Emergency Department Modified Lean Implementation on a Regional Basis

Session
Lean Six Sigma

Authors
Danielle Organ
Management Engineer
HCA, West Florida Division

Michael Lozano Jr., M.D., FACEP
Regional Executive Vice President
EmCare

Donna N. Biehl, R.N., B.S.
Vice President of Clinical Services, Southeast Region
EmCare

Description
Nursing and Physicians partnered to standardize emergency department care across six West Florida Region facilities using a modified Lean strategy. The presentation will cover the methodology to bring the teams together, obstacles faced, a review of the standard processes implemented, and the results in various stages of implementation.

Abstract
An efficient Emergency Department is something that every administrator, director, doctor, nurse and patient desires. Six West Florida region facilities partnered with our contract ED Physician group to perform a shared training and implementation process that taught Lean and time management principles to ED staff and medical providers and applied best practices identified across both groups. The strategy was derived from a 5-day Kaizan Lean event, and modified to fit culture, productivity, and budgetary needs of an ED. All facilities are in various stages of implementation, however, all have seen improvements in front-end metrics. Two facilities cut both the door to provider time and the percent of patients leaving without being seen by approximately 50%, and we have also seen significant growth in volume. Process changes will always result in some challenges for sustainability at a staff level; however, the training program is designed to teach the staff how to think about efficiency and encourages them to come up with their own solutions for an improved process that centers on the patient. Keys to implementation include a well defined collaboration between nursing and providers and a strong effort to ensure that previously defined process are not deviated from during implementation.