South Florida Hospital News
Tuesday September 17, 2019
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November 2006 - Volume 3 - Issue 5

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The Doug Williams Group Does it Again

South Florida Performance Improvement Consulting Group Helps Houston-Area Hospital Achieve Stellar Results

All hospitals want to provide their patients with excellent care and service, and most are diligent about doing so. But, what happens when you're not sure you're achieving those goals, and you're not sure exactly what to do?

That's where OakBend Medical Center found themselves last year. OakBend, located about 30 miles southwest of Houston in Richmond, Texas, was concerned for several reasons.

A recent report by the Centers for Disease Control confirmed that a growing role is being played by emergency departments as "front doors" to health care. According to the report, 114 million patients went to hospitals for emergency treatment, and it took, on average, more than three hours for a patient to get in, get treated and get released or admitted as an inpatient. There was also a waiting time of over 45 minutes to see a physician.

Patient wait times in OakBend's Emergency Care Center (ECC) and the number of patients leaving without treatment (LWT) were critical issues at OakBend Medical Center------significant concerns when you consider that nearly 80 percent of OakBend's inpatient clientele arrives through the ECC. OakBend was also beginning to experience heavy competition from other hospitals and a newly constructed emergency department just a few miles away would be open for business in just a few months.

Bringing in the Experts: The Doug Williams Group

Realizing a serious need to evaluate how they're doing and where improvements are needed, OakBend's administrators did what people in their position do when they need to make absolutely sure they're on top of their game--and remain there.

They called The Doug Williams Group.

The Doug Williams Group is a Miami-based performance improvement consulting firm that specializes in customer service, employee satisfaction, and profitability improvement. With scores of patient satisfaction and process improvement successes at hospitals across the country, they were more than ready to take on the assignment.

"First, it was important to get a sense of what patients were experiencing in OakBend's ECC," says Williams, president and CEO of The Doug Williams Group. "We started the OakBend engagement by conducting a comprehensive assessment of the patient flow process to identify bottlenecks and improvement opportunities. We also gathered extensive input from physicians, ECC staff, and support department staff to bring some focus to our improvement action plans."

At the time of the assessment, more than 8 percent of patients who had arrived at the ECC seeking treatment were leaving without treatment. "For a facility like OakBend, that's a huge number, according to Jody Jones-Noirot, MBA, BSN, RN, OakBend's Chief Operating Officer."The Emergency Department has become more like the front door to the hospital than the back door," she says. "When patients walk in, we want them to know their needs are important and we'll provide them with quality care in a timely manner."

Following the ECC assessment, OakBend engaged The Doug Williams Group to address a number of issues related to how patients were greeted, triaged and provided care in the ECC. The objectives of the engagement were to improve patient flow efficiency, increase patient satisfaction and dramatically reduce the percentage of LWTs. Understanding that improvement in the ECC could only be achieved if ECC improvement became a hospital-wide priority, Williams and Jones-Noirot chartered an ECC Patient Satisfaction Improvement Team comprised of representatives from all hospital departments and the ECC physician group.

The Emergency Care Center Improvement Initiative: A Three-Step Plan

The ECC Patient Satisfaction Improvement Team launched three key initiatives that played major roles in significantly reducing patient wait time and greatly improving Oak Bend's LWT situation.

The first step was the implementation of nurse triage protocols. Although triage protocols were already in place, they weren't particularly effective. The protocols were updated and modified to add patient complaint specific protocols. "The revised protocols have made a dramatic difference". Ted Rodriguez, RN, AAS, director and manager of emergency care and trauma services, says. "Physicians now have the diagnostic information in hand by the time the patient arrives. That's been a big boost to patient satisfaction, and it's decreased our LWT percentages." Also, realizing the need to make a positive first impression, registration/greeters were trained to use standard greeting scripts upon patient arrival and an informative brochure was developed to explain to patients and family members what to expect during their ECC visit.

The next step was to address how the hospital could reduce turnaround time for lower-acuity patients. To achieve this, The Doug Williams Group worked with OakBend to create and implement a QuickCare process. Although six of the ECC's 18 emergency beds were designated as "fast-track" beds, Rodriguez realized the need to completely revamp that system.

A QuickCare pilot project, staffed by an RN and a nurse practitioner, was carefully designed and implemented by a subgroup of the ECC Patient Satisfaction Improvement Team. Three beds were reserved for lower-acuity patients from 11 a.m. to 11 p.m., three days a week. The objective was to reduce turnaround time to less than an hour for QuickCare patients, which would allow ECC physicians to concentrate on more serious cases. "The QuickCare program was so successful that a second nurse practitioner was added, and the program was expanded to seven days a week," recalls Williams.

The third step was the development of numerous process improvement tools developed by The Doug Williams Group. One tool was a performance scorecard that's used to measure a number of patient flow indicators, including: (1) the time between patients' arrival and when they're seen by a physician, (2) the time from when a physician sees them to their time of disposition, (3) percentage of patients who leave without being treated and (4) by-physician utilization and (5) by-physician wait times. The performance scorecard has provided a mechanism to ensure that implemented improvement actions are translated into tangible results.

To measure patient satisfaction, The Doug Williams Group developed a real-time patient satisfaction system that is customized to OakBend's specific needs. The system is used to conduct daily telephone surveys of recently discharged patients. Patient satisfaction scores, specific patient comments, and patientís improvement suggestions are provided to OakBend every two weeks. This not only helps hospital administrators, ECC staff, and ECC physicians make any necessary adjustments immediately, but also allows for positive recognition of physicians and staff. The Doug Williams Group has also conducted telephone interviews of all patients who leave without treatment to learn why they left and what could have been done to make things better. Those calls also ensure that patients who leave know that the OakBend ECC cares that they left and is working to improve.

To say the least, the initiative has been highly successful.

"The Emergency Care Center Improvement Initiative engineered and implemented by The Doug Williams Group had an immediate dramatic impact on our percentage LWT," says Noirot. "Process improvements, management systems and our successful QuickCare implementation have allowed us to reduce our average LWT from eight percent to less than three percent, and we have been holding those gains for 11 consecutive months. In fact, last months percent LWT was a record 1.8%. The improvements are hardwired."

As the charts on this page indicate, the results have been impressive. Percentage LWT was dramatically reduced 3 months after the start of the initiative and patient satisfaction scores have consistently improved to an unprecedented current high of 4.0 on a 4.0 point scale.

"OakBend Medical Center is a good example of the right way to approach improvement in the emergency services area," says Williams. "The senior management team understood from the beginning that significant and lasting improvement in the emergency department could only be made through a hospital-wide initiative with their full engagement. The ECC Director, Ted Rodriguez, provided strong leadership to a great staff who simply wanted to make a good ECC a great ECC.

The Doug Williams Group, a Miami-based performance improvement consulting firm, specializes in customer service, employee satisfaction, and profitability improvement. Mr. Doug Williams can be reached by phone at (305) 598-9880 or via e-mail at doug@thedougwilliamsgroup.com. To view services and success stories visit the firmís web site at www.thedougwilliamsgroup.com.
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