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I was sitting at the stop light and just as the light changed, my wife said “There’s a blue light.”  So I hesitated before going, checking for a police car.
“Why didn’t you go?” she asked. 
“Because you said there was a blue light.”
Confused, we both let the conversation fade away.

After several instances of this, I asked her why she kept telling me she saw a blue light and she asked why I didn’t go when the light turned blue. 
“When the light turned blue?”  Hmmm.  Sounds like we have a failure to communicate.

My wife is from Japan and in Japan, the shade of green used on some traffic lights here in the United States (a bluish, aquamarine sort of green) would be called “blue”.  I think I would call the “go” light on a traffic light “green”, even if it was purple, because for me “green” and “go” are synonymous.  Unfortunately, I cannot convey in writing the big “ah-hah” feeling we both had when we finally figured this out.

So it must be because of the language difference, right?  Maybe not.  You would be amazed to see the number of times we see communication problems because of unclear definitions and using the same word to mean different things in healthcare.

A recent value stream mapping exercise brought out the fact that one root cause of patient flow problems in a surgery department was that “ready” did not mean the same thing to everyone. 
For a surgeon or circulating nurse, “ready” meant “the patient can roll to the OR”. 
For an outpatient nurse, “ready” meant “I have done everything that I am supposed to do.” Patient prepped, IV started,  labs drawn and sent to lab.  But, the lab results may not be back and H&P needs to be signed.  Was she wrong?  Not really.  From her perspective, she was “ready” to move on to the next patient.

So you can imagine the communication problems that resulted from this.

But this is not an isolated incident.  I have seen this same “ready” problem at hospitals in two different states.  I have seen heated discussions over what was and was not happening in a process only to find out (after 3 days!) that the root of the miscommunication was using the same word to mean different things. 

The doctor tells the patient that they have “discharged” them.  For the doctor this meant they wrote the order.  But the nurse may have to draw final labs and give discharge instructions before the patient can leave the building.  Transport will say they have discharged the patient when they take them to their car.  Bed Control may say the patient was NOT discharged even if the patient is gone because the discharge is not entered into the electronic tracking system.  You’ll get three or four different answers depending on who you ask.  And the patient feels like they have been kidnapped because they can’t leave even though the doctor already “discharged” them.

So the next time you are trying to understand a process, don’t assume you know what people mean. Listen to make sure that they are not using the same words to mean different things.  You may have a few ah-hah moments of your own.

This week’s blog was written by Richard Tucker a director with HPP who assists clients throughout the USA with Lean Healthcare transformations. Richard has over sixteen years of experience in business and industry fields in operational and leadership positions. His experience includes new program installation and launch, operations improvement, lean manufacturing implementation (internally and with suppliers), leadership development and supplier program management from prototyping through launch. Additionally, he has many years of Lean experience having worked with a major Japanese automaker, and received much of his experience and formal training in the Toyota Production System, Lean Manufacturing, and Shainin Statistical Engineering while in Japan. Richard’s educational background includes BS and MS degrees from Tennessee Technological University in Cookeville, Tennessee.

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