Thursday, March 26, 2009

Things I have said in a user group meeting

To work on the master plan for the 14-story medical office building, Sven and I have been meeting with the users (nurses and nurse managers) of each of the departments involved in the project.  One floor, the floor with the pre-surgery consult department, has been in a real tizzy because part of their master plan involves moving a pre-bariatric surgery consult group into their department.  They already don't have enough space, and suddenly here comes two more doctors, two more PAs (physician assistants), and the need for three more exam rooms.  [Note: bariatrics is the study and treatment of obesity.  It's a contested field at times, because some healthcare companies and facilities don't want to treat this field due to liability issues and sometimes even moral issues.  Moral in terms of "if we treat it, are we saying it's okay to be overweight? shouldn't we be treating people to keep them from getting that big in the first place?"]

There are a crapton of doctors on the pre-surgery floor, and the first meeting they had with us was with the MOB's V.P. of capital improvements and Sven, one of DA's partners and my boss on this project.  (I was in Vegas during this meeting.)  The second meeting involved the V.P. and me and two of the doctors and three nurses and five or six office managers.  Dear Gawd.  At the meeting we had this week with the pre-surgery group, we had Sven, the V.P., and me, and from the client's side only two office managers and one nurse manager.  Needless to say, we got a lot more accomplished.  It usually happens that way--there's a bell curve involved with amount accomplished and number of people at the meeting.  You need a few key players, but I don't need everybody with a Herman Miller modular desk to show up and throw in their two cents.  These meetings involve a certain amount of detente involved in your reality checks; you have to be able to explain in a civil manner that you can't fit ten pounds of program into a five-pound building.  This is often done best by using questions to highlight the choice that needs to be made or reality that must be faced.  These questions allow the users to talk through how they do business, and by explaining it to us they realize why what they're asking is impossible.  A sampling of things I asked in the meeting:
  • Can you convince any of the doctors to share an office?
  • Really?  What if sharing an office gets them and you more exam rooms?
  • Really? Not even then?
  • If you want more exam rooms, what are you willing to give up?
  • How many soiled and clean utility rooms do you need?  If you can get rid of one of each, there's more space you can use for treatment.
  • Should all the nurses be grouped together in one bank or in two banks?
  • They gossip that much?
  • Doesn't that violate HIPAA?
  • How close does your office need to be to the exam rooms?
  • Do the schedulers need to be near the exit or near ther nurses?
  • Seriously, the doctors won't share an office?
  • How large does a wound dressing exam room need to be?
  • Could you conceivably share exam rooms with bariatric?
  • If you want more exam rooms, what are you willing to give up?
  • How often do the PAs use their procedure room?
  • What is the path a typical presurgery patient takes from start to finish of their appointment?
  • Where are they supposed to watch that video?
  • Are you using anesthesia in the rectal procedure rooms?
  • Why the hell not?!
  • What happens in this office?
  • Do the PAs need direct access to their storage, or can the door to it be in this hall over here?
  • How much medication dispensation are you doing?
  • If you want more exam rooms, what are you willing to give up?
  • REALLY?!  They won't share?!
So that was my day.  How about yours?


xtine said...

I _hear_ some insurance companies don't consider (general) anesthesia necessary during things like colonoscopies.

But you bet the policy-making insurance assholes get anesthesia for their own roto-rooting.

Small Town said...

I've learned that sometimes you need to remind the docs that the code-required minimum dimension for a habitable room is 7 feet. I've had some that think a 6 foot wide exam room or office is OK.

Anonymous said...

If they won't share, then give them really small offices. In today's world, they shouldn't be in those offices too much anyway, since they are supposedly "overscheduled."

doctors. harumph.

cathryn said...

Ha! So hilarious because it's so true! This sounds like every user meeting I've ever done.