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Care Delivery Design Required for MU - Lessons from Order Wheels

August 27, 2010
by Joe Bormel
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Care Delivery Design Required for MU
Lessons from Order Wheels

Lots of CIOs are now contemplating pursuing very aggressive strategies to pursue Medicare-Hospital MU incentives in 2011. And with that, comes massive and probably hybrid care delivery design changes (e.g. some providers using existing order flow with written orders, while others are concurrently using CPOE). The nurses will be making sure that nothing slips between the cracks. The management of orders in the effected care units may be or will be re-designed to accommodate these flows. This was the garden variety work of bringing up CPOE before MU. Now, it's going to be happening wholesale, most hospitals and all impacted processes (CPOE is only one of them).

As I mentioned in my previous post, Adopting the Obvious, I've become interested in the science, practice and psychology of this sort of meta-design. I ran across a story involving Order Wheels that seemed relevant to share. It comes from this freely available Web page by author Richard Farson: Management By Design, http://www.wbsi.org/farson/com_mgtbydesignr.htm :

Adam and Eve on a Raft

Ever since the forties, when sociologist William Foote Whyte conducted his famous study of the interpersonal tensions that arise at peak hours in restaurants, managers have been encouraged to think about human relations in systems terms. Noticing waitresses shouting orders to male cooks, Whyte surmised that such behavior violated role expectations of both gender and status, cooks being of higher status, and women expected to be subservient to men. (Remember, this was the forties). He designed a system in which the waitress would write down the order on a small pad of paper and stick the slip of paper on which she had written the order on a spindle [an Order Wheel]. The cook would then take it off when he saw fit, calling the waitress when it was ready. That system of realigning the roles remains in place, although the spindle has largely been replaced by a revolving drum, or by computers. It is considered one of the first uses of system design in the management of human relations in industry.

Okay, first, please calm down. The gender stereotyping and status issues were painful, probably even for the original author, Dr Farson.

The bigger picture is the approach to design taken, and its fulfillment with the Order Wheel. It respected the needs of those involved, without exacerbating the human dramas that probably exist at peak hours in hospitals as they do in restaurants.

What do you think?

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