Improving Patient Flow and Reducing Emergency Department ...

Realistically Appraising the Need for Resources
Being realistic is a key to success. Hospital teams should ensure that they have the resources they need
and that their strategies are compliant with national, State, and local regulations. Success should not be
predicated on pulling resources from elsewhere. At one hospital, it was clear to the team that a dedicated
nurse and technician were needed to assist the NP in fast track. One respondent said, “We asked the
administration for an additional tech, but I can tell you they said ‘no.’” An ED nurse and tech were
pulled from the ED to staff fast track, though as one respondent put it, “We robbed Peter to pay Paul.” A
respondent from another hospital indicated that one of the lessons learned was that there “needs to be
dedicated personnel, and the strategy cannot be predicated on pulling people from the main ED.”
Anticipating and Addressing Staff Resistance and Culture Change
Through Education
More often than not, some level of staff resistance will be encountered, typically because of increased
workloads or disruption of familiar staff workflow patterns. In UMLN II, some proposed strategies ran
counter to the culture of the department, and many of the patient flow improvement teams found it
difficult to change attitudes and habits. Previous failures to implement or maintain quality improvement
efforts led to cynicism among some staff members. Culture trumps strategy, and as one respondent put
it, “You have to change how people think.”
There were a couple of approaches that the patient flow improvement teams in UMLN II hospitals used
to successfully overcome staff resistance and facilitate culture change (Figure 3). The first is staff
education and reeducation. As one staff educator put it, “there can never be enough education.”
Improvement team members from several hospitals said that more time should have been allocated to
staff training. For example, reflecting on the implementation of the strategy at Good Samaritan, one staff
member said, “Whenever you start a new process, you always find that the time you've allocated for
education is never enough, and that the education component takes more effort and more time than
anticipated.” Team members from Stony Brook University Medical Center, who implemented a new
process for requesting specialty consultations, speculated that additional training might have reduced
some of the miscommunication about the new process and saved time in the long run.
Another important factor in addressing staff resistance is leadership that is completely transparent with
data, sending clear and positive messages to staff and providing constant reinforcement to staff about the
importance of following new processes.
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