Transcript Patient Flow and Bed Management - Ms E Reid

Five Laws of Life,
Medicine
and
Patient Flow
Erica Reid,
NHS Borders,
June 2011
Five Laws of Life, Medicine
and Patient Flow
What are they?
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Occam’s Razor
Sutton’s Law
Hickam’s Dictum
Murphy’s Law
Zanuck’s Corollary
Occam’s Razor
William Occam
14th Century Philosopher
‘Razor’- shave any unnecessary
assumptions from a theory
Effective Patient Flow
Occam’s Razors?
• Identify potential bottlenecks
– EDs/Assessment Units – are processes
unnecessarily complicated?
• Simple Discharge Processes
– What time of day are you discharging the
majority of patients?
– Is it matching the demand for admission?
Willie Sutton
Never carried a loaded gun ‘someone
might get hurt’
Stole from the rich and kept it.
Never robbed banks if women screamed
or babies cried.
Why did he rob banks?
‘Because that’s where
the money is’
Robbed about 100 banks from
the late 1920s to his final arrest
in 1952
Throughout his professional
criminal career he never killed
anyone.
Sutton’s Law
When investigating a patient look in the
place most likely to give the diagnosis
Effective Patient Flow
Sutton’s Law?
• Have you acknowledged active
management of length of stay is a key
priority?
• Are all wards proactively managing patient
flow?
• EDDs, Daily Board Rounds, etc
Hickam’s Dictum
‘Patients can have as many
diseases as they damn
well please’
Effective Patient Flow
Hickam’s Dictum?
• Patients can have many diseases at the
same time, but may also have many and
complex social care needs
• How can you work more effectively with
social work colleagues to reduce delays?
Murphy’s Law
"Anything that can go wrong,
will go wrong"
Origin of Murphy’s law
• Dr. John Stapp, USAF Col. & Flt Surgeon
• 1946-7, High altitude experiments
• Human tolerance of G-forces in rapid
decelerations using test sleds
Murphy’s Law
Stapp’s rocket sled team’s good safety record, explained it
was due to awareness of Murphy’s Law and the need to
circumvent it.
Term was picked up by the aerospace industry.
"Anything that can go wrong, will
go wrong"
Effective Patient Flow
Murphy’s Law?
• Mondays and Tuesdays?
• To board or not to board?
• Moving patients to the ‘wrong’ bed to avoid
breaches
Zanuck’s Corollary
If two men on the same job agree all
the time, one of them is useless. If
they disagree all the time, both are
useless
Darryl Zanuck quoted Oct 1949
Movie Producer & owner of Fox Studios
Movies inc. 42nd Street, How Green was my Valley, The Grapes of
Wrath, Longest Day
Effective Patient Flow
Zanuck’s Corollary?
• Some measure of disagreement and
debate essential
• Management of process and clinical need
• Strict protocol versus case-by-case
tailoring
Kenney’s Law
Just because you don’t agree
with me,
doesn’t mean I’m wrong!
With thanks to Dr Ian Kenney,
Consultant Paediatric Radiologist, Brighton.