11. Distraction

Front line work environments are full of unnecessary distractions detracting focus from the task at hand.  They come in many forms from a noisy vacuum cleaner disrupting a patient consult, to a poorly designed electronic medical recording system.

Dr Gordon Caldwell has presented much work specifically looking at how distraction increases misdiagnosis – see here: 1,2,3. He discusses how optimising work environments to minimise distractions leads to improved patient outcomes.

Those working on the front line understand the particular complexities of their work environments, and are best placed to conceive solutions to remove unnecessary distraction and improve efficiency.

Toyota, famous for its Toyota Production System, recognised this years ago, introducing a framework which effectively engages front-line workers in improving their work.  The company implements an average of nine ideas per employee per year. This has driven Toyota to the top of the automobile industry.

Solutions need to be driven from the front line, assessed through simulation, and when introduced we need the ability to refine them. We need to be enabled to learn and improve from our mistakes.

Unfortunately healthcare systems throughout the world have top down frameworks which restrict improvements being made. Those making decisions impacting front line conditions are often far removed from the front line. Processes allowing the voices of front line workers to really be heard are lacking

As a result our workplaces are full of inefficiency, replete with unnecessary distractions which are almost impossible to remove.

(That front line staff have had to resort to a petition to remove indistinct chlorhexidine exemplifies the current inability to improve).

Dr Umesh Prabhu consultant paediatrician and medical director at Wigan & Leigh NHS Trust, may have devised a solution to help drive the efficiency afforded at Toyota into healthcare. Within his trust he’s instilled a system where front line staff provide formal assessment of their superiors and managerial staff. Front line workers have found their voice, morale has improved and their workplaces have become increasingly efficient.

We’ve little doubt introducing a system like this would have been extremely difficult. Ultimately, however, patients benefit tremendously.

We look forward hearing more about Dr Prabhu’s journey. He’s perhaps delivered a model to be emulated by healthcare throughout the the world.

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