ED interim leadership helps improve patient satisfaction and throughput

A 408-bed community hospital with high emergency department (ED) walk-out rates and a series of failed rapid improvement events (RIEs) asked Philips Blue Jay Consulting to provide interim leadership in the ED and help achieve sustainable change.

Philips provided a consultant to serve as interim director and work with leadership to develop and implement process improvement initiatives. An organized approach for process change to achieve sustainable results was created and the interim leader modeled consistent, clear, and effective communication skills.

The staff and leadership embraced the changes and the implemented process changes achieved substantial results*.
 

• Arrival to room rate: 37% improvement
• Arrival to provider rate: 44% improvement
• Left Without Being Seen (LWBS) rate decreased 41% which generated additional revenue of over $1.2 million annually 
• Patient satisfaction rates increased 334% to the 100th percentile for the nurse who first assessed patient condition 
• The likelihood of recommending the ED increased 109% to the 88th percentile

Assessment

The consulting team completed a thorough assessment of the ED and identified two major areas of operational improvement opportunity: front-end processes and throughput once the patient entered the treatment area.

The ED leadership team lacked organization and clearly defined roles, which contributed to failure of process improvement attempts and the staff to view leadership as inconsistent and not credible.

Approach

Philips Blue Jay Consulting provided an interim director who identified gaps in accountability and disparity of leadership skills. The consultant modeled consistent, clear, and effective communication and an organized approach to process change.

Shared governance was implemented to define responsibilities and the team was reorganized to improve communication, role clarification, and accountability. This provided a clear expectation of duties and responsibilities for daily operations. Corrective action processes were implemented and accountability was emphasized to sustain the agreed process improvement changes.

Monthly staff meetings and shift huddles were implemented to share compliance information, data on process improvements, wins and team celebrations, and other information to keep the staff informed. Recruitment and retention of staff was a priority, team interviewing was used to select new team members, and preceptor-based orientation supported a consistent onboarding process. These changes were well-received by the staff.

This engagement helped to develop a cohesive and consistent leadership team. Standardized and regular communication and accountability led to a more informed and engaged staff. With the culture shift, improvements in patient care were implemented and sustained.

Several process improvement initiatives were implemented and embraced by the newly engaged staff which supported improved performance metrics and patient satisfaction rates.

Project results included the below:  

• Arrival to room rate: 37% improvement
• Arrival to provider rate: 44% improvement
• Left Without Being Seen (LWBS) rate decreased 41% which generated additional revenue of over $1.2 million annually
• Patient satisfaction rates increased 334% to the 100th percentile for the nurse who first assessed patient condition
• The likelihood of recommending the ED increased 109% to the 88th percentile