospital has an Urgent Care unit not far from us, so Mike drove me there.

Here’s a rundown of their performance:

12:09 I arrive.
Go through doorway marked urgent care.
Stand around near the lone clerk signing a patient in.
Eventually she looks up and tells me I should have stopped in the lobby to sign in.
Mike goes back out to sign me in.
He goes home to start planting.

1:09    I’m called to triage room.
           Problem assessed, course of action determined: X-rays
           I’m sent out to waiting room

1:15    I’m called in to wait in hallway for X-ray.

1:25     Lisa, the X-ray tech, checks with me, gets room ready
            Xrays taken
            Back to waiting room -- all the exam rooms full.

1:40     Called to the exam room by the nurse
            Nurse leaves.
            Nurse comes back for more assessing.
  Doctor comes in, looks at the foot, goes out to look at the X-rays, back in, there’s no obvious fracture, but she wants to immobilize with a splint until I can see the orthopedist.

2:09      Getting ready for splint. It involves wrapping the foot with gauze, adding cotton, molding a quick-cure fiberglass slab to the foot and wrapping with elastic bandage, while I lie on my stomach with my knee bent and foot in the air. My foot shakes because I’m pressing my knee on a reflex nerve. Lisa comes in to hold my foot still. Finally the job is complete, but it feels like I’m wearing a wrinkled sock, and I know that will drive me crazy. Nope, not gonna do it.

Rework: the nurse is not pleased about taking the whole assembly apart to get at the gauze. She starts over. I continue to complain about wrinkles, she leaves and comes back with the doctor. (The doctor implies this means she’ll take responsibility for any future flak.) The first fiberglass mold is not going to work. They have to stand there holding another one through the cure time.

I decide to accept the work this time.  Doctor tells me to follow up with the orthopedist. Lisa comes in to say that she can’t burn my X-rays onto a disk because the computer isn’t working right. I can pick them up in the morning, however.

I get exit papers from the nurse. I get crutches. Nurse gets more frustrated when I fail to catch on to how to use them. She gets wheelchair, loads me on with my crutches, and takes me out to wait by the front door, giving the receptionist the responsibility for me.

 3:09             Call Mike to come get me.

Three hours from in to out.

Monday morning: I call an orthopedic surgeon’s office, finding one at the same facility so the X-rays wouldn’t have to be picked up and taken anywhere. Woman tells me the doctor will read the X-rays and decide what’s next. She’ll call back.

Tuesday morning: Nothing from the orthopedist. I call back. Woman said she called yesterday and left a message -- someone must be wondering why somebody called them about foot fractures. The conclusion is that there is no fracture. I should baby my foot. But what do I do about my splint? The woman and  I decide I should just take it off myself, and not go to get entangled with another medical intervention.

Bought a Futuro ankle stabilizer at CVS. It, combined with a trusty hiking boot, is about as much support as the splint. Good thing too, because I did a poor job of protecting the splint in the shower this morning. 

I’d give the whole healthcare service  I received from St. Joe’s a “B.” Some courteous and caring people, some quick flow in parts of the process.

So what do you think? How could it have been improved?

May 14, 2012

Social media at Teva: how supply chains should handle the unexpected

The typical supply chain is a sluggish system, unable to quickly respond to change. Demand fluctuations cause shortages or gluts because procurement and ERP systems are inflexible. Some kanban and pull-based systems can be better, but even they can be jolted by the unexpected.

When disruptions in the supply chain occur, it takes people to solve the problems. But if they struggle with silos and barriers to collaboration, they can't do much. When social media flattens inter- and intra-organizational structures, the speed of communication lets people improvise solutions just in time.

Tony Martins, Vice President of Supply Chain at TEVA Pharmaceuticals, believes this to be true, and shares his insights in a great video produced by my new friend, Peter Carr, for his online Social Media for Business Performance course at the University of Waterloo.

Tony Martins and Peter Carr on YouTube

Tony Martins says that the significant supply chain connections are people to people, not system to system. We still need ERP and other systems to handle structured processes, the way the system is supposed to behave, all things being equal. But we know that all things aren't equal.

A supply chain runs into what should not have happened. Conditions change. If people can spontaneously gather around the problem, they can improvise quickly to set things back on course. Uncertainty is all around us, as asserted brilliantly in Mike Rother's work on Toyota Kata. No one can plan all the right steps. Sometimes they must be discovered.

Only if people have the means of connecting, and can quickly find  other people who have knowledge and access, those who can tinker with the actual vs. the plan, can they counter the disruption.

Collaboration is most effective if key players already know who's who and who knows what. When supply chain nodes are scattered around the globe, people aren't going to get to know each other at the microwave in the break room. Social media tools need to provide for profiles that index people's knowledge and interests so they can be found in an instant. They also need to have groups and communities where people can just hang out and get to know each other. Skype and video conferences can humanize the supply chain actors.

At Teva, they are beginning to manage supply chains socially. What's happening in your company?

May 10, 2012

The disrupted membership organization model

Like you, I belong to a few membership organizations. Some of you know that most of my career has been spent working inside them as well.

TEDx Singapore: can we now have
a conference that never ends?
Since the 1980s and earlier, most engineering-related professional organizations have lost members at a devastating rate. Those groups are shadows of what they once were. Participation in local chapters and large conferences, and number of people willing to plunk down $100 bucks or more a year, has diminished. What has changed?

You may be surprised to learn that not long ago, companies paid for dues when employees joined professional societies. The first day on the job, your boss might tell you that one of your responsibilities was to go to a local chapter meeting. He (pretty much always "he") would be there. In fact, part of his work time was being spent writing a technical paper that he would present in front of a crowd of peers at an upcoming conference. The company would pay fees and travel costs without complaint. Cincinnati Machine, in the 1950s, had a chapter right there in their company. Try to get dues covered by the company today!

Though it's easy to spend $100 on a short trip to Target, it somehow seems like a lot of money to part with for something of vague value. The current value proposition is invariably "networking, education, and discounts." It's not exciting, aspirational, or unique.

"I don't have time." Employees are burdened with so much work that they hardly ever get off at the end of an eight-hour day. Then they are much more involved with family and home. The Little League game or ballet class is more important to them than it might have been to our dads back in the day.

The engineering workforce in the last 30 years has shrunk too. Take a look at the US Department of Labor's tables some day. The tools that make us so much more productive today mean that fewer people are needed.

Professional organizations have fought with all their might to stave off the losses. Growing has become a faint hope.

But in the age of the internet...

First there were the BBSs (online bulletin boards), chat rooms, and listservs (round-robin emails that would keep you informed about a subject from people who also wanted to know). Then there were forums on Yahoo, Google, and on hundreds of websites. By the time the membership organizations got their own interaction apps on their websites, people had moved on.

For many, LinkedIn is now the default. It's more intuitive -- I think -- to learn than Yahoo or Google groups. With the ability to jump into the cloud to discuss something with the millions of people using LinkedIn, a small forum on an association website is of little interest, if you even know it was there. In defense, those organizations eventually went to LinkedIn and formed groups. Now many have twice as many members of their LinkedIn groups as in their home organizations.

Whoa - marketing opportunity, right? Let's drive those people in LinkedIn to join our organization! Never all that successful an effort. Eventually one must realize that you don't "drive" anyone on the internet. You can invite, attract, or flirt, but the citizen of the cloud decides and determines everything.

The social sphere
Today's membership organization model was created long before 1880, when the ASME was founded. Why would we expect it to fit the way we live now 130 years later? It fits the blossoming of the industrial revolution, not the onslaught of the digital revolution.

Leaders and managers in those organizations are struggling so mightily to preserve an antiquated model that they can't see what business and professional relationships, learning, and discounts have become. Networking has become a web of virtual relationships. Learning has become a discussion group, webinar, or YouTube search results. Discounts are expected to be 100% off -- free.

Individual membership dues isn't a revenue stream with much opportunity for growth anymore, but leaders and managers of professional organizations have difficulty letting go. But having so many fewer members on the books, members are all around them, from the far reaches of the world. While they may not give money, they give the gifts of their attention, coaching/learning, and influencing. The more committed of them may go to the trouble of officially joining and contributing money.

So if the old membership model is trashed, what happens? Do those organizations die? This will take creativity and "fresh eyes." To run an organization, put on live events that still draw paying customers, and give vendors access to an interest group still takes money. In the union of two worlds -- the traditional and the virtual -- something will emerge from leaders who experiment, innovate, and cultivate centers of gravity that have distinct identities and roles.

What do you think it will look like?

Copyright @ 2005-2014 by Karen Wilhelm