The case takes place some 50 years ago in a busy Emergency Department of a major teaching hospital.
The front desk registration staff completed the patient identifying and financial information “by hand,” writing the information in script onto the top of the ED chart. The chart had an original cover sheet, with five copies on what was then called NCR paper. (Often referred to as no carbon paper required.)
In order for the fourth and fifth copies to be readable, the registrars had to “press hard” when entering their contribution to the chart. And that proved to be the impetus for change. The fifth copy was for the billing department–they needed to read the patient’s insurance information in order to bill. Too often that information was not readable, causing the billing department to call the ED to find the original first sheet to obtain the insurance information over the phone or have a copy made of the first sheet and send it “interoffice” to the Billing Department.
The Medical Center’s comptroller was understandably not pleased with the process and given the extensive research required, decided on the following solution.
The hospital would invest initially in the purchase of four typewriters, with what was called an automatic “alligator feed” feature. Appropriate paper with required copies would also be purchased. The typewriters could be set for the correct amount of pressure to provide readable copies for the billing department.
The comptroller announced his solution to the ED administrator, who was to arrange for the ED registration staff to begin a training process to learn how to type with sufficient speed and accuracy, and how to specifically utilize the alligator-feed typewriters.
The training was mandatory for all three shifts of registrars but the training was only conducted during regular business hours. The hospital paid the 4:00 p.m. to midnight shift and the midnight to 8:00 a.m. shift overtime to come in for the daytime training.
The training took place over a three-month period.
The ED administrator decided to launch the use of the new typewriters on the midnight to 8:00 a.m. shift, since this was the shift that typically had the lowest volume of paperwork, which would minimize staff pressure. The registrars from all three shifts were instructed to attend the first night’s session.
The ED administrator came into the ED that morning, expecting to see the new ED charts with the registrars’ portions typed. Instead, the old handwritten system was used. The administrator was told, “The electric typewriters don’t work!” After some inquiry it was learned all the motors had burnt out because “a person or persons unknown” had poured cola into each of the machines.
Questions
Assignment Questions:
What do you believe were the causes of the evident resistance to change?
What do you believe could have been done to minimize the resistance?
What should now be done going forward?