Emergency Department

Emergency Department

Quality Improvement in Emergency Department

The first step in quality improvement in the emergency department is to unfreeze the old culture. However, it is impossible to unfreeze the old culture if people do not have an understanding of the existing culture. The first thing is to call for a meeting involving the hospital’s management, emergency department head, physicians and all the staff members that work in the emergency department. The aim of the meeting would be to inform the interested parties about the long waiting time in the department compared to the state and national averages, therefore, leading to a decline in the quality of the departments. People working in the department can give their views on what they believe to be the contributing factors before any changes are implemented. From the exchange of views from different people in the meeting, it must be agreed that reduction of waiting times for patient’s waiting should become part of the hospital’s and a priority for the department (Eitel, Rudkin, Malvehy, Killeen & Pines, 2010).

The next step involves the formation of powerful building coalition. A team should be selected from the department and management to come up with a plan that should be followed as the department embarks on implementing strategies to reducing the waiting time at the department to be equal or below the state and national averages. The importance of working with people with different capacities in the team is because some of the strategies might require external resources that are not in control of the emergency department. For example, there may be need to hire extra physicians and buy machines to automate some processes, and therefore a good relationship with the top management is critical. The team must realize why it is urgent to reduce the waiting time for patients.They should be aware it is giving a hospital a bad image that may cost it in future if nothing is done to improve the quality of service delivery in the hospital’s emergency department (Silvester, Lendon., Bevan, H, Steyn & Walley, 2004). The team selected to spearhead the changes must develop deadlines for various things in their plan like when the additional staff members are expected to report and when the extra equipment and supplies must have arrived in the department.

Another important step is the development of a vision and the strategy. The vision would entail achieving patient satisfaction through the reduction of their waiting in the emergency. To achieve attain the vision, there are various strategies that will be implemented. One of the strategies is the replacement of malfunctioning diagnostic machines and ensuring that the staff members are committed to following the guidelines that are stipulated about the amount of time a patient should spend on a certain stage of service delivering and those who fail to do so being held personally accountable. Bedside registration should be introduced to reduce the amount of time the patient’s relative use when handling the registration of their patient (Sayah, Rogers, Devarajan, Kingsley-Rocker, & Lobon, 2014). . A nurse should also be appointed to coordinate allocation of beds, to manage timely assessment and to schedule the patients to various clinical teams.

The vision and strategy developed should be communicated to both the hospital’s top management and all individuals (Plsek & Wilson, (2001). The head of the department should hold a meeting with the staff and elaborate the strategies that have developed by the team were selected at the beginning. Any concerns from the staff should be noted and considered, but it should be clear that the change inevitable and everyone should be ready to embrace change.

It is also critical to empower the staff working in the emergency department to implement the vision and strategy. Once the strategy has been developed, it should be the responsibility of the emergency department to implement it and control the allocated resources. There should also be an improved compensation system where some employees to perform and reduce the waiting time below the set targets through their creativity are awarded a pay rise. The employees also need to be motivated by looking into any challenges reported in their area of work to ensure that there is a smooth flow of work. The supplies should also be under constant supply to avoid frustrating the employees who strive to serve patients promptly but are frustrated by lack of supplies or inefficient storekeeping (Grube, 2004).

It is also important to generate short-term wins six months after the department started implementation. The department head should have a meeting with the employees and inform them on some of the achievements they have made so far and congratulate them for their efforts although they might have met all the targets, the fact that the previous delays have reduced they should be appreciated. After some gains have been achieved through reduction of time spent in some areas where the number of minutes can be measured it is important to consolidate the gains and produce more change. The change in time should be continually after three months and communicated to determine what more needs to be done. Finally, the new approaches of the culture developed in the hospital should be refrozen. Every employee should be fully aware of the new ways of handling patients, and even new employees should be taught the new culture of the department before embarking on working.

Conclusively, the change process requires careful planning and involving all interested parties from the beginning. With teamwork and support from the top management implementation of change is more effective.


Eitel, D. R., Rudkin, S. E., Malvehy, M. A., Killeen, J. P., & Pines, J. M. (2010). Improving service quality by understanding emergency department flow: a White Paper and position statement prepared for the American Academy of Emergency Medicine. The Journal of emergency medicine38(1), 70-79.

Grube, J. (2004). Health professions education: A bridge to quality.

Plsek, P. E., & Wilson, T. (2001). Complexity science: complexity, leadership, and management in healthcare organisations. BMJ: British Medical Journal323(7315), 746.

Sayah, A., Rogers, L., Devarajan, K., Kingsley-Rocker, L., & Lobon, L. F. (2014). Minimizing ED waiting times and improving patient flow and experience of care. Emergency medicine international2014.

Silvester, K., Lendon, R., Bevan, H., Steyn, R., & Walley, P. (2004). Reducing waiting times in the NHS: is lack of capacity the problem?. Clinician in Management12(3).

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