Project Masters was hired to help with an improvement initiative within a hospital. Results included increasing patient satisfaction, decreasing the time it takes to see an Emergency Department doctor, and lowering Out-Patient Length of Stay (LOS) in the Emergency Department. All of this was done without increasing the number of doctors, staff or rooms!
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 %. 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? From looking at the hospital’s data, it became very apparent that over 80% of the emergency room’s Customers were outpatient. 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 hospital assembled a cross-functional team to work with our 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 which 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.
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 80 %.
The biggest benefit the hospital gained is 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.