JMos as leaders of Change

Dr Manoj Patel
MBCHB, MBA (Harvard Business School) Management Associate Elsevier

Why do some locums get paid top dollar to sleep on a quiet night rotation? Why does every ward have a different set up? Why do I need seemingly hundreds of passwords to access computer systems? Hospitals are peculiar beasts where many things dont make sense to the mind of an JMO.
One such question troubled me during my 1st year as a House Officer. The various departments in the hospital I was working seemed to have no channels of communication between each other. I completed a General Medicine rotation where my teams patient list would magically appear at a printer every morning it was great. My next rotation was General Surgery where I had to arrive 15 minutes every morning to create a list by taking screen shots off a nursing list, pasting into Word, cropping and then repeating if the list ran over one computer screen. Everyone agreed that this was ludicrous, but predictably nothing was ever done about it.

So, I set out to find why Gen Surg couldnt simply copy the Gen Med process.
Mistake #1: assuming that this would be a simple process!

I had moved onto my next rotation by the time this ordeal came to its bitter end. Understandably, I was left bemused and disheartened by this attempt to improve the system.

December 2011

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11. The new patient lists eventually appeared on the wards, but no one used them because of their poor layout. 12. All surgical RMOs continued to use the original copy, past, crop method!

F ind the IT department responsible for developing the Gen Med patient lists. Incidentally, this department was not based in the main hospital. Learn that the creation of such a patient list required a work order. This work order required approval from the departmental head. Develop and conduct a survey of what the ideal Gen Surg patient list might look like Arrange a meeting with the department head to present the survey findings and request the aforementioned work order. Co-ordinate a meeting between the IT department and department head. Re-present proposal. Be informed by IT that my proposed patient list was different from the Gen Med patient list and hence would cost a few thousand dollars to implement The department head thought he knew best and said we would simply copy the Gen Med list. Despite this, the consultant surgeons then insisted that their names should appear in full on the list, together with their respective titles (e.g. Associate Professor of Lower GI Surgery). This column alone took up one third of the page, therefore leaving no room for writing notes!

Over a 3-month period this was the sequence of events that unfolded:

I have since reflected on the process and thought about what I could have done better: Managers and IT people work to budgets and numbers. I could have calculated the potential cost saving from an effective list. Six House Officers arriving 15 minutes early every day to create lists, at a per hour cost of $60 = $32,850 per year. Im sure this simple figure would have caught the attention of managers and provided a compelling argument to invest a little money required for the lists. It is shocking to think about the financial cost of such a silly and simple process of creating a patient list. Imagine what could be done with that money. There is a well-entrenched hierarchy in surgical specialties. On reflection, I should have held strong and should not have allowed the surgeons to impose what were impractical and ill-considered views. This is difficult, particularly as they are the gatekeepers to training programs and write our appraisals. The purpose of the list should have been communicated more effectively. Once the list was implemented, I could have performed a follow up survey to elicit feedback on how they could be improved. As I had moved department, I should have offered this opportunity to a colleague. Related to the above point, I should not have given up when I did. Hospitals can be bureaucratic beasts and change takes time and patience.

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JMOs are faced with opportunities for improvement every day. It is easy to accept the status quo, but this is not good for our healthcare system. It requires leadership to take the initiative to improve systems. We are ideally positioned to do this as we work at the coalface and hence experience the pain of inefficiency first-hand.

We should not wait for hospital management to ask us about how improvements can be made. We need to stand up and voice our opinions for change, and help push them through.
In the short term this will be a painful process as hospitals simply dont know how to deal with JMO-lead initiatives. But, with persistence and time, managers will learn about the important role JMOs can play in leading improvements in our healthcare systems. At the end of the day all parties need to work together towards a common goal. It often seems as if managers dont want to work with us. It is up to us as JMOs to take the first step as leaders of change.

December 2011