More Than Broken Bones

March 18, 2009



By Michael Tatham Jr, President, The Tatham Group

What’s broken in this story? 

 I was having a great game – 20 points, 4 assists and 11 rebounds.  I was diving for the ball to gain possession but what I didn’t realize is that my opponent was doing the same.  The result?  A head-on-head collision.  I set off for St. Michael’s Hospital’s emergency room reception and register as soon as I arrive.  Thirty minutes pass before I’m called to speak to a triage nurse.  I point out the obvious head injury – the three-inch gash on my brow is bleeding profusely – and explain to her that I’m a mild hemophiliac.

 For those of you not familiar with hemophilia, it is an inherited bleeding disorder in which your blood doesn’t clot normally.  That means bleeding occurs for a longer time and small normal injuries take longer to heal or may be fatal or permanently debilitating if the injury is in the brain or joints. I choose St. Michael’s Hospital as my home base even though it is located further away from me than the hospitals in the University Health Network.  My hematology clinic is located at St. Mike’s, which assures me that they will always have the expertise and medications to take care of my injuries. 

 The triage nurse records my information and directs me to the waiting area where I’m to wait until my name is called.  I’m starting to get nervous.  It’s been another two and a half hours and I haven’t seen a doctor or received any medication – specifically clotting factor to prevent internal hemorrhage in my brain.  As the clock is ticking I get up to speak to the registration desk.  I try to impress upon them the importance of my being seen sooner rather than later.  I’m agitated but they patiently explain to me that they are doing all that they can and can I please take my seat until I’m called.  Thirty more minutes pass before I hear my name called and I’m escorted to a bed in the emergency room.

 Recognizing that the emergency process is just not designed for this particular problem I find the nearest doctor and tell him what medications I need, when (now) and why.  With many other screaming patients the doctor was clearly overwhelmed.  An hour later I start receiving the proper meds and the doctor arrives to assess the gash on my brow.  During the stitching I had a conversation with the young doctor and asked him about the working environment in the emergency clinic.  These are the key observations that stuck out to me but that are definitely not unique to healthcare:

  • Majority of the emergency procedures that are put in place are not followed because they do not work.
  • The various departments that need to be coordinated with the emergency room are disconnected – each working in its own narrow silo.
  • Physicians are spending a lot of time filling out paperwork versus seeing patients.
  • Physicians are following up with patients that did not receive the required testing because of other constraints.
  • Overall the majority of the staff has their own tribal processes for dealing with various situations, which causes more complexity and confusion however gets things done for that particular person for their patient.

 As I waited another 2 hours to get a CATscan I reflect on these facts and decide that I should develop my own tribal process before registering.  I now make sure to take DDAVP on my own and contact my appointed hematology nurse, my get things done hero, before entering Emergency.  She then navigates her way through the hospital using all her special skills to link processes and departments together to give me the care I need.  Wow, what a tiring job that would be!  It would be much easier to let a capable process do the work so you can go home at a reasonable hour and pass on responsibility to the process – right people/department at the right time. 

 It is evident that I was experiencing the effects of very smart, talented people working in bad processes.  Unfortunately the various disconnects between all of the departments and functions negatively impacts the patients and puts a large amount of stress on everyone working in the hospital.