Athenian heroes do not win quests without a feat of cunning. In the myth of Theseus against the Minotaur, the hero's greatest challenge is to navigate the Labyrinth. If Theseus can only find his way through the maze, then monster slaying is what epic heroes do best, and we know he'll win the day. As he set out into the Labyrinth, Theseus carries not only his sword, but also the unlikely, a fist full of string; something sharp and something shrewd. The complexity of the healthcare system is aptly compared to a Labyrinth. Today, Dr. Pratik Doshi presented the first lecture in our series on Quality Improvement by introducing us to Process Maps as a method to define the problems we aim to improve. Dr. Doshi presented two methods to design process maps at our Quality Improvement lecture focused on the Define component of the DMAIC process. The first is a sequential map. It outlines key tasks, interactions, and decision points as identified by walking the process.
Plutarch, the Roman author, maps the process for conquering Theseus’ quest as a sequence of events:
- Sail to the city of a mad king who demands human tribute from your people
- Avoid being frisked; smuggle your sword into enemy territory
- Upon arrival, win the love of the king's daughter
- Feign martyrdom and assume the place of your countryman in the sacrificial ritual
- Gain inside knowledge of the maze from its architect, passed by the king’s daughter
- Receive a ball of string from your lover and lay it along your path as you enter the maze
- Surprise the fell beast and gain the upper hand in battle
- Follow the string back; flee island
Theseus lacked the omnipotent position of narrator. He was a hero with a task in front of him—forcefully correct King Minos’ cruel judgment that Athens owed him fourteen of its brave and fair citizens. He would have seen the benefit of the second method Dr. Doshi presented, a goal-oriented process map: Hierarchal Task Analysis. This is the method for Theseus, a man who makes a name for himself by stabbing epic beasts in the throat.
For Theseus, approaching his situation as a sequence of events would be less useful than considering his two requisite tasks: slay the Minotaur, return home. As an epic hero, he already had some sense of how to approach killing monsters, but what of this issue regarding a Labyrinth? Hierarchal Task Analysis could direct Theseus to further consider this problem, rather than charge headlong, and lose himself in a maze.
Outside pundits marvel that health care has been slow to adopt business process improvement. Stepping inside our maze, we gain the view that the healthcare system may not always be best defined as a sequence of events. Dr. Doshi provides us with two means to accomplish a heroic quest. Whichever of these two methods we utilize, Process Mapping is our string, laid down as a guide for clear analysis of our system for providing medical care. Able to navigate our Labyrinth, we can seek its challenges.
Your commments about the complexity of healthcare underscore the importance of the "Define" phase of the DMAIC process: if you do a poor job of defining your problem in a complicated system, you will have a VERY hard time making an impact on outcomes. One thing that Process Maps are particularly good for is narrowing the scope of a project to something that is concrete and manageable. Dr. Tsai's project is a good example: "decreasing pediatric mortality" is a huge, nebulous, daunting problem; "decreasing the time it takes to get blood products to the OR" is concrete and focused, and can be addressed by a QI project. As future physicians who will be attempting to reform the American healthcare system, we must remember that much of this reform will come from projects that might at first seem to be rather small in scope... but which, both individually and together, can have huge impacts on the quality and efficiency of healthcare delivery.
ReplyDeleteTsai's blood products situation reminds me of a laid back (Arkansas?) fire station that keeps only 1 of its 7 fire trucks fueled at any given time.
ReplyDelete"Only in America." Wait, only in America's healthcare system.
@Brimmage: Just as an engineer observes a blue print to identify the linchpin of a mechanical design. Perhaps very small, but very important.
ReplyDelete@First Aid:Once Dr. Tsai looked into the problem it became more akin to a fire station keeping trucks with diesel and gas engines and having no immediate instruction on how to distinguish the two. Sloth has always been a deadly sin. We can add needless complexity.
I wouldn't insult Arkansas by comparing them to our shortcomings. One of the best examples of an expertly managed supply chain was born and bred in Arkansas: Wal-Mart.