Posted by: Adam Deane | 15/04/2011

BPM: The Handover

BPM HandoverYou see things differently when you’re about to die…

A few months ago, during one of my business trips to Portugal, I suddenly felt a sharp pain in my chest.
Now, you can imagine the feeling… Ahhh! I’m having a heart attack!!
The last thing you would like is to die in a hotel thousands of miles from home…

Right! I said to myself. Let’s go to the hospital and get checked out.
I usually keep away from doctors, medicine and hospitals – you live longer that way…
I wasn’t looking forward to going to hospital.
The health care in the UK is bureaucratic, the service is atrocious, the nurses are lazy, but the doctors are excellent.
The main problem with the NHS is the administration. The system is good. The management is bad.
I followed the US Healthcare debate with quite a bit of amazement.
We see it as a basic right. The Americans see it as a prerogative.

So for the American readers… let me just explain what a hospital is…

Anyway, I arrived at the hospital and checked in.
I was there for 2 hours… I wasn’t waiting for 2 hours… I was being checked for the whole 2 hours: Ultrasound, cardio, x-ray.. you name it, I got it.
In the end, the doctor sat me down, and told me the dramatic news….: Nothing…
Really nothing… maybe you slept with the air conditioning on… your heart is in great shape… really.

I felt like a real plonker.. I thanked him, and apologised for wasting his time.
“Not a problem” he replied. “It gave me a chance to practice my English…”

Now the real reason for this whole story is to highlight an observation there that I’ve been thinking about ever since.

During my stay at the hospital I was transferred from department to department. From one doctor to another. Each doing a specific test.
Every transfer included a proper handover procedure.
Doctor 1 explained to Doctor 2 who I was, what was the health concern, what was tested, what was planned.
It’s a very efficient system. They spend 3 minutes doing an official hand-over.
Doctor 2 is then responsible for my health and well being. The clock starts ticking.

Compare it to business procedures.
Think of the call centres. The good ones have a hand-over procedure. If they need to pass you to another department, they stay on the line and explain to the next person who the customer is, what the complaint is about.
The bad call centres ask you again and again for your name, postcode and password every time you get passed to another department.

BPM is no different.
A good process has a good hand-over procedure. Audit-trail, history, previous task view, next task view…etc..
Maybe we could we learn a lesson from the doctors…

Enjoy your weekend


Responses

  1. Adam, glad to hear that your heart is fine!!! Would be a pity to loose you …

    Your example of how the doctors handled your case is however not really agreat example for BPM, because during each of those checkups they did with you, it wasn’t the process that was in control but the DOCTOR! And depending on the results of each of the tests a different kind of next activity might have been decided. The outcome of each of those tests wasn’t judged by rules but by an experienced expert, who then decides on what happens next. As you were lucky and no problems were found you rushed through all the standard procedures. But for those who are not so lucky or healthy this would look completely different. And it most certainly wouldn’t be controllable by simple Boolean rules.

    I admit one thing however: Some checkups can be optimiized by reducing the number of tests and enforcing a simple structure of decision making. Gerd Gigerenzer has covered that well in his Bounded Rationality Toolbox. It is a complex interaction between human decision-making and rules that still wouldn’t eb able to be implemented with BPM, well-defined handovers or not.

    All in all, what you describe is (big surprise) a great example for ACM that will handle such complex knowledge worker interactions with ease and even with little or no initial process analysis. Especially that at any point in time completely unpredictable things might appear in the diagnosis (outcome) of a previous task.

    Interesting final question: How much did they charge you?

    • Thanks Max,

      The point I was emphasising was “hands-over”
      I think that both ACM processes and BPM processes need it.
      It doesn’t matter if the process if adaptive or strict – the person receiving the next task needs as much information as possible to make an informed decision.

      I wouldn’t want doctors using ACM or BPM. I would rather they use their brain, skills and experience.
      But I would like to see ACM and BPM adopt clearer handover procedures. Adaptive or Strict, it doesn’t matter. Communication is king.

      Cheers,
      Adam

  2. Hello Adam.

    First things first:

    Visiting Portugal and not giving me call? I think I’m going do delete all the links with you! (joking).

    I’m glad that you express your point of view from two different dimensions:

    First, for a country that is near bankruptcy it is very moralizing knowing that compared to other countries, I would say the more developed, health care services in Portugal work well. You know that we, Portuguese complaint about it?

    In Portugal public health care is provided almost for free, but we Portuguese that complain about everything don’t have the idea of the quality for service ratio. Sometimes it’s necessary to hear real world stories from foreign people to understand how it works.

    Secondly: There is truly an effort in Portuguese health care system to streamline the process. This effort was introduced decades ago. There are some very good examples of 100% paperless processes working effectively.

    The problem lies in efficiency. This the reason of the bail-out. And it’s on efficiency that we need to work hard.

    • Hi Alberto,

      Loved Lisbon. Been to Baixa, St. George’s Castle, Oceanarium, but the best place to visit is Belem!
      Although Portugal is currently going through economy turmoil – you can’t see it in the people’s behaviour. The shopping centres are still full, shops are busy, restaurants are packed…
      Lisbon is lacking the tourism marketing that Spain does, but I’d advise everyone to visit. Lovely place.

      Portugal’s government is implementing BPM in order to cut costs, automate manual work, and improve transparency and control. I visited some of the government offices (some in beautiful old palaces). The project I did was for the Ministry of Finance.

      I ate good food (steaks and fish are the speciality), gained some weight (too many pastel de nata’s), and enjoyed the weather…

      Obrigado,
      Adam

  3. Hand-over? What is this … Adam dreaming again?
    More likely throw the file at someones head and apologize from a safe distance.
    Sorry, couldn’t resist it.

    Good example though of how things sometimes actually do work. But I think you missed one the main reasons: It isn’t just that they had a defined hand-over procedure but that the doctors and staff were competent and process-savvy enough to execute it. It’s the What and the How and the WHY that makes it a success and not just the order to hand-over a patient to the next in line.

    It does make we wonder though if the results of our little survey would produce different results in the healthcare sector: http://taraneon.de/blog/2011/03/25/bpm-process-awareness-levels-still-too-low/

    Anyway, hope you won’t need to test that particular process again!

    Thomas

  4. Hand-over? What is this … Adam dreaming again?
    More likely throw the file at someones head and apologize from a safe distance.
    Sorry, couldn’t resist it.

    Good example though of how things sometimes actually do work. But I think you missed one the main reasons: It isn’t just that they had a defined hand-over procedure but that the doctors and staff were competent and process-savvy enough to execute it. It’s the What and the How and the WHY that makes it a success and not just the order to hand-over a patient to the next in line.

    It does make me wonder though if the results of our little survey would produce different results in the healthcare sector:
    http://taraneon.de/blog/2011/03/25/bpm-process-awareness-levels-still-too-low/

    Anyway, hope you won’t need to test that particular process again!

    Thomas

    • Thanks Thomas,

      “It’s the What and the How and the WHY that makes it a success” – liked that!

      Adam

  5. Hi Adam, sounds a lot better than our Australian hospital processes – for a classic example of a lack of handovers, see my post: http://www.theprocessninja.com/process/2010/01/a-triage-for-hospital-processes.html
    Cheers, TPN

  6. Oh and by the way, I’m no longer at the RTA – if you could update your bpm bloggers list that would be great as I’d prefer not to be associated with the useless, scumsucking RTA. I move around quite a bit so best to just call me after my superhero name “The Process Ninja”. Cheers, Craig

  7. Hi Adam

    Thought I’d add my recent experience of a trip to a UK hospital… My wife fell and hurt an ankle last year so I took her to A&E. On arrival she was booked in and had some basic info recorded, before seeing a triage nurse. She was then directed to x-ray.

    The use of barcoding on a patient record card meant that each person that spoke to my wife was able to recall the notes and artifacts created by the previous healthcare professionals. After scanning the barcode the radiographer knew exactly the symptoms and cause of the injury and so my wife didn’t have to answer the same questions over and over. Following x-ray we went straight to a doctor who scanned the barcode and was able to check the x-ray image on screen. The excellent handover facilitated by the barcoding technology made the whole process a little less painful – even if the sprained ankle was not.

    Mrs Fairgrieve was less impressed that I was showing more concern for how the hospital process worked than her poor ankle!

    • Hi James,

      Good to hear of the good experience, and to learn that there are hospital processes that work.
      My sympathy with Mrs Fairgrieve… :-)

      Adam


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