Make a Patient-Centric Culture the Focus of the ED

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:

• Does the first impression of the ED suggest a welcoming, caring environment?
• Are staff and leaders committed to maintaining a patient-centered culture?
• Are service standards clearly established as non-negotiable behaviors?
• What tools and tactics have been put into place to improve the patient experience?
• Are leaders rounding on patients? Are staff rounding on patients?
• Are whiteboards in place in every room? Are they used regularly?
• Are patients kept informed about delays? Their care?
• Are the ED leaders familiar with their patient satisfaction vendor tool?

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: 

1. Ensure a team is dedicated to satisfaction and service. This group might be part of an existing committee or shared leadership structure or may be a freestanding
2. Leaders and staff must do everything in their power to keep patients informed.
3. One of the best ways to keep patients informed is for nurses to round on patients regularly either hourly or as often as possible.
4. Another effective tool for keeping patients informed is the use of whiteboards. These boards can be challenging to hardwire in the ED but can be very effective for communicating with patients and their families. Keep them simple and focused.
5. Develop Words that Work^SM for everyone in the ED to use when interacting with patients.
6. Consider creating a process for calling patients by phone upon discharge to check on their condition.

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:

• Has the team established clear throughput goals?
• Is the entire team committed to the same throughput goals?
• Is the model achieving acceptable goals?
• What does the current throughput model look like?
• How many steps are in the typical patient experience? Are any wasteful?
• How many times does a patient have to stand up and sit down?
• What are the barriers to creating an optimal flow model? Are they being addressed?
• Are lab, radiology, registration and inpatient departments committed to efficient ED flow?

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.