'A hospital in pieces? Not if you want to take advantage of ‘chunking’ – the best approach'

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By Douglas Kruger

I don’t mean to throw a cat among the catheters. But a multi-part hospital, spread out over the countryside?

There’s research on this topic. Indeed, there have been decades of research into how to accomplish ideal set-ups when the problem is a complex set of operations, and the goals are efficacy and agility.

For instance, it turns out that the best approach for hospitals to follow is a principle called ‘chunking’.

Hospitals in the US increasingly use chunking to provide an exponentially faster, and more pleasant, customer experience. Chunking means to organise into thematic ‘bits’ around the needs of the customer. It is, quite literally, the opposite of spreading your services out according to the dictates of geography, or the demands of a blind bureaucracy.

Let’s play out a practical scenario to see how this works. Say, for example, you need a heart bypass.

Under a system that is not unified into thematic chunks, you might have to make as many as nine different stops. You go for your initial consultation in one building. Then walk to another to pay for it. Then you’re admitted to a third building; the ‘admissions’ wing. Then you might be wheeled to the cardiology unit. After the operation, you would be taken to ICU, and then to a recovery ward. After that, you would need to see a specialist to determine how well your operation went. Then you need physio and, ultimately, to process the paperwork; all in separate locations.

All of this may suit the original builders of the hospital – they get to put wings wherever the terrain permits. Or it may suit the admin department, who can now organise their filing according to distinct silos. But it is fatally anti-patient.

By contrast, in a thematically organised hospital, every one of these functions would occur in one place only. The hospital would group, or chunk, everything to do with heart procedures into a single area. The services would then ‘swirl’ around the patient. You walk through the door, lie down on a bed, and remain right there for the entire sequence of events, with specialists all coming to you in turn. You’re healed, you go home.

The results of such an approach are formidable: care levels go way up. Levels of customer input demanded of an already suffering patient, go down. The chances of mistakes across divisions are reduced. Measurably. That’s why smart hospitals do it.

An added advantage is that the specialists all talk to each other, rendering a chunked room an ‘intelligent team’, or a ‘smart cell’, rather than a series of disconnected silos. Everyone is working on you, the prioritised patient, in co-ordination.

If something goes wrong, you are not shunted to another division, to await your turn. The specialist who saw the issue talks directly and immediately to the specialist who can solve the issue, right there and then.

A final but genuinely valuable upside to chunking is the feeling of hosted continuity on the part of the patient. They don’t have to introduce themselves, and tell their story, to each new person in the chain, like a complete stranger approaching the healthcare system anew. Instead, they have been welcomed into the correct place, and everybody there now knows who they are and at what stage of service they may be. This radically humanises a business. Imagine.

We’re doing the opposite. And we’re amplifying the error. It’s bad enough when all those parts have been separated into buildings that are at least, nevertheless, on the same grounds. But spread it out over an island? By the standards of agile chunking, at least, that’s a worst-case scenario.

Not only is it a massive increase in admin (for the patient), but your chances of mistakes go up, and your levels of co-ordinated intelligence… well… disappear. As does the humanity of it all. Specialists who should be talking become strangers to one another.

And can we ask what happens if there is a serious emergency in one building, and a patient needs to be transferred to another through rush-hour traffic? In a ‘chunked’ set-up, the correct specialist would simply walk into the room. In our set-up, the specialist would be several towns away – good luck and God speed.

I fully appreciate that we have space issues. If we build it all in one place, it might displace a tree that pre-dates William the Conqueror, or an important potato or something. But are we genuinely going to prioritise that over human life? I think we are worthy of conservation too.

If space is the most important consideration, sure, you can atomise the services. Scatter them to the winds – why not?

But if efficacy is your goal, that changes everything. Then, a unified venue is your best bet. Don’t spread it out. Group it together. Theme it around the inputs required to alleviate human suffering. Create swirling teams of co-ordinated intelligence. That’s best practice, as perceived from the perspective of excellent patient care, not the perspective of space, and certainly not that of bureaucracy.

Do that, and our healthcare could become world-class.

  • Douglas Kruger is an award-winning professional speaker and author. His books are all available via Amazon and Audible. Meet him at douglaskruger.com.

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