Restoring Dignity to the Emergency Department Patient Experience
CHALLENGE
An urban emergency department on the east coast faced what seemed like insurmountable challenges. Overcrowded and underresourced, the emergency department had an average length of stay exceeding 8 hours. Walk-out rates topped 10% nearly every day and patient satisfaction scores were in the first percentile. Patients were frustrated. Staff were burned out and, at times, openly hostile. The client needed help to turn things around.
30+ stakeholder interviews
Operational analysis
Time-motion studies
Process mapping
Journey mapping
Clinical functionality assessment
Patient consumer experiential analysis
Provider consumer experiential analysis
Co-creation sessions to explore innovation opportunities
APPROACH
What began as a simple operational improvement project quickly turned in to an exercise in reimagining the patient experience while shifting the department’s culture.
Comprehensive operational data spanning back years was analyzed to study every step in the patient care journey. As in most emergency departments, the opportunities uncovered were both internal and external to the emergency department. While the staff wanted to focus on external influences, system leadership has other ideas in mind.
An interdisciplinary ED work group consisting of nurses, physicians, technicians, registration staff, security, imaging technicians, transporters and housekeeping staff engaged in collaborative process to rebuild the entire ED experience. Tools from lean, design thinking, agile, gaming theory and simple common sense were leveraged to effect change.
RESULTS
The transformation of the emergency department was nothing less then profound. A new patient flow model focused on accelerated diagnostics and making use of waiting room time to expedite care resulted in marked drops in overall length of stay and walk-out rates. Patient satisfaction scores rose to levels never-before seen in the ED, settling in near the 75th percentile.
The crowning achievement of the emergency department transformation was the impact it had on the staff. A new sense of hope and pride in the department quickly developed. One nurse in particular who was on the verge of being fired over service excellence issues became one of the biggest advocates of the new processes. Not only did this nurse thrive in the new operational, but they also earned a promotion shortly after the new processes were implemented.
75%
drop in walk-outs
25%
reduction in overall length of stay