Windsor Regional Hospital like several hospitals in Ontario was experiencing long wait times in its Emergency Waiting Room. ER physicians, management and staff in the ER were as concerned about long waits as their patients were. Wanting to do something about it, the hospital challenged itself to improve the ER process as a top priority! The ER Team had traveled to several different Emergency Departments in both Canada and the United States, searching for solutions. Discovering the training offered by the Michigan Manufacturing Technology Centre, several ER staff were committed to becoming lean Champions and Six Sigma Black Belts, adopting a philosophy and environment conducive to continuous process improvements now and in the future.
The ER, of all departments at Windsor Regional Hospital was the first to be introduced to the Michigan Manufacturing Technology Center’s LEAN Healthcare Systems and Six Sigma philosophies. The LEAN technique was originally instituted by Henry Ford in the automobile industry, later refined by Toyota in the 1950’s. Mike Rother and John Shook of Michigan were the two LEAN pioneers who created the analysis method. Quite simply, the philosophy allows staff to look at each and every process in the organization to determine the steps that would actually add value to the delivery of health care and eliminate those that do not.
The process began several months earlier leading up to a “Kaizen” event. Every department that interacted with the ER were involved, with a great deal of planning to identify where processes could be improved. “Kai” and “zen” are two Japanese words meaning “good change”. It is a method of rapid improving processes in the workplace. A Kaizen Team is composed of a cross-functional group of staff representing the varied departments in which the improvements have been made. In this case, the ER staff applied problem solving, organizing and process improvement methods that were deemed the most effective.
ER staff were energized by the process and prepared for the Kaizen event that took place over a five-day period. Utilizing LEAN tools, ER staff began at 4:00 a.m. on a Monday morning, starting by standardizing each room in the ER in order to eliminate delays in accessing the tools required to care for patients effectively. This proved to be a labourious task, going through every inch of the department, re-organizing everything from crutches to medications to pieces of gauze. The activity eliminated as much waste and excess inventory as possible in an attempt to re-allocate resources where they should be, directed at patient care. Each morning over the five days, the team met to assess their accomplishments and establish the day’s priorities in order to meet their objectives by day five. The end result of the “good change” now gives ER staff more time to spend meeting the needs of patients.
“As part of a new way of providing direct patient care, the ER established an Ambulatory Care area for patients not requiring a stretcher for treatment however, still be treated effectively in less time while still maintaining the highest levels of care for stretcher patients.” stated Theresa Morris, director of the Emergency Department at Windsor Regional Hospital.
Through revolutionizing the way patients are cared for in a more timely and effective manner in the ER, everything in the department is now at the finger tips of staff. New projects will embrace ongoing continuous improvements as a way of doing business from this point on. One of the physician leaders in the Windsor Regional Hospital Emergency Department is Dr. Robert J. Woodall, who created a revolutionary method of operation within the ER defined as ‘WArP SPEED’, a completely new set of concepts that will pioneer new ground and break new records for efficiency, with more focus on care of the patient. This concept requires several process changes which include construction changes in the ER as well as a state-of-the-art Electronic Charting System.
“WArP SPEED concepts will move the ER at Windsor Regional Hospital into the future where wait times will virtually be non-existent, allowing the Emergency Department staff to do what they were all trained to do, care for their community.” said Dr. Woodall.
Windsor Regional Hospital is a large, multi-site health service organization providing Acute Medical and Surgical Services including Emergency, Family Birthing Centre, Neonatal Intensive Care, Paediatric Services, Critical Care, Regional Cancer Services, Children’s Mental Health, Complex Continuing, Long Term Care, Mental Health/Addictions and Physical Rehabilitation Services to over 400,000 people in Windsor and Essex County (within the Erie St. Clair LHIN, Region One). By adopting the new way of thinking and applying an environment demanding continuous change for improvements, Windsor Regional Hospital is poised to be at the forefront of Emergency care in Ontario.