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.
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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
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
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
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
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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.
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
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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.
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.