Elusive Autonomy… It’s a Systems Problem
As we continue to dig deeper into helping Wendy achieve autonomy so that she can eat when it is physiologically right for her body. I tried to understand the environment where she works even more, to see wha surrounds her everyday.
Her office is the on the first floor, the lunch room with the microwave is on the second floor. There is cafeteria in the main hospital across the street but it is about a ten minute walk and cafeteria lines are often long. There is a gas station, about a three minute walk away, which tends to be there all the cheez-its originate from.
I also tried to understand what lunch times look like. So here is how it works: There is often a nurse assigned to a doctor in the hospital. All doctors have their lunches from 12:00–12:45, however, the nurses are unionized. Therefore, nurses have staggered lunches, some at 11, others 11:30 and so on. Also, they are protected by the union, so their lunch times are protected and definite, they don’t miss lunch. However, when a nurse goes on his/her lunch break, the burden of her work falls on another nurse, who was already assisting her own doctor. So you find, some nurses managing multiple doctors patients while the other nurses are on lunch. Meanwhile, doctors can only have lunch from 12:00–12:45. Also, patients are not considered officially late except they miss their appointment time by 30 minutes. Therefore, imagine having an 11:00 appointment, patient shows up at 11:15, that pushes things back 15 minutes, so now, your fifteen minute 11:45 appointment doesn’t begin until 12:00, remember the nurses are also juggling multiple doctors because of staggered lunches. So, prep time takes even longer. By the time she starts speaking with the patient it’s already 12:30. Lo and behold, lunch time is over and my 12:45 appointment is here.
So, there were two concepts I was thinking about as mentioned in my last blog.
- A system where doctors and nurses are paired or put in groups to keep each other accountable for eating meals by incentivizing behavior.
A network or a system that pairs doctors with nurses or other practitioners in the space. In this case, since nurses are definitely taking breaks, can we pair doctors with nurses to ensure that doctors are also taking breaks when nurses take breaks. Can the hospital close down for 45 minutes a day to allow employees take break? That may be a stretch.
However, the challenges with this are
a. The system is difficult to intervene in because it requires the participation of the individuals and the institution.
‘Healthcare settings are hard to do things in because there are so many things that don’t go according to plan because healthcare is people centered and things are always moving. ’
b. The mindset of involved groups of people need to be heading toward a common goal. It is hard to get consensus from all parties.
‘You see, where I work, there is a strong sense of entitlement and the reality is that a lot of the doctor/nurse relationships are strained and strictly professional. There may be a nurse and a doctor that get along well but it often doesn’t go beyond that. ’
3. Medical work is patient centered.
Patients want to spend a significant amount of time with their doctor, even if the appointment is only scheduled for 15 minutes.
‘Patients assume quickness is incompetence. So if anything goes wrong, they are convinced it is because I did not spend enough time with them. All this information is overwhelming for patients but they forget I went to school for this, so I can figure it out really quickly.’
‘If things were centered around me, it may work but my time is centered around my patients. We are pretty much at the mercy of the patients.’
This requires a change in the hospital system within which she functions. However, there is another opportunity
2. Play with the juxtaposition of time and meals as it pertains to her. What if she had dinner for breakfast, lunch for dinner, etc. Often what happens is either she is so hungry she eats her lunch at breakfast time and then has to order a meal, which is often unhealthy. Or, she is unable to get any time to eat at the end of the day, thus, having lunch for dinner. So what if we played with that.
- Systemic change is difficult to implement and requires the engagement of various parties, a higher leverage point but because it has larer impact.
- I am unsure if I am able to create an intervention for her real pain point which is the ever moving system she exists in, and it seems I am unable to touch it.
- I feel like I am not creating anything physical, how can I find the middle ground.
- Food prep together for the week
- Self-recording of how the prototype is going.