Guest Columns

Emergency department efficiency vs. customer service

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Kristina Culp
Kristina Culp

In healthcare, not all “wasted time” is truly wasted. In fact, some of the most important aspects of healthcare are less than 100% efficient. Of course, we can and should strive for greater efficiency. But we also must understand that absolute efficiency would eliminate the human elements of care.

Lean and Six Sigma strategies can drive significant gains in healthcare efficiency … but only up to a point. Healthcare is a business that involves humans caring for and touching (often literally) other humans. At some level, we have to accept that total efficiency is neither achievable nor desirable.

Over-communicating can be better

Nearly 75% of people older than 65 have at least one chronic illness. By 2030, the U.S. will be considered super-aged with more than 20% of the population over 65 years old.

As this trend continues, healthcare providers in long-term care facilities and elsewhere must address the special needs of our elderly population. Most people spend more time in health facilities as they age, which can be confusing and even frightening. Healthcare staff may need to explain procedures, schedules, and medications in more detail or in less technical terms or explain repeatedly for older patients. This is not wasted time. 

Instead, this is a level of communication that is necessary to ease the patient's level of uncertainty and confusion and possibly help them focus on getting well instead of being stressed about the unknown. In addition to “over-communicating,” moving a little more slowly may help this population feel more at ease and process what is going on around them. Again, attempting perfect efficiency may not be your best goal to provide the care these patients require.

Choosing your battles

Operational efficiency and improvement should be implemented toward an end goal: better care for patients. Consider the intake process in an outpatient center, primary care physician's office, or emergency department. After check-in, when a treatment space is available, the most efficient process might be to shout out patients' names and which treatment area to go to. But few people would consider this the best way to respect the patient's privacy and create a calming environment.

Some healthcare facilities have taken a lesson from the restaurant industry to improve their intake process. In some restaurants, the host/hostess provides each patron with a hand-held pager that vibrates when a table is ready. In others, the hostess might discreetly jot down a distinguishing feature of each person waiting (“green jacket”) so she can easily spot the party and approach when a table is ready. The intake process in an ED, outpatient facility, or doctor's office can use similar techniques so that, when a space is ready, a staff member can escort the patient and family members to the treatment area.

Consider also the technique of scripting — “canned” ways of communicating with patients that bring some uniformity to the process. There is definitely a place for this, as it can provide for an effective and consistent way to address what could be sensitive topics.

The danger, however, lies in trying to over script interactions with patients, especially when talking about difficult topics. While there are some ways of phrasing things more efficiently, some conversations are just going to be difficult and may require time and privacy — neither of which is free.

Finding the balance

Although improving efficiency in the patient's treatment process is a worthwhile goal, there is a point at which additional efficiencies provide diminishing returns. People aren't robots — either on the giving or receiving end of care. Moving a patient through a process too fast can actually decrease satisfaction scores and quality. For example, giving patients and family verbal directions to their treatment area may result in a lot of frustrated, even lost, people. For this reason, some facilities make it a point to escort patients and family wherever they need to go. A cheaper alternative — not quite as attentive but still effective to a degree — is to improve maps and signage throughout the facility.

Value stream mapping and process mapping are great tools to identify opportunities for improved efficiency. But we must always keep in mind a few essential truths. Patients are the reason for the processes, and no two patients are exactly alike. Furthermore, every minute spent does not deliver the same return; time spent waiting on lab results is more wasteful than time spent settling patients and making them feel comfortable in the environment. 

Start with the point of view that you can help improve efficiency up to a point — without sacrificing care and compassion. Next time you think about waste in healthcare, just remember that not all “wasted time” has the same value: Some “waste” actually contributes to the patient's positive experience, satisfaction and outcomes.

Kristyna Culp is a managing principal and director of operations at FreemanWhite. She specializes in transforming complex operations into manageable, efficient systems.

Guest Columns

Guest columns are written by long-term care industry experts, ranging from academics and thought leaders to administrators and CEOs.