6/15/2009
The Rural Emergency Department
Rural Emergency Department Performance Improvement
Clint MacKinney, MD, MS
• Always “open” – 24/7
– Life saving care
– Public health surveillance
– Safety net provider
• Front door, but also...
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• Front window!
Minnesota Rural Health & CAH Conference
June 15, 2009
Duluth, MN
– First and lasting impressions made here
• Deserves leadership attention
Clint MacKinney, MD, MS
Not Necessarily the Money Pit
• High fixed costs impact revenue calculations
• Revenue, plus
– Admissions
– Ancillaries
• To do list
– Document optimally
– Reduce barriers to admission
– ED as customer
– Collect co‐pays
Clint MacKinney, MD, MS
Performance Measurement Counts
• Above average?
• Without measurement, governance by hunch
• Need to demonstrate performance
• Reporting precedes P4P
• To do list
– Measure performance
– Track quality, service, and financials
– Report to board and staff
Clint MacKinney, MD, MS
Quality is Job One
• Quality is our mission
• Assess performance relative to Mission
• Quality not always self‐
evident
• To do list
– Include in the Scorecard
– Communicate results
– Review every high risk, low frequency event
– Measure variation
– Don’t assume a non‐
punitive environment
Clint MacKinney, MD, MS
What’s Wrong with Serving the Customer?
• Disney and HCAHPS
• Customer service can move market share
• A potential customer service nightmare
• We see 10x the number of inpatients
• To do list
– Behavioral standards
– Patient call back and satisfaction survey
– Focus on improvement, not just benchmarks
Clint MacKinney, MD, MS
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6/15/2009
ED Staff Deserves Leadership Attention
• Southwest Airlines makes employees a priority
• Employee/patient link
• Attention is the currency of leadership
• To do list
– Dedicated clinical time for managers
– Push decision‐making down
– Leadership rounds
– Follow‐up all explicit and implied commitments
Clint MacKinney, MD, MS
Design (Form) Follows Function
• Evidence‐based design
• Cannot afford not to design for efficiency
• Lean Thinking process opportunities
• SPACE
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Safety
Privacy
Access
Consistency
Efficiency
Clint MacKinney, MD, MS
Making the Perfect Handoff
• Most error‐prone healthcare process
• Flash points
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Waiting to see private MD
Between ED shifts
Admissions
Transfers
• To do list
– All patients seen by ED doc
– Bedside handoffs
– Consistent communication (e.g., SBAR)
– Document the handoff
Clint MacKinney, MD, MS
Driving the Liability Nitro Truck
• Perfect opportunity for disaster
– The Law
– Hospital policies
– Medical liability
• To do list
T d li t
– Register, see, and treat all
– Transfer policies
– Contract to stipulate care in ED only
– Admission protocols, not hand written orders
– Bedside handoffs
Clint MacKinney, MD, MS
Community Benefit – It’s What We’re All About
Questions?
• Community benefit
– Essential service
– Reduce government burden
– Safety net provider
– Safety and security
Clint MacKinney, MD, MS
[email protected]
• To do list
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Price transparency
Community education
Support local EMS
Human service needs
Document charity care
Clint MacKinney, MD, MS
Reprints available at:
www.stroudwaterassociates.com
Clint MacKinney, MD, MS
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