Project Masters was hired to help with an
improvement initiative within a hospital. Results include
increasing patient satisfaction, decreasing the time it
takes to see an Emergency Department doctor from an average
of 182 minutes to a 2-month average of 143 minutes, and
lowering Out-Patient Length of Stay (LOS) in the Emergency
Department from a baseline of 336 minutes to a 2-month
average of 288 minutes. All of this was done without increasing
the number of doctors, staff or rooms.
Hospital Challenge:
A hospital was getting some of the lowest emergency department
patient satisfaction scores of any hospital in the country.
Gallup Patient Satisfaction scores were in the range of
1 to 10 percentile. Although the emergency department was
helping patients and saving lives, their patients were
not happy with their experience in the emergency department.
The hospital had tried training its staff to show more
concern for the patients. They tried to do more things
to make the patients more comfortable (warm blankets, ice
chips, meal coupons, etc.) However, nothing seemed to have
a positive impact on the scores.
Challenges & Solution(s) Provided:
Using the DMAIC (Define, Measure, Analyze, Improve, and
Control) Process, the first step was to identify the scope
of the process: who are the Customers and what do the Customers
expect? The Emergency Department had about 35 beds with
which to handle the 150 to 200+ patients per day that they
saw. From looking at the hospital’s data, it became
very apparent that over 80% of the emergency room’s
Customers were outpatient. They came to the Emergency Department
to see a doctor and then they went home. They expected
only the best possible treatment and they wanted it quickly.
However, it was taking an average of over 3 hours to see
a doctor and they could expect to be in the emergency department
for four to five hours once they arrived. Even with warm
blankets and meal coupons, the three hour wait to see a
doctor was never pleasant as the patients were already
not feeling well and they had to sit next to people that
seemed even more ill. Patients would regularly call an
ambulance to take them to the emergency department thinking
it would get them to see a doctor sooner. Or they would
present with “chest pains” hoping to get treatment
faster. When none of this worked, they became increasingly
dissatisfied.
The next step was to actually see what the patient sees
by measuring the process. The hospital assembled a cross-functional
team to work with the consultants. The team used several
Lean tools including Patient Process Flow, Value Stream
Mapping, and Full Work Analysis. Once the current state
of the process was understood, the team collected data
on the cycle times, change over times, defect rates, patient
volumes, and other pertinent data. Many great suggestions
and ideas were discovered during this stage and were recorded
for later use.
An analysis was performed using all the data. Ideas were
collected that resulted in a consensus on the best improvements
to make. To determine whether the ideas were really going
to be improvements, a pilot was run to prove the benefits.
Since the team was made up of a good cross-section of the
emergency department, they had enough staff with the right
skills to run their own track for a few hours. As some
of the team worked the pilot, other team members would
take data on the proposed process. The consultant then
led the team through data analysis and discussion to make
even more improvements, given their new knowledge from
the pilot.
All of the improvements were then documented in an “Education
Packet” to help educate the rest of the Emergency
Department staff or any new hire. Every person in the department
and some of the ancillary people were educated in their
new role including doctors, nurses, technicians, and administrative
staff. Communication sessions were held with other departments
in the hospital to explain what the team had found, how
they would be changing their process, and what results
they expected. Since change is not easy, the team was used
to “coach” the rest of the staff for the first
3-weeks to ensure that the new changes would stay in place
and to catch and correct any issues that were created by
the new process.
Sustaining the new process was accomplished by creating
a “Lean
Committee” that would advise the Emergency Department
Director on what issues were being encountered and to make
suggestions on how to overcome these issues. In addition,
the consultants devised an audit that could be done by the
Emergency Department on a regular basis to see if they were
sustaining the gains made by the implementation team and
to define a path for further improving the process.
Benefit:
The Emergency Department has held their gains. They reduced
the average Door-To-Physician time from 182 minutes to
143 minutes. Outpatient LOS dropped from 336 minutes to
288 minutes. Patient Overall Satisfaction increased substantially.
No new staff was added. The team expects even better results,
as they are able to implement some of the longer-term improvement
opportunities in the next month. Their goal is Door-to-Physician
time of 45 minutes, Out-patient LOS of 120 minutes, and
Patient Satisfaction greater than 80th percentile.
The biggest benefit that the hospital has gained is that
they now have people trained in improvement techniques
that can be applied to any process in the hospital. Improving
the Emergency Department helped to expose other opportunities.
Admission Holds can clog the Emergency Department and cause
extensive wait times. As a result, this hospital has chartered
a new team to use some of the same techniques on the admission
process. In addition, patients who leave without seeing
a doctor are a defect to the Emergency Department. This
has been a great opportunity to apply the Six Sigma tool
set.
