Chicago Hospital Reorganizes – Poorly

Cross-functional teams are essential in lean, both in planning and in implementing improvement efforts. You need different perspectives to see all the possibilities. And you absolutely have to include the process users on the team.

Apparently the University of Chicago Medical Center doesn’t understand that.

The center is planning to reorganize its emergency room. According to the Chicago Tribune, the American Academy of Emergency Medicine, which represents 5,000 emergency-room doctors and residents, says the planning process is flawed because it does not include the center’s own ER physicians.

"Not including emergency-room physicians and nurses ... would be analogous to changing the way surgery is performed in an operating room without involving any surgeons or changing the way a cardiac catheterization lab works without cardiologists," said Dr. Larry Weiss, president of the American Academy of Emergency Medicine and a professor of emergency medicine at the University of Maryland...

Since the restructuring, the U. of C. said it has been meeting regularly with physicians and staff, including emergency-room personnel.

"Like nearly every hospital in the country, the University of Chicago Medical Center is trying to make the best use of limited emergency-care resources," the medical center said in a statement Tuesday night to the Tribune. "We are searching for effective ways to provide the right level of care for patients with widely varying needs. This process, still under way, involves the active participation of physicians and nurses."

There are also issues regarding the fact that the reorganization is aimed at clearing the ER of patients with non-urgent injuries and illnesses by redirecting them to community hospitals and clinics.

The American College of Emergency Physicians called for a Congressional investigation into the U. of C. initiative and whether it violates federal "patient dumping" laws…

The U. of C. maintains that its Urban Health Initiative and related emergency-room reorganization announced last week is about getting patients the right treatment at the appropriate location in a tough economic climate and that it does not violate the law. That announcement also included moves to terminate 450 employees in a major restructuring…

As a specialized teaching facility, U. of C. costs are much higher than those of other hospitals, its official say, so it makes more sense to refer patients elsewhere when possible.

The academic medical center in Hyde Park has said 40 percent of the 80,000 patients who come to its emergency room each year do not need to be there. These visits cost the hospital tens of millions of dollars a year in time spent by staff and specialists treating cuts, bruises and other less critical conditions that can be handled at community hospitals or health centers.

Beyond what may be a flawed planning process, I see other problems here. First, the Center could be focusing on having two different ways patients flow through the ER (i.e., value streams), one for true emergency cases, one for all others.

Second, I have to be skeptical of the claim that a specialized teaching facility has inherently higher costs than any other hospital. A lean strategy could undoubtedly find ways to bring those costs down.

The associations attacking the U. of C. could bolster their case by presenting examples of hospitals that have used a lean approach to improve planning and reduce costs.