BHA FPX 2110 Assessment 2 Team Meeting and Project Charter

At the meeting held at Green Valley Hospital, a few issues were raised that related to operations undertaken in the Emergency Department. First of all, Mr. Lee, the administrator of the hospital, opened the meeting by highlighting some aspects which will be addressed during the meeting. First, there is a need to recognise that the efficiency of an ED presents a number of operational challenges that need to be tackled to ensure its sustainability and delivery of high-quality health care. The literature has advocated a systematic process improvement approach, which is well endorsed for attaining these objectives.

Dr. Johnson, chief of medicine, also voiced his worries with the way the department was operating. The problem outlined here is typical of emergency department inefficiencies, and has been consistently found in the literature to be connected to longer waiting times, a greater number of staff to care for patients, and poorer quality of care provided to patients. The recommendation of Mrs. Garcia fits into the framework of clinical governance and evidence-based practice, which focus on quality improvement in care provision by establishing effective and appropriate training for staff and stringent adherence to clinical guidelines.

This involves developing the nurses’ skills, applying clinical protocols consistently, and holding nurses accountable for clinical practice, which all help to improve patient flow, minimise clinical errors, and enhance overall efficiency of service delivery in the ED. Lastly, according to Ms. Thompson, the finance manager, the cost incurred in running the ED each day has been steadily increasing. The main causes of this increase are the prices of supplies, salaries, and electricity costs. One of the highest costs involved in higher healthcare spending is the high cost of supplies, salary costs, and electricity bills, as mentioned by Zurynski; this is reflected in the current literature on health spending.

The primary key challenges for GVH’s operations, especially with respect to the ED, include inadequately available resources and sluggish workflow. However, the most critical challenges are related to the excessively long waiting times of patients in the ED, which require immediate solutions. The overlong wait times lead patients to become irritated and also may cause delays in patient assessment and treatment, which can negatively affect patients’ safety and well-being. In addition, the delay causes stress to the hospital staff, causes overcrowding, and reduces efficiency in services provided.

The improvement project I intend to design is going to occur in the ED of Green Valley Hospital (GVH) to eliminate patients’ wait times. This not only impacts patients, but also the nurses and the hospital’s overall management. There is currently a waiting time of about 45 minutes before patients meet with nurses and up to 90 minutes before they have an appointment with a physician, resulting in reduced patient satisfaction, delayed care, and increased clinical risk. It also adds to the job load, stress, and burnout of the nurse, which has a negative impact on the nurse’s ability to provide timely and effective care.

A common issue in healthcare is patient wait times, which is especially problematic in rural areas where there is a shortage of staff, a high number of patients, and a lack of resources. To overcome this problem, Lean Six Sigma (DMAIC) methodology will be used as the main method of improvement. Nurses will have a key role in this programme by being actively involved in triage prioritisation, ensuring the best patient flow, real-time identification of inefficiencies, and ensuring timely communication with physicians. Their participation is integral to lowering wait times, curbing waste in health care workflows, and ensuring consistency of health care delivery that will impact quality and efficiency of care in the ED.

Lean Six Sigma works well in the ED, due to the integration of Lean principles – waste reduction and process flow improvements – with Six Sigma – reducing variation and improving quality. While PDSA is about small incremental changes, DMAIC is a structured and systematic approach to determine the root causes and apply sustainable changes to an entire system. It uses the DMAIC (Define, Measure, Analyze, Improve, and Control) process to help guide it through the process, which involves identifying a problem, long wait times, and determining project goals and stakeholders.

During the Measure phase, important measures, including triage time, patient length of stay, and throughput, are gathered to provide baseline measures of performance. The Analyze phase involves statistical analysis and tools used to map the process to uncover root causes of delays such as staff or resource shortages, inefficient triage systems, and diagnostic delays. Specific, focused interventions (such as workflow, staffing, and triage changes) are put into practice and piloted in the Improve phase. Lastly, the Control phase is about Sustainable improvements through monitoring mechanisms and audits and the establishment of standardized procedures.

This approach is a particularly appropriate method for GVH as emergency department delays frequently reflect multiple and interrelated inefficiencies of the system, which will likely require a large-scale and structured approach. Moreover, Lean Six Sigma fosters standardisation, minimisation of waste and optimisation of processes, which have a direct impact on patient flow and the reduction of waiting time. On a global level, the Lean Six Sigma (DMAIC) approach will give GVH a strong, sustainable, and evidence-based approach to reduce ED wait time and improve the quality and safety of patient care.

Green Valley Hospital ED Project Charter

Emergency Department Patient Wait Time Reduction Initiative

Problem Statement

Business Case & Benefits

The problem that is currently on hand is a problem with “long delays” that are very common in the Emergency Department of the Green Valley Hospital. The time waiting for patient assessment and examination is usually around 45 minutes to 90 minutes, respectively.

These delays are common in this institution and are associated with staffing shortages, inadequate triaging, as well as the ratio of the number of patients to the size of the premises to offer health services. While delays in most circumstances are unavoidable, they have a negative effect on many things.

For instance, they lead to uncontented patients, longer treatment times, overburdened hospital employees, and disruptions to work processes. Additionally, waiting times for patients can be detrimental to any medical facility’s bottom line as the value-based payment programs provide lower reimbursements.

Why this recommendation is important: bringing about improvements in wait times will have a direct impact on the safety of the patient, patient satisfaction and quality of treatment received, and will also help to address stress experienced by staff.

The following undesirable consequences will likely occur in the future if the recommendation is not implemented immediately, for example: an increase in complaints from patients, patients’ dissatisfaction with the provision of services, erosion of the hospital’s reputation and financial capacity from participation in performance-based payments programmes.

Initiative

Timeline

Work to decrease emergency department patient wait times through enhancing the efficiency of triage, patient flow and staff coordination through the use of the Plan-Do-Study-Act (PDSA) quality improvement approach.

Phase

Planned Completion Date

Actual

Define:

 January 14^th

January 18th

Measure:

 January 30^th

 March 10th

Analyze:

 April 10^th

 April 12^th

Improve:

 May 10^th

 May 12^th

Control:

 June 4^th

 June 20^th

Scope – First/Last and In/Out

Team Members

1st Process Step

Position

Person

Title

% of Time

Last Process Step

 Establish and evaluate improved triage and patient flow processes to ensure ongoing improvements to minimise ED wait time.

Project Sponsor

 Mr. Lee

 Hospital Administrator

 10%

Project Manager

Improvement Coordinator

(Your Name Here)

50%

In Scope:

Out of Scope:

The project focuses on the existing triage and reworking it into an effective method of patient flow and minimising delays. New processes will be trialled in a PDSA cycle and changes to employees’ duties and tasks will be introduced during the peak seasons. Continuous assessment will be made of time spent waiting, time spent in the ED and patient flow, through the development of clear communication of staff members and feedback to them.

This is not an attempt to address these issues, including a change in staffing throughout the hospital, a larger physical Emergency Department, or a new technological flow in the entire hospital.

Clinical Lead

Nursing Lead

Financial Officer

 Dr. Johnson

Mrs. Garcia

Ms. Thompson

Chief of Medicine

Head of Nursing

Director of Finance

20%

20%

10%