Monday, October 13, 2008

Poka-Yoke: Mistake Proofing an Office

Poka-Yoke is mistake proofing something. Anaesthesia is replete with these handy little tools. For instance the regulator for oxygen will only fit on an oxygen tank due to a pin-index system. On our anaesthesia machines the lowest percent of oxygen you can give is 30% otherwise the machine cuts off and the patient breathes room air.

But PokaYoke extends far beyond life-threatening situations. I’ve previously described how our office had problems managing emails from referring practitioners. At first we just created an email account. We couldn’t tell which emails had been processed into the referral management software (our EMR) so we created subfolders (processed/not processed). Then, the users could accidently drop emails into the wrong folder so there was no net benefit. Finally we created a bit of script that moved emails automatically into the EMR and once the information was entered an automatic email was sent back out with the confirmation information including who had entered the data. Total cost about $3000 and worth every penny.

From a general point of view you want to mistake proof something so that an action is either prevented or met with some sort of control to prevent the mistake. In the case of the oxygen cylinder or referral management there is a forced control of the situation. You can also have an automatic shutdown (as in the case of the low oxygen level), a warning or a sensory alert.

Here are four other poka yoke’s from our office:

Staff Schedule
Our office grew from 20 to 60 staff in short order. Originally we used a plain Excel sheet to schedule staff with an autopublish to the web so they have access to the schedule. Mistakes started to pop up where we would forget to assign a nurse or an assistant to a provider leaving the day short staffed. Using conditional formatting and the countif function we created an Excel sheet that returned visual inputs as a summary function to see at a glance the number of staff per office. Total Cost: $0 as long as you can work Excel

Wait Times Graphs
When we started using wait times as a measure of our success we needed a faster means to visualize our performance. We connected an excel sheet to the EMR for a visual representation of our wait times for critical procedures. Prior to this we would have to count the days, look at the schedule and estimate or go with “a gut feel”. Total Cost $0 as long as you can work Excel

From Wait Time & Delayed Care

Patient Cancelations
When a patient cancels an appointment or forgets to complete a test what happens? Most offices leave the chart of the shelf or call them once and that’s the end of it. Our EMR has a fail-safe that if a patient cancels an appointment they are automatically put back on a recall list. The staff will then contact them again in the usual means. If the patient doesn’t wish to follow through they are removed. Usually, they’ve forgotten the appointment and simply need the reminder. The software prevents us from “forgetting” a patient. Total Cost: Appx $2000 included when we designed the original EMR

From Wait Time & Delayed Care

Confidential Information
Dealing with many young adults our office completes the medical history without parents in the room then we bring them in to hear the information about a surgical procedure (all with the patient’s consent of course). Although the teen/young adult wants their parents present to receive the information about surgery they don’t want them to know a disclosure about marijuana use (the most common scenario). Because we still have paper charts we put a large paperclip over the chart to prevent the practitioner from accidently opening it to the medical history and inadvertently disclosing the information without the child’s consent. Total Cost: 30cents for the paperclip.

Those are just 5 poka-yokes from our office. I’d be interested in hearing what everyone else has done in clinics to mistake proof procedures. For more information on poka yokes at an industrial level (health care) visit or

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