Aug 5

Getting to Gemba – a day in the Cardiac Cath Lab

 

On Friday last week, I spent the day¬†at one of¬†the Cardiac Catheterisation Labs at St. Thomas’ hospital, London. Not as a patient, you understand, but as an observer. You might ask¬†why a moderately squeamish person like myself¬†would do this willingly? Well, my reason was a principled one. I firmly believe that it is impossible to innovate effectively without a¬†clear understanding of the context and usage of your final innovation. Ideally, I like to “go to gemba”,¬†otherwise known as¬†the place where the problem exists, so I can¬†dig for tacit knowledge and observe unconscious behaviours. In¬†this case, however, I’d rather got the cart before the horse because, due to the wonder of Open Innovation and Ideagoras, I answered an RFP (Request For Proposal) on Nine Sigma about improvements to catheter systems, used, for example, in cardiac pocedures, without ever seeing how such an item might be used. At the time it was a bit difficult to see the system in action because a) my foot was in plaster and b) I didn’t know any cardiologists. So, I went ahead and broke my rule and answered the RFP with what I hoped was a pretty creative and novel solution. The Nine Sigma clients at the other end thought so too for a while until they got frightened off by the potential development time. Meanwhile I found a willing cardiologist and he invited me into his cath lab for a day. It was quite an experience – I didn’t pass out and I learnt a lot! Here are a few observations:

There are a lot of people in the lab during a procedure. I’d imaginged just a cardiologist and maybe a radiologist before I went but actually there were two cardiologists present during all the procedures I witnessed (admittedly more complex than average), one radiologist, one catheter nurse, one nurse to look after the patient who is conscious throughout, one technician to monitor the vital signs and at least one further technician behind the scenes to record key image video sequences

Everyone has to wear heavy lead oversuits to protect them the from x-ray radiation from the imaging system. My feet really ached at the end of the day – so much for a sedentary lifestyle!

The x-ray dose and contrast fluid (used to show the artery size on the x-ray image) dose are strictly limited due to the exposure risk to the patient and capacity of the patient’s kidneys to process the contrast fluid from the blood stream.

You can do an awful¬†lot “percutaneously” – see, I’ve got the jargon going already¬†– it means through the skin, under local anaestetic. You can even fit a replacement atrial heart valve using a catheter!

It can be really tricky to find and unblock arteries sometimes, especially if the blockage is close to the intersection with a larger vessel. This can be a very frusutrating and fiddly procedure requiring super-human levels of patience. This illustrated how much the cardiologists rely on “feel” when using the catheter system.

There are already some very impressive technologies available to reduce the friction in catheter systems. One such solution is known as “crosswire”, a 0.014″ diameter hydrophillic coated guide wire often used to break through blockages (as part of a procedure known as Angioplasty). Aparently “a lot of people don’t use crosswire because although its easy to position, it doesn’t stay put”. This is because it can be pushed out by the patient’s blood pressure.

There is a tremendous array of different catheter systems in the lab store, with different end forms, from many different manufacturers. Each cardiologist has his or her personal favourites.

Anyway, I didn’t disgrace myself and I’ve been invited back for another day or so. What did I learn that I didn’t know before? The key things I learnt were:

  • the guide wire isn’t just a means of steering the catheter into place as I thought. It is a functional tool in it’s own right
  • Feel is really critical to the cardiologist
  • There is a huge benefit in speeding up procedures in terms of patient wellbeing and lab efficiency
  • Current catheter systems lack¬†the level of detection capability and controllability needed for some more complex PCIs (Percutaneous Cardiac Interventions)

The whole experience reminded me that in terms of innovation getting to gemba is critical. When was the last time you saw your products in use up-close and personal?

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  1. Curious Cat Science and Engineering Blog March 28th, 2009 4:48 pm

    Cardiac Cath Lab: Innovation on Site…

    Photo of John Cooke at the Cardiac Catheterisation Labs at St. Thomas’ hospital in London
    I manage several blogs on several topics that are related. Often blog posts stay firmly in the domain of one blog of the other. Occasionally the topic blu…

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