Can a Bad Business Process Actually Kill You?

In my most recent job I worked as a systems analyst. It was my task to understand what was happening in our business and create effective and efficient business systems to solve problems.

I live in Canada and despite the notion of socialized medicine the delivery of medical services is treated very much as a business here. Doctors, at least the ones in private clinics, are saddled with quotas about how many patients they have to see in a day. I’m sure these clinics employ people like me to try and squeeze inefficiencies out of the system.

Systems Analyst Gone Bad

A couple weeks ago I went to the doctor for an annual checkup. He gave me a form with check marks all over it and sent me to the “lab” to get blood tests and x-rays and to be hooked up to all sorts of devices. As I left the appointment, he told me, “we’ll call you if there is anything out of the ordinary.”

Sounds good, I don’t have to think about it unless I get a call.

A few days later, after getting all the test done, my inner systems analyst finally woke up and started to ask questions.

“The doctor hasn’t called…do you think he received the test results?”

“What if the results get lost before they ever get to the doctor?”

That was it, the key question that exposes the potentially FATAL flaw in the clinics system for informing patients.

Let’s Back Track a Bit

I can see how this system was developed. You take the doctor’s normal day and isolate all the activities that he/she performs. Then identify areas that could be streamlined or eliminated.

They probably realized that doctors or nurses were spending a fair amount of time telling people that everything was fine with their test results and thought that is was a waste of valuable time. So they decided to change the trigger for the process and only notify people when they needed some kind of follow-up. Makes sense right?

Question Assumptions

From a business point of view it makes sense except it is based on a key assumption. The assumption is that if something is wrong the doctor will always know about it.

The primary scenario checks out fine against the assumption; the result is as expected and the patient is not notified and the clinic saves money.

“patient gets tests done, doctor receives tests and reviews them, patient’s health is normal, no further action required.”

What about this one.

“patient gets tests done, the test results are lost by the courier somewhere between the lab and the doctor’s office. No one ever reviews the patients test results. The patient is never called.”

To the patient the results are the same, but what if the patient had a serious medical problem that needed immediate attention?

“Patient thinks he is fine, but dies because no one called him”

This is an example of a system or process that didn’t have anyone on the design team questioning the assumptions that it was based on.

Make sure you pull out all the assumptions that your systems are based on and bounce them off of a couple other knowledgeable people to make sure they are true…in every possible circumstances. The more critical the process the more it needs to be validated against alternate and unusual scenarios.

Do you have any bad system horror stories of your own? This kind of thing is way too common and really does cost people everything from an inconvenience to their lives on a regular basis.

- Jon Symons

This post was written by Jon Symons, see my short bio. Or use the contact page to get in touch.