Top Tips from CEOs for Improving ED Performance
Wondering how senior leaders can effectively drive change in the ED? Here, Rick Lassiter, CAO at Parkwest Medical Center in Knoxville, TN and Janet Wagner, CEO at Sutter Davis Hospital in Davis, CA share their perspectives.
HR: Why is ED flow so important?
RL: The ED is the front door to your organization and your community. Forty percent of our admissions come from the ED. With high volumes, reducing long turnaround times is key. In fact, when I’m at church or in the grocery story and I see patients, that’s one of the first things they mention: a long wait time! In the ED, we work on getting patients who need to be seen out the door faster. On the inpatient side, we work on getting those who need to be admitted into a bed sooner.
HR: How can CEOs play an effective role in addressing ED flow challenges?
JW: Stay engaged with staff and physicians. I make high patient satisfaction a priority. We measure by shift and department in the ED. CEOs can verbalize the expectation and support staff with education and training. The ED is important for CEOs to stay close to because it is very often the first experience the patient has with the hospital and influences the remainder of the stay.
RL: Make it a part of what you talk about every day. I attended frequent meetings of our Flow Team along with the CNO and CFO to raise visibility of this issue. We asked tough questions, like “How long does it take to clean a bed? What’s the turnaround time for housekeeping?” By identifying barriers as a team, we identified seven flow obstacles to overcome and raised accountability.
The end result was the development of an electronic Flow Board that’s posted on every unit so we can see what patients are waiting on. The goal: Discharge 40 percent of patients by 11 am (instead of seven percent). After nine months, our pilot unit is meeting goal, with the rest of the hospital at 13 to 14 percent.
HR: How do you use accountability to support and drive change?
JW: For patient satisfaction, we have weekly meetings with managers and post results on all units once a week. If satisfaction drops, I ask staff to focus on a strategy for recovery. It’s a coach-support-train model for sustaining results. This creates the infrastructure so everyone knows how to read the patient satisfaction surveys and use the data.
RL: We use Studer Group’s Leader Evaluation Manager™. Every nursing manager has a heavily weighted goal on his or her evaluation to discharge 40 percent of patients by 11 am.
HR: Has improved flow in the ED contributed to higher satisfaction by the medical staff?
RL: Our medical staff is mainly concerned that their post-op or direct admission patients are placed in a room in a timely, efficient fashion. Since they essentially compete for beds with ED admissions, we changed our process by discharging patients earlier in the day. By reviewing the surgery schedule and relying on our ED admission trend data, a flow coordinator can plan for anticipated admits from post-op early in the day and ED admits for later.
Our admissions are up five percent over last year; surgery minutes are up 11 percent and ED visits are up 3.5 percent. Yet, length of stay is fairly constant. Our work on flow has helped us handle the volumes.
HR: Any advice to other senior leaders looking to improve flow in the ED?
JW: Look at the process and engage physicians and staff to improve cycle times where needed. Ensure someone is managing those processes every day and every shift. It’s like air traffic control. And absolutely include key physicians, medical staff and the hospitalist. You need physicians who understand and can respond to flow challenges as well as managers who can execute improvements.
And remember, just because we improve something, doesn’t mean it’s easy to sustain it! Process improvement is an ongoing endeavor. It requires a culture and mindset of constant attention.
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