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Lean Management and Maternity!

9 January 2015

In February this year I found out that I was pregnant. I gave birth to my baby in October, so it’s hard to talk about the challenges that I’ve faced this past year without discussing my pregnancy – it did kind of absorb the whole of 2014! As a lean specialist, it’s been very interesting to experience what is the biggest interaction with the National Health Service that I’ve ever had.

From a technology perspective, the experience was patchy. On the one hand, the technology used to assess me and my baby’s well being was fantastic – the clarity of the scans, how they could measure limb lengths and fluid volumes at the touch of a button, the sensitivity of the blood tests and, in labour itself, the technology which was monitoring my baby’s health was very reassuring.

This level of technology was not replicated within the associated reporting administration however. A yellow maternity note file was issued to me upon my first visit to the hospital – it becomes somewhat of a maternity “passport”, needing to accompany you at every appointment. If, like me, a few early complications means that you follow a “Consultancy led” path (i.e. you need to see a Consultant for extra care as opposed to midwives) then the notes travel with you many times for multiple scans and appointments where each time more (frankly illegible!) writing is added to the pages – new appointment times, hand written inside the front cover – the contents there in, becoming more and more precious.

These files also become the method to alert the next stage of the hospital process of your attendance, the order of the yellow files becomes your place in the queue. At every appointment, the physician quickly flicks through the file to attempt to decipher what has occurred previously in order to progress your care. Given the immense pressure that the service was under, it was no surprise that often, it became my responsibility to provide a quick summary of ‘where we were’ in order to trigger the next step. My lean brain found this quite difficult to deal with. There seemed to be a lot of opportunity for human error as key information lay hidden within a mountain of handwriting. Too much relied on the confidence and capability of me as a human to demand my care.  Employing lean tactics such as visual management could help to make the process more streamlined and effective and less reliant on the patient.

I’ve written about the power of visual management before and it seemed to me that there was a great need for more visual management throughout the process… from where to sit and wait, to how long the queue wait is, to clear markings on my file as to why I was Consultant led and what the major issues were. It would be even better if the visual management solutions could be captured using technology to ensure a seamless, transparent, transferable experience.

Whilst I spotted the potential for lean improvements at many parts of the process, the NHS staff that I encountered were always helpful, knowledgeable and most importantly, really cared. The problems lay within the process itself, and having the time and space to improve the process, not the people working within it. I felt like every medical issue I was experiencing was carefully examined, but yet I did not feel very confident in the process itself. There was definitely a need to redesign the process from a patient’s perspective, not the clinician’s. For example, I felt compelled to ring to check upon receipt of a gravely worded letter from the “Department of Radiology” (not the Antenatal Unit that I was familiar with) for a “Fetal Anomaly” scan, that this was just the routine “20 week scan” that I had been warned of.

Looking back at this experience, I realise that a key problem for me is coming to terms with the beautifully effective process that I can picture in my head, with the reality of how hard this is to actually achieve. When waiting for an appointment, part of me just wanted to stand up, shout “STOP!” and start running a lean workshop, but I was deeply conscious about how that would be received (!) and also, how naïve I was as to the actual pressures and strains that all of the staff were under.

In the end, all we can do is have an idea of what a better reality could look like, and do our best to work towards it. Next year will be a challenge for me. I’m finding that babies do not take well to being “leaned” and they can be frankly, illogical. I’m going to have to deal with this whilst having time off from my career, something that I will find quite difficult. I’m hoping that the break will enable me to reflect on my lean knowledge and really consider the practicalities of making lean improvement happen in reality. I’m going to have to learn that achieving perfection is unlikely and I’ll just have to do what I can, when I can, focusing my attention on what’s most important, my lovely new baby. Giving birth to my baby proved, as exciting as ‘elegantly simple’ processes empowered by technology are, it’s the kindness and diligence of human beings that will always make the critical difference.