Satisfaction Rx: Run hospital like an ED
Satisfaction Rx: Run hospital like an ED
Unified care stops some problems before they start
Numerous emergency medicine experts have noted that a number of ED overcrowding and flow problems really are hospitalwide problems; few, however, have recommended running a hospital "like" an ED to solve those problems.
However, that's precisely what Charles Flinn, MBA, CHE, vice president at Saint Clare's Hospital/Denville (NJ), and Jan Bednar, RN, BSN, ED manager, have done. Their efforts have earned them a national patient satisfaction award from The Jackson Organization, a Laurel, MD-based market research firm specializing in health care. The organization uses a percentile ranking system similar to that used by Press Ganey.
The ED's scores usually are in the mid-90s. "We've been doing that for several years now," Bednar says.
At the root of those rankings are improvements in several areas that relate to patient satisfaction. For example, it formerly took about three hours from the time a patient presented until all labs were completed; that time has been cut to one hour. And there have been no diversions since February 2005. The key to this success, says Flinn, is "a unified approach to patient care involving physicians, nursing, and ancillary services. A synergistic team has been created down in the ED."
Bednar says, "We've been building this team for the last five years. Customer service has to be No. 1."
Driven like an ED
Flinn, who came to the facility two years ago, has a background in emergency medicine and "decided to drive the whole thing like an ED" to address patient flow and diversion issues.
Emergency medicine, he explains, is episodic, and providers sometimes do not get to see the effects of their work over the entire continuum of care. Accordingly, Flinn says, "They like to come up with quick wins — develop an idea and execute it."
Discussing patient flow
Those quick wins are enabled by what originally were called "bed huddles." Now known as patient flow meetings, they began in January 2005. "We chose a small office for all department managers to come together every day at noon to discuss the ED's needs," Flinn recalls. "This unraveled the whole picture of what flow looks like."
The meetings, which last 12 minutes, involve all clinical departments, social work, case management, and the house department; even EMS staff participate by phone.
"What happens is we come to the meeting with our [bed] needs, and don't leave until we have them filled," Bednar explains. Bargaining goes on between the departments. A kidney stone patient may be admitted to the pediatric unit, or a unit that has been shut down may open up as "flex" unit to accommodate ED needs. "The beds may need to be cleaned, but basically we walk away from the meeting with [more] beds in the ED," says Bednar. "It's now rare that we hold anyone more than a couple of hours, and there's improved satisfaction because of that."
Testing speeded up
Flinn often turns to the ED staff for suggestions on how to improve. "For example, we had some opportunities for improvement in outpatient and pre-admission testing," he says. "What they suggested did wonders."
The suggestion was to open the fast-track sooner than normal. It still officially opens at 10:30 a.m., but now at 6 a.m. it is open for pre-admission testing of patients, with the ED tech functioning as the "concierge" who facilitates the process.
"Patients are not being triaged," Bednar explains. "We are simply utilizing the space in the ED for pre-admission testing." In other words, she adds, it is an outpatient service using ED space and staff. Flinn says, "Patients used to go to a different floor for X-rays, EKGs, and labs, and often they would get lost. Now it's all done in one area." Blood is drawn by the tech, and a nurse does the assessment, he says.
This change hasn't added anything to the budget, Bednar says. "We've just rotated duties and been more creative with staff hours." The tech and nurse, she explains, are already working during those hours, so all that has changed are their responsibilities and scope of practice.
Watch the 'little things'
Flinn also has brought an entirely new type of management to the ED, says Bednar. "It made me realize that the little things we may not notice, our patients do," she says.
Flinn says he has adopted the "broken windows, broken business" approach first used by former New York City mayor Rudolph Giuliani. "If the lighting is not right, if the signage is crooked, they have to be fixed," he says. The staff pay attention to all the little details, Flinn says. "Pick your head up when you see someone walk through the hall," he says. "Have a smile on your face."
The ED physicians and nurses have bought into the approach, says Bednar. "They live by example, so I try to set the right example and tone, and that helps," she observes. "But they are an awesome team."
Having Flinn provide greater administrative presence in the ED also helps, Bednar says. "So many services depend on what happens in the ED, and now the ED is driving the way the hospital operates," she says.
400-plus callbacks every month
Bednar says her attention to patient satisfaction also has caused her to be very proactive about doing callbacks. For example, a patient may complain that the length of stay was longer than he or she thinks it should have been, "If their nurse flags me, I'll call the patient within 24 hours to ask if there's anything we could have done better," she explains. Bednar says she originally had a goal of calling back 15% of all patients (400-600 a month), but recently increased it to 25%.
Not all patients who have a positive experience will share it, "but if they have a negative one, they'll tell 20 people," she admits.
Sources
For more information on ED-driven patient satisfaction strategies, contact:
- Jan Bednar, RN, BSN, Manager, Emergency Department, or Charles Flinn, MBA, CHE, Vice President, Saint Clare's Hospital/Denville, 25 Pocono Road, Denville, NJ 07834. Phone: (973) 625-6000.
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