A new post on Harvard Business Review's blog by a team from Boston-based Brigham and Women's Hospital sheds light on how the hospital "pulled the Andon Cord" — altered all administrative levels to the necessity for change — and brought its emergency department from the 6th to the 99th percentile in patient satisfaction by decreasing wait times and improving patient flow.
According to the blog post authors, reducing the "door to bed" time from an average of 65 minutes in 2009 to an average of 22 minutes in 2013 has decreased walkouts from 3.3 to 1.5 percent and has allowed Brigham and Women's to repurpose waiting room space for patient care.
Process improvement steps the hospital took include:
1. Getting everyone on the same page. Brigham and Women's impressed upon the ED leadership the seriousness of the problem with required reading: "Our Iceberg is Melting," a book by John Kotter about succeeding through change in any condition.
2. Taking notes from the principles of lean manufacturing. Brigham and Women's brought in operations and services experts to train leaders and front line staff on quality improvement techniques in the style of lean manufacturing.
3. Making change a group effort. Brigham identified key stakeholders at all levels and made interdisciplinary redesign teams of these stakeholders to foster idea development from all stages of the patient care process.
4. Supporting Change. Brigham supported teams with data analysts to determine where the patient-flow processes could be improved, so interdisciplinary teams could know where and when to put their minds to brainstorming change.
More on Capacity Management:
North Adams Hospital Slashes ED Wait Time by Half in a Month
3 Examples of Reducing Inappropriate ED Use
Study: Patients Prefer Boarding in Inpatient Than ED Hallway