Seldom if ever do we recycle our newsletter material. We want to keep our newsletters both fresh and innovative. But, this week we couldn’t resist,  plus we’ve added over 3000 subscribers around the world since our last release of this article.  I’ve had a number of conversations this past week at various sites about COW’s. You know, those computers on wheels.  I thought we’d re-run a popular article from a couple years ago and republish it, which takes a humorous but oh so true look at this subject.  Enjoy! And, don’t forget to join us in Nashville on May 18th at Belmont University for our National Lean Healthcare Powerday.  Slots are limited and are going fast, plus we anticipate the event to be sold out.  Charles Hagood, President of HPP, Inc.


“Tech support, this is Alex,” he answered, sipping his mocha double latte.

“Hello Alex, this is Hazel up on Cardiac 6 West.  We have a dead COW up here.”

“A dead COW?!?!” he sputtered.

“You know, COW, Computer On Wheels.  They were supposed to help us monitor meds.”

“Sorry, Hazel.  I’ve been in tech support for seven years and just got into healthcare.  I have never heard a computer called a COW!  But anyway, what can I do for you?”

“I told you it was dead.”



“OK, let’s see here,” as he pulled up the troubleshooting guide for the MCD/Mobile Computing Device, thinking to himself, “Why can’t we at least use common terminology?”

“Let’s see…are you plugged in or mobile?”

“I would say mobile right now.  Before you get started, let me tell you that we know the script for restarting these things.  Restarted the application, check.  Plugged it in (the battery might be low), check.  Tried to repair the wireless connection, check.  Disabled and re-enabled the wireless manager, check.  Rebooted from complete power down, check.”

“Great, did you…”

“Did you know I can go get vitals and chart them quicker than I can do all this stuff?  I AM a nurse!  Can you assess a patient, start an IV?”

“Uh, no.  What else did you do?” Alex asked tentatively.

“Well, I pretty much exhausted MY tech support skills, so I fell back on my nursing skills.”

“Nursing skills?”

“Yep, I pulled a saline IV and started a drip.”

“On the computer?”

“Yep, stuck it straight in the USB port.  That didn’t help much, so Karen and I decided to call a Code.”


“Yep, Code Blue.  Cardiac arrest.   We grabbed the defibrillator and shocked it three times to restart the CPU.  That’s when it started smoking.”


“Yep, after the third one we heard a loud POP.  So I tried manual compressions on the keyboard.  We worked for 30 minutes right there in the hall before we stopped.  So now we have a dead COW… and a bunch of exhausted nurses—we did everything we could.  Probably even broke the cart.”

After a long pause, Alex offered, “Uh, let me get my supervisor.”

From a lean healthcare perspective, clinicians fighting technology creates waste.  Patients wait.  Staff members get frustrated taking valuable time (and mental focus) away from providing patient care. 

Is “support” a verb in your organization?  Does the technology support the caregivers and their work?  Or does the caregiver become “tech support” (a noun) instead of caring for patients?  Ask yourself these questions the next time you are out on a gemba walk.

This week’s blog was written by Richard Tucker. Richard is a Director with HPP and has served as a coach, facilitator, and project manager for healthcare clients in the training and implementation of Lean Healthcare Tools and Methodologies. Prior to joining HPP, Richard had over sixteen years of business and industry experience in operational and leadership positions. With his work in healthcare, Richard has lead teams in the utilization of lean healthcare tools to eliminate waste, giving back precious time to the front line caregivers to focus on their patients. One project eliminated over 2 miles of walking (and one hour of time) per nurse each shift by relocating frequently used supplies closer to the point of use. A critical care team standardized the care of central line catheters to significantly reduce blood stream infections and improve staff satisfaction with the new process. In addition to his ongoing support of healthcare organizations in their lean journey, Richard is a founding faculty member of Belmont University’s Lean Healthcare Certificate Course. Richard’s educational background includes BS and MS degrees from Tennessee Technological University in Cookeville, Tennessee. Richard has attended formal training courses in Lean Manufacturing, Leadership Development, and Shainin Statistical Problem Solving.

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