It’s a busy day in the emergency department at Markham Stouffville Hospital. But it’s not unusual. The hospital sees 52,000 patients a year in its growing community in York Region. The hospital, built almost 20 years ago, was designed for a population of 150,000. The current population is 300,000 and is growing steadily every year. “To say that we are bursting at the seams, is an understatement,” says Janet Beed, President and CEO. “We are scheduled for redevelopment but because our new building is at least several years away from being open to patients, our staff are looking at some creative ways to manage in the meantime.”
The leadership team at Markham Stouffville Hospital turned to the LEAN methodology, a process that brings together teams to examine current processes and identify opportunities for positive change and improvement. The goal of LEAN is to increase efficiencies and improve patient and staff satisfaction. “Patient care is always enhanced by this process,” says Beed. “We look at things from the patient’s perspective and find ways to make it better.”
The process also supports staff satisfaction and engagement because the team is made up of a variety of staff from the hospital. The strength of the process is that everyone on the team is treated as equals and their ideas are valued. There is no hierarchy, there are no defined roles. LEAN brings together a group of staff committed to making it better for patients and each other. It doesn’t matter if you are a doctor, nurse, lab technician or a clerk, your ideas are valued and taken into consideration.
“The staff really came together around this process,” says Dr. Andrew Arcand, Chief of the emergency department. “We looked at the way we do everything, from managing patient flows, to supply, to triage, to offloading ambulances. We put everything under the microscope and looked for ways to do things more efficiently and effectively. In the short term, we know we won’t have more space, so we have to look at ways to do things better in the current space and with the current resources we have.
Through the LEAN process, the department has held six Kazien events. These weeklong improvement events bring together a team of people who collaboratively identify areas for improvement, trial the improvements and implement those changes that worked well. Through the events, over 50 areas for improvement were identified and put into place.
“Generally, we do things really well here; but we are always looking at ways to do things better. Through the process, we found many areas for improvement. Some were minor adjustments to current processes around things such as the flow of patients and information throughout the department,” says Arcand.
Some minor improvements, such as creating visual cues to trigger reassessment and a time card stamp that helps to track the time from when a patient enters the department by ambulance to when they are offloaded, help to improve the overall care provided to patients. The team also identified some larger areas for improvement and went to work implementing their solutions.
Rapid Assessment Zone (RAZ)
The team created a Rapid Assessment Zone (RAZ) to provide quick assessment and treatment for patients who do not require a stretcher. The RAZ enables faster turnaround times for patients who can be cared for in a chair. Patients are assessed by the physician on a stretcher and any follow-up care is provided in the most appropriate location. “We knew that we needed a way to move patients through the department quicker,” says Heidi Pedersen, Manager of the emergency department. “The RAZ allows our staff to deal with patients in a more timely fashion, particularly those who do not need to be lying down in a stretcher. Patients want to be seen by a doctor as quickly as possible, and this is one way we can make that happen. The RAZ has resulted in faster turnaround times for patients and a decrease in wait times to a see a physician.”
A light went on(and off)
Some of the changes were more subtle than others, but still ended up having a significant impact. “We all know how busy the emergency department can be and we wanted to look at ways to ensure everyone was managed effectively, including our ambulances,” says Arcand. A light was installed at the triage desk that flashes when an ambulance is waiting to be offloaded. “It’s a little thing, but this visual cue allows our staff to immediately know when an ambulance is waiting. And if there isn’t, our staff can spend those extra minutes caring for our patients.” The result has been shorter turnaround time for ambulances and an improved relationship between paramedics and staff.
Welcome to theemergency department
“Hello, I’m the emergency department (ED) volunteer. How may I help you?” Not exactly the words you expect to hear when walking into a busy ED, but that’s the role of the new volunteer greeter position recently instituted at the hospital. “Coming to the ED can be a difficult and confusing experience for some patients,” says Arcand, “and part of that anxiety can be from not understanding the process.” The role of the greeter was introduced to provide patients with a central point of contact who can answer their questions and direct them appropriately.
“I am passionate about the ER greeter volunteer role because I enjoy interacting with the patients to prepare them for their triage assessment. It is rewarding to know that both patients and staff have benefited from our services,” says Alex Prosser, one of the volunteer hospital greeters. “As the lead volunteer, I also provide standardized training to new volunteers and summer student volunteers.” The response from patients has been overwhelmingly positive. “We’ve heard from our patients that the greeter makes them feel better and not as anxious. The greeter plays an important role in our department,” says Arcand.
The response from the staff to all of the improvements has been equally enthusiastic. “Many of our staff has participated in the improvement events,” says Pedersen. “By being part of the solution, they have a real sense of ownership over the changes and are always looking for ways to make things better. As Joanne Alfane begins her nursing shift in the department, she glances at the busy patient board. “It’s always going to be busy here. But the one, two or 50 improvements that we have made, have really made a big difference and have helped a great deal in taking care of our patients.”