The Art of Making Sustainable Change in Your Hospital Part I

I have discussed specific ways to improve the performance of your Emergency Department by providing specific action steps to take and the key areas to look at first. But once you start this process, how do you go about making changes in your organization that will last? How do you go about changing the culture of an organization?

The guiding principle is that the approach must be comprehensive, inclusive and implemented consistently over an extended period of time. There is no overnight or quick fix that will be worth anything to your organization in the long run. You must commit to actively working to address the particular problem daily for a period of six months to a year. After that you must continue to monitor it daily to ensure that there is no backsliding or returning to the previous culture that created the problem.

The first step in the process is to identify the particular problem being addressed; such as lowering the number of patients leaving the ED without treatment or increasing the number of inpatients discharged before Noon. You must also collect baseline data on the current performance in each area; such as LWOT of 4.5% or 12% of patients discharged before Noon. If you don't currently have in place an accurate measurement system you must initiate one. If you can't measure it you can't manage it.

The next step is to break the particular problem into the individual components that take you from the beginning to the end of a process. For example if you are decreasing the time to get an MI patient diagnosed in the ED to the Cath Lab with balloon inflation, there are multiple departments and multiple steps that can be the source of bottlenecks and delays. Analyze the entire process and create separate teams to look at each area and improve it. Is the primary care physician contacted and do you wait for his response before calling the cardiologist? How long do you wait for the cardiologist response before calling in the Cath Lab team? Are the Cath Lab team members called individually in sequence or do you have a broadcast page alert? If you get the people in each of these areas involved in helping address the issue, not only will you get much better information about the problems but you will also get much stronger support for the solution.

In the next post I will discuss how to integrate this input and the all important process of establishing an effective measurement and feedback system.

More on this later.

Mark Brodeur