Bon Secours Memorial Regional Medical Center: Process and People
Hospital Systems
Thursday, 01 November 2007
Bon Secours Memorial Medical Center: Process and People - Health Executive - RedCoat Publishing
Michael Robinson details how this Virginia medical center successfully transformed its emergency department.
On average, patients in American emergency departments wait two hours just to see a physician. Boarding, diverting, and walkouts have become the norm. For the men and women at Bon Secours Memorial Regional Medical Center, the norm wasn’t good enough.

Bon Secours Memorial Medical Center: Process and People - Health Executive - RedCoat Publishing
Michael Robinson
In 2005, the 225-bed Richmond, Virginia medical center, the second largest in the four hospital Bon Secours Richmond Health System, began a year-long journey to transform its ED. Using Six Sigma as a process improvement methodology, the organization created a framework for change—and change it did.

Prior to its ED initiative, it took 79 minutes, on average, for a patient to see a Bon Secours Memorial Regional physician. Today, a patient is in a room in an average of 15 minutes and seen by a physician in 30 minutes or less. And the hospital hasn’t sacrificed quality for speed. For the past six months, ED patient satisfaction scores have risen above the 90th percentile.

According to Bon Secours Memorial Regional’s administrator, Michael Robinson, the medical center’s successful ED transformation provides a powerful lesson for other hospitals struggling to change: it’s not just about process; it’s about people.

“The system redesign work and process flow work that was a part of the Six Sigma process clearly reinvented and redesigned emergency services in this community,” he said. “But it wasn’t until we addressed the cultural issues in the ED that we really achieved a breakthrough.”

The process
As part of Bon Secours Richmond Health, Memorial Regional had a bit of a head start in its Six Sigma initiative. The medical center had access to black belts already in the system and had some experience with the methodology thanks to an earlier project to improve coding and compliance documentation.

Knowing the much larger ED project would require effort from everyone involved in emergency services, staff at all levels—from nursing to administration to radiology—were included in the training and redesign process. By getting everyone involved and behind the initiative, the project gained momentum and enabled the organization to create cross-functional teams to pinpoint and address issues.

Major changes quickly followed. For example, the medical center cross-trained its nurses to triage patients anywhere, removing a major bottleneck in the waiting room. Bon Secours Memorial Regional also expedited turnaround time on critical information by using its integrated information system to access specialists at any Bon Secours Richmond hospital. “PACS allows us to interface our ED with any radiology department in our system,” Robinson said. “It was something we had to come to terms with, but a free radiologist is a free radiologist, regardless of what campus they’re on.”

As the department was redesigned, metrics were implemented throughout, enabling the medical center to accurately measure its performance in all aspects of emergency care. Within six months, Bon Secours Memorial Regional was running with all of its new processes and techniques, and staff and administrators anxiously looked at the data to gauge the results. They were disheartened to find the ED was not only still diverting, its walkout rate hadn’t been dented, and patient satisfaction rates hadn’t improved.

“We were watching the metrics. We had everyone involved, and we thought we’d achieve the breakthrough, but we didn’t,” Robinson said. “The team wasn’t happy, but we made an important realization: it wasn’t just process that had to change; we also had to change the culture.”

The people
Determined to transform the ED in spite of the relative set back, Robinson and his team opened the channels of communication to get feedback from everyone involved. The stories they heard from ED staff were enlightening. “We had worked together to redesign all of our processes, but once that was done, we ended up still working in disparate camps,” Robinson said. “That had to change. And to do that, we had to change the mindset.”

To jumpstart the culture change, the medical center took 40 members of the ED team off site for a full day of team building exercises. Guided by an organizational development leader, Bon Secours Memorial Regional staff learned what it means to truly work as a team. At the end of the day, all 40 staff members gathered together to discuss the challenges in the ED, brainstorm solutions, and truly put any and all issues on the table. The organizational development leader then asked staff to separate themselves into three groups and challenged each group to come up with ideas to shave just two minutes from the ED’s door-to-doctor time.

“It was interesting how they separated themselves into groups,” Robinson said. “Each of the three teams included doctors, nurses, and allied health professionsals—everyone responsible for emergency care. When the organizational development leader pointed this out, a big light went on over everyone’s head. It was a real breakthrough for us.”

Back at the medical center, the staff created a code of conduct built around the team concepts they established, and everyone signed off on it. A month later, the medical center began experiencing a quantum leap in ED improvements. And when patient volume surged more than 40% in one year, the staff didn’t miss a beat.

“What we’ve done in the ED has re-energized us around the things we’re most passionate about,” Robinson said. “It’s become a driving mantra for all of our sister facilities. It’s a bar that we’ve raised. I’m really proud about what we’ve done in emergency medicine, and I’m looking forward to making more of those breakthroughs.”
 
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