Changing Patient and Workflow paradigms at the Emergency Room in Hospital De La Concepcion

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Tools, Techniques & Strategies for Change

Noris Torres
Vice-President, CIRACET Corp

The Emergency Room (ER) of a 160 bed hospital in Puerto Rico has been experiencing a decrease in patient satisfaction levels and excessive waiting times. As ER visits increase the administration hopes for a more efficient process. In order to improve the ER processes and patient satisfaction levels, Lean Manufacturing and Six Sigma concepts were used in the evaluation of patient services and workflow.

After moving Hospital De La Concepción to their new facilities in 2004 the Emergency Room started to confront the follwoing difficulties: a decrease in patient satisfaction levels, and a significant increase in length of stay (LOS). Moreover a 15% increase in the ER visits was also observed when compared to 2004.

The scope of the project was to analyze the ER processes from patient arrival to patient disposition. Lean Six Sigma concepts were used in order to meet or reach the project goal: a 20% decrease in the LOS and a 10% increase in patient satisfaction levels.

As a part of the project methodology, special attention was placed on evaluating the value stream and improving patient and workflow taking into consideration the voice of the customer and the voice of the business. Lean tools were used to assess a faster process. In addition, Six Sigma concepts were sued to evaluate the process capabilities to meet customer expectations and process variations.

Major findings included:

  • Identification of non value added activities such as rework, waiting, motion of people and material and information movements were identified throughout all ER processes.
    • Waiting times represented more than 40% of the total length of stay
    • Transportation of patients and movement of materials and information accounted for more than 2 hours of a nurse shift.
  • Elimination of bottlenecks. It was identified that the constraint was the treatment process performed by the nursing staff that includes processing medical orders, and initializing patient treatment among other tasks.
  • The current layout is a major obstacle to improve workflow.

During the evaluation process, the Laboratory and Admission processes were also evaluated and improvements were also recommended. One of the major lessons learned was that it is very important to identify the real cause of the problems and the domino effects that could arise from process changes.