Fight The Sludge!

I’ve heard many words used to describe the things that cause unnecessary waits, delays and aggravations for both patients and caregivers.

The US Institute for Healthcare Improvement, for instance, encourages healthcare leaders to help their teams identify ‘the pebbles in their shoes’ – ie, the things that get in the way of doing what matters.  Fans of Lean Thinking, on the other hand, will be very familiar with the term ‘muda’, the Japanese word for waste, which is defined as any human activity that absorbs resources but creates no value.

Now, however, we have a new word to help us identify healthcare improvement opportunities: ‘sludge’.

The word was first coined by author Cass Sunstein to describe situations in which systems are seemingly designed to impede people from doing what they need to do.  He concedes that it’s okay to impose a little bit of sludge to make sure that those who are trying to get something actually have a right to that thing.  So being triaged before being given a GP appointment or having to wait for your medical insurer to approve a consultation is probably acceptable as long as it’s done as quickly as possible.  The problem, however, is that healthcare systems frequently create sludge that prevents people getting timely access to care or deters them from seeking it in the first place.

Fortunately, in an insightful recent Harvard Business Review article, three senior healthcare managers have described how they use ‘sludge audits’ to measurably improve patient care and increase employee engagement by eliminating or reducing anything that adds unnecessary time and cost to healthcare encounters.

So next time you’re casting around for ideas for an improvement project, maybe think about rolling up your sleeves and clearing out some sludge!

– Benedict Stanberry

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