When I was a little girl, I spent many summers visiting my grandparents. Aside from visits to the town’s outdoor pool, passing the days required lots of imagination and creativity. Looking back now, I smile when I think about how much fun we had with only a couple of TV trays and chairs, a homemade scratch pad, a broken phone, and some unused space underneath the staircase.
I noticed that same spirit of ingenuity recently, when I participated in a Rapid Process Improvement Workshop aimed at reducing waits for low acuity patients presenting to the ED at Saskatoon’s Royal University Hospital. Once we had a picture of the current state — about 1 in 3 patients visiting the ED are low acuity, waits to see a physician averaging 2 hours, and about 8% leaving the ED without being seen — ideas for possible solutions began to fly.
Right away, someone observed, “this just shows how critical it is to set up a 24-hour urgent care clinic close to the ED” And I don’t think I’d be exaggerating if I said people were already imagining what that clinic would look like, bricks, mortar, and all.
Then reality hit. We had 3 days. No extra resources. Just a healthy dose of curiosity, imagination, and “just do it” attitude among the 8 of us on that RPIW team.
Well, we did “just do it.” In 3 days, we re-purposed 300 square feet of existing ED space into a minor acuity treatment area. Out went to 2 hospital beds and in came:
- a handful of comfortable chairs (after all, the folks coming to this area are walking in and able to sit);
- a curtained off examination table (not terribly different from a curtained off ED bed); and,
- access to an adjacent private room.
The RPIW team got input from four ED physicians, triage nurses, several other ED nurses and ED staff about what types of patients would be good candidates for this new treatment area. We talked about what standard work would look like, what we were trying, and why.
By the final day, we were seeing a 50% reduction in the wait time for low acuity patients (from the time they were triaged, to the time they were assessed by a physician), and even better, no patients left without being seen.
Is the new minor acuity treatment area perfect? Not at all. But, based on early data, it does appear to be an improvement over what was happening before the RPIW. Is there room for improvement, for working out the kinks? Yes, and this is tough but “must do” follow-on work.
As with every RPIW, there will be a couple of audit metrics, to determine whether the improvements made during the week are sustained over the longer term. If they’re not, staff working in the area will need to determine what corrective actions to take to bring things back on track.
It’s still early days in this journey. Historically, we’ve thought of constraints as a barrier to innovation. However, my recent experience on this RPIW tells me we can tap into that same spirit of imagination and creativity that was so useful to us, and came so naturally, when we were children.
What do you think? Why do we have a tendency to think that innovation requires more resources, rather than seeing the need to improve without adding resources as an opportunity for innovative thinking?