Dr. Richard Zane quickly spotted huge waste and inefficiency soon after he was hired to head the University of Colorado Hospital emergency department in 2012.
He recalled having a patient assigned to him for a nosebleed. It should have taken him 10 minutes to examine the patient, stop the bleeding and document the encounter. “I went to find the nose packing, which should have been on a cart within arm's reach, but I spent 40 minutes trying to find it,” he said. “What a colossal waste of time and money. Take that encounter and multiply it by 50,000 visits a year.”
Zane realized this was part of a larger problem that he needed to address immediately. A new, much larger 56,000-square-foot emergency room was being built and would open in less than a year. Ambulances were being diverted from the hospital because the existing 18,000-square-foot ED couldn't handle more patients, patients were leaving without being seen, the waiting room was often full, and patient and staff satisfaction were both low.
Zane and the hospital's leaders decided to redesign how services would be delivered. “We simply did not have a choice,” he said. “It was a broken system with well-intentioned doctors and nurses trying to do the right thing.”
Zane and his colleagues launched a structured improvement process. The guiding principles were to keep it data driven, set specific targets and identify tools to achieve them, and be accountable for results. Process maps were drawn showing how patients traveled the department and how all staffers performed their work. “Everything was on the table, but it had to be patient-centric,” he said.
The hospital hired an industrial process-improvement expert, Derek Birznieks, who had Six Sigma process-improvement training but had never worked in healthcare. “I thought that there would be a big learning curve, but healthcare is very similar to industry in everything it does,” Birznieks said.