Thursday, September 1, 2011

Tips From A Road Warrior (15): Who Cares About Meals These Days?

I was on board for the first leg of a long intercontinental flight when I noticed that we were already 10 minutes past the departure time. As I was upgraded to business class (one of the very few perks I get for having flown more than 2 million miles on my airline of no-choice), I had noticed that ground personnel had come and gone twice to recount the number of meal trays in the front galley. After another five minutes, the captain came on to announce that there were a couple meals missing which would cause a take-off delay. After another 10 minutes, yet another supervisor came in the cabin to do another recount. By then the passengers were beginning to get restless. Some of the passengers started to suggest leaving and were willing to give up their meals as long as we would leave. I was getting nervous as I needed to make a connection as well. After a total of 40 minutes, someone brought the missing meals and we finally left the gate. 

I had a similar experience a year or so prior, with a different airline, which caused only a five minute delay, because the captain asked who preferred a hamburger, rushed out to the terminal to McDonalds, brought back three "value meals" and we took off without any noticeable delay. 

I have found similar stalemates while working with healthcare imaging and IT professionals, both on the vendor support side and within internal departments. I am sure that many of us have experienced the traditional “finger-pointing” that takes place when a problem appears and the different parties involved focus on the blame instead of working together to solve the problem. 

At one particular site, a new digital system was installed, which produced images with a circlular mask around it that was supposed to be black. Unfortunately, the images displayed on the PACS workstation showed up with a white mask around the images, which obviously is a major distraction for the radiologist who is trying to read the image for a diagnosis. The presence of the bright surrounding decreases the sensitivity of the radiologist for seeing differences in the dark areas, thus posing a patient safety issue. In this case, the imaging vendor was blaming the PACS vendor, and the PACS vendor blamed the modality. It did not help the modality vendor's case that the PACS system had been installed for several years without any similar issues. In this case it took getting both parties together with a consultant to look at the details of the DICOM header information to see that the specified mask information was being ignored by the PACS workstation. 

It is also not uncommon for different departments to disagree about who is responsible for certain, often mundane tasks. The result is that the work falls between the cracks. At a hospital located in the Arizona desert, dust and sand was a chronic problem for the dust filters of the computer fans, which frequently clogged, causing overheating and failure. There was disagreement between the biomed department and the IT department as to who should clean and vacuum these filters on a regular basis. In one extreme case, there was even a disagreement about who is supposed to be cleaning CR cassettes, an activity that is in most cases done weekly or sometimes even daily by the technologists on evening or night shift. 

Many of these situations can be resolved by having a shared sense of responsibility. In the case of the airline the crew should have focused on the primary mission, which is transporting people to where they want to go on-time rather than ensuring that all passengers are fed. In the case of healthcare IT the focus needs to be maintaining systems in support of patient care. A clear definition of roles and policies about who does what is a big help, but in many cases there are gray zones that need to be driven by the mission. I, for one, prefer to deal with institutions that show this commitment; unfortunately one is often strapped into the airline seat, or laying in a hospital bed before you find out whether the people are committed to the mission. 

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