Along the journey, hospital and ED leaders must always remember that their entire effort and focus must revolve around the patient and their families. Every initiative put in place and every element we attempt to optimize is done so in an effort to create a patient-centered culture. In the quest to create a patient-centered culture, consider these questions as a self-check:
In the quest to improve the patient experience and to create a welcoming service culture, leaders must first commit to the notion doing so is possible. We must challenge ourselves to put any cynicism aside, to set manageable goals, and consider these specific tools and tactics:
In addition to ensuring a solid set of patient-centered tactics and behaviors are in place, leaders must also address flow and efficiency in the ED. It is impossible to separate service excellence from operational excellence, and the goals of every emergency department should include seeing patients promptly, treating them appropriately, and dispositioning them efficiently. To gauge the level of operational efficiency, we consider the following questions as a self-check:
While there is no simple answer or one-size-fits-all solution for flow, here are some HealthStream Coaching principles to consider to enhance efficiency and reduce overall turnaround times:
1. Examine the ED and all of the steps in the flow process with a fresh set of eyes. Look at all of the steps in the process and whether or not each of them is necessary.
2. Remove (or reduce) any wasteful or unnecessary steps in the process.
3. When possible, create a process that encourages individuals to do things in parallel (versus serial). For example, in some EDs, the RN and MD assess the patient together in a joint process.
4. Ensure that all positions (RN, MD, Ancillary) are scheduled based on volume and acuity by hour-of-the-day, sometimes referred to as demand-capacity staffing.
5. Ensure there is a team focused on ED flow and a team focused on Inpatient flow. Having these two teams aligned and united in their approach is ideal to create a push-pull model.
6. Ensure the triage process is shortened and has been streamlined as much as possible. A triage is a function (not a place) and is not always necessary. If the next patient that arrives is going to go to Room 3 regardless of his condition, conducting a triage does little to help create the expedite the process.
7. Keep vertical patients vertical, and keep them moving. It is often a temptation to put everyone in a gown and have them lie down on a bed. This process is outdated and not necessary for every patients.ED flow can become complicated, especially at large, busy, urban departments. In many cases, bigger, more complex departments will require a deeper look into look into the operation and multiple factors affecting performance. Many hospitals have embraced Lean or Six Sigma methodology as an option and have found success with such strategies for reducing overall turnaround times.
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