This week a Team of GBMC people spent 5 days studying our system from when a patient is first seen by an Emergency Department physician until those that need to be admitted to the hospital are actually in an inpatient bed.
The Team was chartered because we identified this as a strategic opportunity for improvement when we created our operating plan for this fiscal year. We set a goal for ourselves to reduce the average time from when a patient arrives in the ED until they are in an inpatient bed from 8.5 to 6.8 hours… a reduction of 20 percent.
GBMC HealthCare set this goal because our patients get very upset when they are still in the Emergency Department long after they have been told that they need to be admitted. This is no surprise. Almost every adult has accompanied at least one family member who has waited in some ED to be moved to an inpatient bed. If we don’t want this for our own loved one, no one should wait. Not to mention the cost to our system of extra staffing and foregone admissions when other people leave our ED and go somewhere else for care.
The Team included doctors and nurses from the ED, hospitalists and inpatient nurses, secretaries and people from many support services. Their mentor was Neil Crockett from Next Level Partners and they were aided by a number of our Performance Improvement Masters. After getting some training, the team set out to study the current processes. They went to the ED and the inpatient floors and watched them and documented the way they were doing things. The Team identified 89 sources of unnecessary variation and waste.
They were amazed that for almost every step that they studied, each person doing a task was doing it differently. They then identified 56 actions that they could take to redesign the processes within the system. The Team then divided these actions into things that they could change right away: “Just do it’s”, things that they could test immediately (trystorming), and more complicated things that could be changed over time. They immediately implemented the “just do it’s” and began implementing the things that seemed to work in the “trystorms”.
I went to the final Team report today and was amazed at how much they had accomplished. Every team member had a greater understanding of how the other team members were doing their job and how complex the system of admitting a patient from the ED actually is.
There is a lot of work to be done to redesign healthcare in our country and in the GBMC system. When we talk about delivering better health, better care, and lower cost, the uninitiated believe that this means more work for those providing the care. It is only when they develop the deeper knowledge of what is going on in our existing system that they see that a lot of what they are doing is not really benefiting anyone and if they do the work of redesign, they will accomplish better health and better care with less work.
It was really exciting to see that this was one of the learnings from the Team’s efforts this week. I am awed by what they accomplished and am more excited than ever about the transformation of the GBMC HealthCare system.