Mr.Cognosti and Mr.Chronos visit the doctor

Mr. Chronos, the world-famous expert in Time and Motion Cost Management is visiting a GP and as usual has spurned the 7-yr old Newsweek copies, and is watching the dance of people moving in time through the office.

He sees patients coming in, wasting time filling in forms that mostly duplicate effort, he sees time being wasted here, there, everywhere. He nods in silent approval though, spying how the patient is first received by a receptionist at slightly higher than minimum wage rate, then screened and passed at a suitable time to a nurse who earns a fair bit more, screened again, and if necessary passed to a nurse-practitioner at considerably more than the receptionist, and finally, if all else fails, filtered through to the doctor with all preliminary tests, checks, measurements, and statements already captured by lower-cost employees.

Mr.Chronos is pleased.

Meanwhile, Mr.Cognosti is besides himself with despair, he is horrified, dumbfounded, and perplexed.

He sees information, understanding, knowledge lost and ignored at every handoff, and he sees the doctor dealing finally with a tiny and constrained subset of the information that was streaming out of the patient from the second they stepped through the door.
The doctor didn’t see how turning to close the door the patient momentarily lost balance, she didn’t see the slightly unsteady gait on the approach to the desk, and she was oblivious to the fine trembling in the hand as the patient wrote on the form.
The receptionist of course, more concerned with the efficient flow of people and untrained in human motor systems, saw but did not perceive the information, and knowledge was lost.
Mr.Cognosti is almost in tears as he notes that the doctor sees the patient only when they are seated and has been cocooned by procedure to be blind to so many symptoms and signs, and fails to correctly diagnose the growing brain tumour until many months later.

It isn’t that Mr.Chronos is wrong, it is just that he sees the world through a different set of eyes than Mr.Cognosti, and safeguarding time to the detriment of knowledge is not always a prudent thing – and since patient outcomes is the final goal, the current setup is a case of poor knowledge management.

To get better outcomes, Mr.Cognosti needs to be heard, and in some places, knowledge must be prioritised over time. Perhaps the doctor needs to see the patient walk towards her and greet them with a handshake. Perhaps she needs to collect those basic measurements herself, because when she palpates a pulse, she is wired up to detect far more than just the rate.

The office has Knowledge Management practices, just not very good ones in this case, and improving their KM would perhaps improve their goals of good patient outcomes.

That is my story, and I am sticking to it.


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2 Responses to “Mr.Cognosti and Mr.Chronos visit the doctor”

  1. Stuart French Says:

    A nice little example of efficiency versus efficacy.

    Have you seen Dave Snowden’s blog post about Resilience versus Robustness?

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