Three years ago, the emergency department at 150-bed Cape Canaveral Hospital hit bottom, ranking in the 12th percentile on the national Press Ganey Associates customer-satisfaction survey. The morale of physicians and staff sunk alongside patients' feedback.
By last August those scores had soared to the 94th percentile and staff satisfaction ranked in the 97th percentile in the Gallup Survey, while the vacancy rate for registered nurses plummeted to nil.
For the innovations that led to these results, Cape Canaveral, Cocoa Beach, Fla., has earned the Spirit of Excellence Award for Service.
"What impressed me was their steady and deliberate performance improvement initiatives," says judge Steven Tucker, president of Conemaugh Memorial Medical Center in Johnstown, Pa.
"Their emphasis on systematically addressing operating issues through a focus on performance improvement, combined with a passion for service excellence, has created a formula for sustained excellence."
The department thoroughly reorganized its intake process in June 1999, decreasing patient wait times by 85% during a six-month period, which resulted in a 15% increase in patient volume.
That result, achieved by cutting more than half of the 20-plus steps out of the triage process and initiating bedside registration, actually preceded the 12th percentile Press Ganey rating.
But it was those improvements that rallied a committed core of staff who partici- pate in a multidisciplinary Customer Service Improvement Team that continues to fo-ment change.
"As we pulled together and the staff saw they could make change happen and we could get positive results, we just continued to dissect our process one step at a time," says Susan Key, director of emergency services. She notes that the average patient registration time is now 11 minutes.
"The time (they wait) to see a physician really increases their satisfaction," adds Michael McGoohan, medical director of emergency services.
A significantly bolstered clinical information system, brought online in December 2000, provides patient tracking, order entry, nurse documentation and discharge instructions, all in real time.
"This allowed us to streamline many, many processes, have real-time patient tracking and pull accurate data immediately," Key says.
"We can look at what's happened in the past month, or the past day even, instead of having to wait until the records are pulled," says Donna Shaw, director of quality outcomes.
A five-bed "Express Care Area" for less-acute patients, which opened in March 2001, has helped create additional momentum, McGoohan says.
"If you have 40 people in your ER and you're able to get rid of 15 of them rapidly, it immediately decreases the confusion," he says. "You know what's going on in the system, and you're able to move patients."
These process changes have helped bring about a culture change as well, McGoohan says. "The attitude of having an ownership mentality makes a difference," he says. "Once you cross that bridge and start working together as a team, it makes a huge difference."