Emergency Department director Melissa Ritchey and the staff were feeling discouraged in January 2013. Wait times in the department were too high. Too many patients – as many as 7 percent in some months during 2012 – were leaving without being seen.
When she learned Tucson Medical Center would embrace a “Lean” management philosophy, she was first in line. “I needed help. We had tried a series of strategies, but it just seemed nothing was working.”
The staff got to work, relying on multidisciplinary teams to break apart and deeply analyze steps in a process, looking for inefficiencies and bottlenecks.
Example: In 2013, it was taking as much as 30 minutes from a time a patient received discharge instructions to the time that patient was walking out the door. Staff set a goal of 15 minutes to more quickly free up beds for other patients.
Every day, staff huddles to track the numbers, troubleshooting problems they encountered when they miss any target such as the 15 minute mark. Sometimes, they’re so eager to see their measurements that they call and ask for their numbers if they are not working that day.
That kind of engagement is reflected in measurements.
Wait times in the main emergency room have dropped from an average of 4.6 hours to meet the industry standard of 3.5 hours.
By 2013, staff had reduced the number of patients who left without being seen from a high of 7 percent the year before, to 3.5 percent. This year to date, that number is 1.75 percent.
“It has been a culture change, the department is not what it was like 5 years ago” Ritchey said.
She admits when she first heard about Lean, she was a bit skeptical, since other strategies had not made a dent. The difference? “This process really does empower the staff. It’s really about generating a sense of ownership.”
Emergency room nurse Heather Williams agreed. “This is a very different place now than it was a few years ago. Staff is really involved in helping to determine what works and as a result, we’re really working as a team and there’s much more pride and ownership than ever before.”
For Ritchey, was it difficult, as a manager, to let go? “You always hear that it’s hard to look at the big picture when you’re always trying to put out fires. Now, if a computer is broken or we need to come up with a holiday schedule, the staff takes ownership, and it really has allowed me to focus on the big picture and assure the staff have what they need to care for our patients.”
“For a manager, it’s really about finding that balance between when you need to issue clear directives and when you can step back and let staff decide how to take care of it.”
She thinks happier patients and happier staff worked together to fuel another happier number: Higher volumes. In May 2014, the department saw 500 more patients than the previous May, with year-to-date volumes 7.5 percent higher than expectation.