The Definitive Guide to Emergency Department Operational Improvement: Employing Lean Principles with Current ED Best Practices to Create the “No Wait” Department

Published:
April 22, 2011 by Productivity Press - 353 Pages
Author(s):
Jody Crane, MD, MBA, Emergency Physician, Mary Washington Hospital, Fredericksburg, Virginia, USA; Chuck Noon, PHD, Professor of Management Science, College of Business, University of Tennessee, Knoxville, USA

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ISBN 9781439808405
Cat# K10415
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ISBN 9781439808412
Cat# KE10388
 

Features

  • Offers specific how-to's for ED operations from experts in healthcare and Emergency Medicine
  • Explains how to develop solutions organically 
  • Utilizes a recipe format to facilitate step-by-step application of concepts
  • Teaches through working examples of EDs from across the country

Summary

In a unique and integrated approach, The Definitive Guide to Emergency Department Operational Improvement: Employing Lean Principles with Current ED Best Practices to Create the "No Wait" Department exposes you to the academics behind managing the complex service environment that is the ED. The book combines applied management science and ED experience to create a model of how to improve your emergency department operations.

After summarizing the current state of emergency medicine, the book offers an in-depth presentation of Lean tools used in the ED along with basic and advanced flow principles grounded in queuing theory and the theory of constraints. It then shows how these concepts are applied in the emergency department and why they work, supported by a comprehensive case study in which Lean principles were used to transform an underperforming ED into a world-class operation.

The authors highlight three commonly referenced intervals in the ED: door to doc (input), doc to disposition (throughput), and disposition to departure (output). After reviewing best practices, the authors explain how to achieve excellence in your own environment by discussing change management, leadership, dealing with resistance, and other critical elements of creating a culture of change. Under any scenario realized by healthcare reform, this book provides the tools and concepts to improve your ED for patients, staff, the organization, and ultimately, society.

Table of Contents


Chapter 1 - The Current State of Emergency Medicine and the Need for a New Operations Paradigm
·         ED Overcrowding
·         Danger Waiting
·         Hospital-wide Flow
·         US Healthcare System
·         The Need for Change
Part I: Academic Topics Critical to Understanding ED Operations
Chapter 2 - Lean Healthcare
·         Introduction and History of Lean
·         Patient Value
·         Service Families and Value Streams
·         Value Stream Mapping
Chapter 3 - MUDA
·         Seeing waste from the patient’s perspective
·         7 wastes
Chapter 4 - Lean Tools Critical for ED Operations
·         Workplace Organization/5S
·         Visual Workplace
·         Standard Work
·         Mistake-proofing
·         Inventory and Supply Management
·         Flow in Healthcare Systems
Chapter 5 - Flow in Healthcare Settings
·         Queuing Theory
·         Background
·         The Simple Queue
·         Arrival Rate
·         Arrival Distribution
·         Poisson Distribution Pattern
·         Service Rate
·         Service Distribution
Chapter 6 - The Effect of Variation in Healthcare
·         The Effect of Server Utilization in Service Industries with Diverse Variation Patterns
Chapter 7 - Achieving Lean Flow
·         The Approach to Reducing Flow Times through Queues
·         Reducing Arrival Rate
·         Reducing Variation in Arrivals
·         Reducing  Service Times
·         Reducing Variation in Service Times
·         Adding Capacity
Chapter 8 - Using Data and Simulation to Solve Complex Queuing Problems in Healthcare
·         Examples of Applied Queuing in ED Settings
·         Healthcare as a Network of Queues
·         Patient’s Perspective
·         Server’s Perspective
·         Conservation of  Flow
·         Volunteer Walk-in Clinic
Chapter 9 - Approach to Reducing Waiting Through a Network of Queues
Chapter 10 - Lean Design in Queuing Networks
·         Principle 1: Reduce the Number of Queues
·         Combining Steps
·         Concurrency
·         One-Piece Flow
·         Principle 2: Pooling
·         Principle 3: Pull Systems
·         Principle 4: Segmentation
·         Reduction of Service Times
·         Reduction of Variation
·         Radically Different Segments
Chapter 11 - The Psychology of Waiting
Part II: A Step-by-Step Guide to Fixing Your Emergency Department
Chapter 12 - Defining key Intervals in Emergency Operations
·         Door to Doc
·         Reception
·         Registration
·         Triage
·         ESI
·         Chief Complaint Based, Directed
·         Bed Placement
·         Patient Segmentation
·         Doc to Decision
·         Initial RN Evaluation and Assessment
·         Initial MD Evaluation
·         Ancillary Services
·         Patient-specific In-ED Treatment
·         The Relationship between Service Capacity in the ED
·         Load Leveling
·         MD, RN, Bed, Ancillary Balancing
·         Virtual Beds
·         Decision to Departure
·         Decision to Admit to Bed Assignment
·         Inpatient Utilization as a Function of ED Holds
·         The difference between Staffed Capacity and Licensed Capacity
·         Forecasting Demand
·         Surgical Smoothing
·         Finding Critical Inpatient Capacity
·         The Value of Patient Flow Teams
·         Bed Assignment to Departure
·         Hospitalists
·         Calling Report – The Games People Play
·         The Effect of Incentives on Throughput
·         Faxed Reports
·         Full Capacity Protocol
Chapter 13 - Making Change Happen
·         Leadership
·         Change Management
·         Picking the Right Project
·         Picking the Right Team
·         Define Current Process
·         Analyze the Data
·         Listen to Patients
·         Improve Process
·         Define Future Process
·         Rapid Cycle Testing
·         Implementation
·         Dealing with Resistance
·         Management
Chapter 14 - Case Studies in ED Improvement
·         Mary Washington Hospital
·         Ochsner Health System
·         Banner Health
·         Florida Hospital
·         IHI
Appendix

  • Glossary
  • Index

    • Author Bio(s)

    About the Authors:

    Joseph T. Crane, MD, MBA is one of the nation’s leading experts in emergency department (ED) operations. He is an emergency physician practicing at Mary Washington Hospital in Fredericksburg, Virginia. In addition to his clinical responsibilities, from 2002 to 2009, he served as the business director of his group, Fredericksburg Emergency Medical Alliance. In 2004, he graduated from the Physician Executive MBA Program (PEMBA) at the University of Tennessee, where he is currently an adjunct professor teaching physician-led operations improvement.

    Dr. Crane’s work focuses on innovative approaches to ED and hospital-wide operational and patient flow improvement, specifically addressing the application of Lean manufacturing concepts within the healthcare environment. He also specializes in leadership and change management for operational and clinical improvement. Dr. Crane is an emergency medicine faculty member of The Institute for Healthcare Improvement. His company, X32 Healthcare, teaches and consults with organizations on process improvement using Lean applications. Through these engagements, Dr. Crane has worked with hundreds of EDs from around the world on adopting innovations in the delivery of emergency care. He has taught and worked in a wide variety of settings in the United States, Canada, Europe, South America, and the Middle East, including courses or sessions at The University of Tennessee, The University of Kansas, George Mason University, and Harvard University.

    Charles E. Noon, PhD is a professor of management science in the College of Business at the University of Tennessee. He is a founding member of the highly ranked Physician Executive MBA Program and continues to teach in the program. He holds a PhD in industrial and operations engineering from the University of Michigan. His teaching interests include operational improvement, business modeling, simulation, and decision analysis and support. His applied research concerns computer-based models and process improvement, and his papers in these areas have appeared in Interfaces, Journal of Healthcare Management, and Networks and Spatial Analysis. Dr. Noon also teaches in the full-time MBA program, the Management Science PhD program, and various nondegree executive education programs, including a new offering entitled Lean for Healthcare. He is the recipient of numerous teaching awards and serves as a teaching mentor for junior faculty. To stay current, he periodically consults with hospitals on process improvement, capacity planning, and staff scheduling.

    Editorial Reviews

    … for practical reasons there is value in translating TPS to the healthcare arena. Jody Crane and Chuck Noon do this well, providing meaty examples and a level of technical depth that go beyond other Lean healthcare books that I have seen.
    —Jeffrey K. Liker, Professor of Industrial and Operations Engineering, University of Michigan, Shingo Prize-Winning Author of The Toyota Way

    … this book will help you and your leadership team create a culture where ‘a community of scientists’ continually improves and better serves patient, hospital, and societal needs— improving quality while simultaneously reducing cost.
    —Mark Graban, MS, MBA, Shingo Prize-Winning Author of Lean Hospitals: Improving Quality, Patient Safety, and Employee Satisfaction

    … will open your eyes to cutting-edge concepts that drive ED operations…
    —Maureen Bisognano, President and CEO, Institute for Healthcare Improvement

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