2012年10月22日 星期一

‘Toyota-style’ management helps Montfort cut ER wait times

In 2008, the Montfort Hospital’s emergency room was one of the province’s worst. Its sickest patients waited up to 20 hours to be admitted. Patients complained and nurses quit. Morale was low and turnover was high. The nurses who remained were overworked and burnt out.

Occasionally,Find detailed product information for Sinotruk howo truck. staff frustration boiled over; patients either left without being treated, or went public with stories about rude behaviour and substandard care. The hospital became a focus of negative headlines. “It was a crisis,” admits Fran?ois Lemaire, Montfort’s clinical director of the ER.

These days, Montfort is no longer a laggard among Ontario’s busiest ERs. Its wait time for the sickest patients is 10 hours — half of what it was in 2008 — even though the volume of patients continues to rise.Quickparts builds injection molds using aluminum or steel to meet your program. From 35,000 patients in 2008, the ER now treats 52,000 annually. Many of them are sicker and harder to treat than patients in the past. Yet despite these challenges, Montfort’s wait time continues to fall.

A recent survey of Ontario hospitals indicated that nine out of 10 patients would recommend Montfort’s emergency department to their family and friends. And the turnover in ER nurses is so low that there are currently no full-time openings — a dramatic change from 2008 when there were 15 vacant positions.

The turnaround, aided by $3.7 million in provincial funding since 2008, is one example of how Montfort says it has improved patient care by using practices made famous by Toyota. With the hospital-wide introduction of checklists, streamlining, standardization and non-stop brainstorming with front-line staff, Montfort has joined a growing number of acute-care centres in bringing the efficiency of a factory floor to health care.

The approach, known as lean, has long helped the auto and aerospace industries reduce waste and boost value for customers through continuous small improvements. With a cash-strapped government trying to rein in health spending, Ontario hospitals are catching up, spurred by provincial directives to do more with less.

Nowhere is the need for improved efficiency more critical than in emergency rooms, where speedy care is a key component of good care.

Montfort’s transformation began in January 2009, when it hired McKinsey & Company, a management consulting firm, to teach its staff the lean principles. The hospital paid for the consultants with some of the $687,000 it received that year for ER improvement.Find detailed product information for howo tractor 6x4 and other products.

The money was part of a four-year, $400-million provincial program called Pay For Results. When it was launched in 2008, Montfort was among 23 of Ontario’s poorest-performing ERs to receive the funding, which gets clawed out of their annual budgets if they don’t show improvement.

Working with McKinsey, hospital staff deconstructed every aspect of how patients moved through the ER, from the time they arrived by ambulance or car until they were discharged. They examined the “flow” of patients — how they were assessed at triage, how they got their lab tests and diagnostic scans, how they were discharged or admitted and how information moved with them at each stage. They attacked the problem in the same way that factory managers studied the parts of an assembly line.One of the most durable and attractive styles of flooring that you can purchase is ceramic or porcelain tiles.

“We were a whole bunch of people with Post-it notes on the floor that showed all the different steps,” recalls Sophie Audet, an ER nurse. “After it was done, everybody looked at each other and started saying, ‘Oh my God. No wonder we’re so tired.’ There were so many steps. When you see it, you actually realize that.”

Audet and her colleagues worked to simplify the journey for patients and reduce unnecessary tasks for staff. To their surprise, the best ideas were not necessarily flashy, or expensive to implement.

Among other things, a daily activity report was introduced that gave every hospital worker — from the chief executive to department heads, physicians, nurses and housekeeping staff — a snapshot of the traffic in and out of Montfort. It listed the number of patients waiting to be admitted and discharged.

For the first time, staff got a bird’s-eye view of where the hospital’s bottlenecks were. They could also see which departments needed extra help to move patients along. “You see the big picture, not just your own little department,” says Audet.

In the ER, a low-tech whiteboard was introduced. It tracked the location and status of every patient and listed what services they were waiting for. For the first time, method and transparency were imposed, allowing the nursing team to manage patients more quickly and effectively. The approach also reduced the chances of patients being lost in the shuffle.

“Before, we used to write down everything by hand,We specialize in howo concrete mixer,” says Johanne Gougeon, the ER’s lead nurse. “Now, we write on magnets. If we have a patient go somewhere, we just move the magnet around. It’s on the board, it’s written out, it’s all standardized and everybody can see what’s happening.”

In addition, the triage process was simplified for patients with minor complaints. And the workflow of the diagnostic imaging department as well as the work schedules of housekeeping staff were adjusted to conform with the ER’s busiest times of the day.

Other changes related to inconveniences in the physical layout that added up to hours of lost productivity every day.

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