In a previous article we described how LEAN uncovered two root causes of patient dissatisfaction in the ED, wait times and communications.
Lack of communication a huge issue everywhere in hospitals, clinics and long term care. I covers a wide range of issues and individuals from physicians to nurse to anyone who comes into contact with the patient.
But what constitutes poor communication? What exactly do we need to do to improve?
In talking with the provider group, they were very defensive. They told us that they refuse to give drug seekers drugs and that’s why their scores were low. They stated unequivocally that they would continue to do so. I told the that I would never presume to tell any physician how to practice medicine. I did suggest I could help with how they communicate with the patient that could make a difference in the scores.
LEAN tools were used to determine the root cause of the patient’s dissatisfaction. We continued to survey patients. However, we shifted the focus of the questions. We developed a living Pareto chart to help determine the root cause. The results were puzzling. Patients told us they were not getting results quickly, they were not informed of delays, when tests were ordered, they had no idea how long they would take, when in the waiting area they had no idea how long it would be before they were seen by a provider.
We brought all the parties together and studied the data. A provider remarked that it was impossible to tell young woman how long it would take because the provider had no,idea how long it took to get the results of a pregnancy test. The lab manager piped up 45 minutes.
“Well,” the provider said, “at least I know how long one test takes.”
We had just discovered the root cause.
We realized that no one had any idea about test times. They were unable to manage a patient’s expectations regarding the wait time. A kaizen event was done, led by the ED, with all ancillary departments. Service level agreements were developed between the ED and ancillary departments. These agreements defined the time to deliver each service to the ED from the ancillary department. Importantly, it also detailed the expectations of the ancillary department of the ED in order to meet the service time. Once the agreements were in place, they were shared among staff, posted in the departments and reviewed regularly to reflect any changes. These agreements became an integral part of new hire orientation within the departments.
All staff are now able to manage the patient’s wait time expectations. They could tell the patient the time it would take to get results. The patient knew it wouldn’t be just a few minutes but that “It will take the lab XX minutes to get the test done and results to us.” or “It will take imaging XX minutes to have your x-ray to…”
Service level agreements had a huge positive impact on patient satisfaction. Wait times did not necessary decrease dramatically but because the patient clearly understood how long things take, their frustration level dropped and satisfaction increased.
Service level agreements had an additional bonus. Departments used the times agreed to in the service level agreements as their KPIs on their gemba boards. This led to several kaizen events to improve times, efficiency and effectiveness in the departments. Improved service to the ED resulted in an upward spiral of overall patient satisfaction in the ED all as a result of implementing LEAN and LEAN tools in the ED to tackle patient satisfaction and communication problems.