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Willoughby K.A.,University of Saskatchewan | Chan B.T.B.,Ontario Health Quality Council | Strenger M.,Royal University
Leadership in Health Services | Year: 2010

Purpose: The purpose of this paper is to provide details on a study to determine the wait time and service time for various emergency department (ED) patient care processes and to apply the science of plan-do-study-act (PDSA) cycles to improve patient flow. Design/methodology/approach: The paper used direct observation to collect patient flow data on 1,728 patients at multiple ED sites in Saskatchewan, Canada. It calculated wait times and services associated with important care processes and then tested, measured and implemented ideas to reduce wait time. Findings: On an average, patients spend nearly five hours in the ED with about one-half of the visit devoted to waiting for the next required service to take place. Waiting for an inpatient bed, specialist consultation or physician reassessment comprised relatively long wait times. Through the use of visual reminders and standard process worksheets, quality improvement teams were able to achieve large reductions in physician reassessment waiting time. These improvements required minimal materials cost and no additional staff. Research limitations/implications: The case study featured EDs within a particular Canadian province, so may not be generalizeable to other settings. We only sampled a fraction of ED patients at each facility. Practical implications: Admitted patients waiting for a hospital bed represent a key contributor to ED congestion. PDSA cycles are a valuable approach to achieving quality improvement in health care. Originality/value: The paper fulfils an identified need by breaking down an ED patient's waiting time into several high-level processes. It also applies improvement science to ED patient flow. © Emerald Group Publishing Limited.

Lowe G.,Graham Lowe Group Inc. | Chan B.,Ontario Health Quality Council
Healthcare Papers | Year: 2010

This article proposes a comprehensiveframeworkfor assessing, reporting and improving the quality of work environments in healthcare organizations across Canada. Healthy work environments (HWEs) contribute to positive outcomesfor healthcare employees and physicians. The same HWE ingredients also can reduce operating costs, improve human resources utilization and ultimately lead to higher-quality patient care. We show how health system employers, governments, quality agencies and other stakeholders can implement effective HWE metrics. The common reporting framework and metrics we propose enable managers and policy makers to use HWE ingredients as levers to improve organizational performance. Progress requires the active involvement of stakeholders in developing common metrics, the integration of these metrics into existing measurement and reporting systems, the building in of managerial accountability for work environment quality and support for ongoing improvements at thefront lines of care and service delivery.

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