Creating Effective Organizational Culture
The obstacles that Murrell had to overcome were complicated and challenging. First and foremost, Kaiser Permanente’s South Sacramento Medical Centre was experiencing a lack of effective organizational culture. An effective organizational culture provides a clear sense of the organization’s purpose, employees understand their significant and long-term goals which was absent with the health care facility. Murrell had to create a strong organizational culture to improve teamwork and to empower them to adopt the change and consider process improvement as an important factor (Elkholi et al., 2021). Overall, Murrell had to make a cultural change over time to bring adaptability to the new process amongst every staff of the emergency department. On the other hand, optimizing working conditions for staff was another obstacle that Murrell has to overcome. Making a better system for the patients is essential but making the system easier for staff doing the work is more essential. Since the capacity of the emergency department was not that large, the working condition of the staff to quickly decrease the length of the patent’s stay was challenging and it was difficult for them to ensure a smooth flow of operation. In addition, the staff was unaware of the process and the purpose of lean operations in the emergency department (Crane, 2017). They lack adequate knowledge on how to manage and execute operations concerning lean operations. Therefore, looking at every system was needed as organizational change has been performed for process improvement.
Information technology (IT) has been helping health care organizations to enhance patient care effectively. There are many sorts of information technology present that assist health care facilities to efficiently capture information to improve health care services (Welch, 2012). As mentioned by Landman et al. (2010), an emergency department information system (EDIS) is a frequently used IT to improve access to patient-related information at the point of care. Using IT in the emergency department has created a positive impact, however, the author has also discussed the negative impacts that might cause due to system downtime that can affect staff workflow negatively. Besides, as per the IT policy of the American College of Emergency Physician’s (ACEP), EDIS is an effective EHR system which is developed particularly to manage patients’ data and simplify processes to provide support to patient care and operation in the emergency department (Landman et al., 2010). Besides, the implementation of intelligent automation to provide real-time information about patient movement would help the ED of health care settings to efficiently capture the metrics for measuring the wait-time and act according to improve (Goto et al., 2020). It is therefore understood that the use of such IT in a health care setting, can prompt the process and accelerate patients’ discharge after completion of required aid. In this way by using IT, health care organizations can efficiently capture the metrics to evaluate the gaps for improvement and improve processes.
The VISUAL workplace concept has been well-known for assisting operations to minimize their waste and procure improvement. This can be accomplished by improving communication with the team, minimizing complexity, and making discrepancies transparent (Cohen, 2018). In lean management, visualization is one of the most significant components. In the health care settings, the VISUAL workplace concept help reduce errors that can occur as a result of a lack of communication amongst team members or staff. Communication is an essential factor considering workplace safety as well as ensuring the right treatment and diagnosis for patient safety (Schonberger, 2018). An example of a visual workplace in context to restaurants would be the positioning of utensils, devices, and safety instructions to give employees instant access to deliver products fast and minimize wait-time (Matthews et al., 2020). Suppose, the cook of the restaurant wants a knife for chopping onions, then with the use of visual workplace concept, he can easily identify the positioning of the knife and will pick it up for use. In this way, it reduces wastage of time and seeking help for others by ensuring process improvement at the same time. Therefore, these techniques will also apply to healthcare facilities concerning treating emergency patients who are been admitted in the emergency department of a health care setting.
Optimizing Working Conditions for Staff
The 5S steps of a lean visual workplace include sort, set-in-order, shine, standardize, and sustain. This method is used by organizations to improve productivity by reducing waste and enhancing quality by eliminating variations (Polancich & Pilon, 2019). In addition to that, it enables a structured dialog regarding standardization which establishes a clear understanding amongst employees of how the work is supposed to be done. Concerning the case study, the 5S to develop a visual workplace has been executed, first by examining everything at the workplace whether they are working effectively or not. Second, set-in-order by putting everything in an orderly manner so that it can be used and restored promptly and safely such as patients’ data. Third, shine, in regard to maintenance of the process by focusing on productivity. Forth, standardize the process by specific guidelines, procedures, and checklists to ensure quality patient care and satisfaction. Fifth, sustain the process by effectively managing the team, process, and aligning it with organizational goals (Polancich & Pilon, 2019).
The goal of continuous flow is not possible in a health care setting like manufacturing organizations where raw materials move to be a finished product. But in the case of health care, patients flow might be for a period, it will gradually reduce over time. By creating continuous flow in the emergency department, it will accumulate numerous patients once at a time and it will likely increase the wait time which might lead to patient dissatisfaction or worsening of an emergency medical condition (McHugh et al., 2011). On the other hand, there are probabilities of having overcrowding of patients and that might lead to the arousal of errors in recording patients’ data, shifting patients to doctor’s room, and discharging patients (McHugh et al., 2011). Diagnosing or screening a patient requires some time and having a continuous flow of patients might increase wait-time which may adversely affect patients’ satisfaction level and possibly would lead to a breakdown of severe medical illness (Morley et al., 2018).
Some of the innovative ways in which the flow group could create capacity over the next five years without adding floor space or personnel to the emergency department can be achieved by adopting the lean operations process. Implementing the low acuity flow method of triaging patients to home who have fewer medical complications (Berkowitz et al., 2018). It can be done by providing a general physician in front of the ED premises so that patients can be screened quickly, get all he cares for, and return to home. It helps clear the waiting area fast and makes capacity for high acuity patients. Furthermore, by segmenting the patients in context to low, medium, and high severity. Treat vertically as many patients as possible to make bed capacity for needed patients. Setting goal to save beds for only high acuity patients (Garrett et al., 2018). In this way, it will make patients feel better and satisfied with the service as well as improve the overall process.
References
Berkowitz, D. A., Brown, K., Morrison, S., Payne, A., Pettinichi, J., Schultz, T. R., … & Chamberlain, J. M. (2018). Improving low-acuity patient flow in a pediatric emergency department: a system redesign. Pediatric quality & safety, 3(6).
Cohen, R. I. (2018). Lean methodology in health care. Chest, 154(6), 1448-1454.
Crane, M. D. (2017). The Definitive Guide to Emergency Department Operational Improvement: Employing Lean Principles with Current ED Best Practices to Create the No Wait Department. Productivity Press.
Elkholi, A., Althobiti, H., Al Nofeye, J., Hasan, M., & Ibrahim, A. (2021). NO WAIT: new organised well-adapted immediate triage: a lean improvement project. BMJ Open Quality, 10(1), e001179.
Goto, T., Hara, K., Hashimoto, K., Soeno, S., Shirakawa, T., Sonoo, T., & Nakamura, K. (2020). Validation of chief complaints, medical history, medications, and physician diagnoses structured with an integrated emergency department information system in Japan: the Next Stage ER system. Acute medicine & surgery, 7(1), e554.
Landman, A. B., Bernstein, S. L., Hsiao, A. L., & Desai, R. A. (2010). Emergency department information system adoption in the United States. Academic Emergency Medicine, 17(5), 536-544.
Matthews, B., Salisbury, I., Schlosser, P., Smith, F., & Sanderson, P. (2020, April). High Tempo Work: Design Challenges for Head-worn Displays in Quick Service Restaurants. In Proceedings of the 2020 CHI Conference on Human Factors in Computing Systems (pp. 1-12).
McHugh, M., Van Dyke, K., McClelland, M., & Moss, D. (2011). Improving Patient Flow and Reducing Emergency Department Crowding: A Guide for Hospitals. Ahrq.gov. Retrieved 29 January 2022, from
https://www.ahrq.gov/sites/default/files/publications/files/ptflowguide.pdf.
Morley, C., Unwin, M., Peterson, G. M., Stankovich, J., & Kinsman, L. (2018). Emergency department crowding: a systematic review of causes, consequences and solutions. PloS one, 13(8), e0203316.
Polancich, S., & Pilon, B. (2019). The application of the Toyota production system LEAN 5S methodology in the operating room setting. Nursing Clinics, 54(1), 53-79.
Schonberger, R. J. (2018). Reconstituting lean in healthcare: From waste elimination toward ‘queue-less’ patient-focused care. Business Horizons, 61(1), 13-22.
Welch, S. J. (2012). Using data to drive emergency department design: a metasynthesis. HERD: Health Environments Research & Design Journal, 5(3), 26-45.
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