- Reduce variation that does not add value
- Be a "thin-rulebook company." Establish department values and principles and empower employees to provide service accordingly. Make no decisions at a higher level that can be made at a lower level.
- Collaborate with radiology to decrease the number of patients that need oral contrast. A retrospective chart review indicated that use of oral contrast added an average of 155 minutes to a patient's length of stay.
- Schedule staff so that they operate at 85% maximal capacity. Running consistently at 100% capacity in a system with unscheduled arrivals and variable service times is not the most effective way to operate.
- Exhorting the troops and acting as an example often is insufficient to motivate change as it is viewed as "more work." Help people understand why change is good for themselves ie it makes their jobs easier and more fulfilling. All meaningful and lasting change is intrinsically motivated, not extrinsically motivated.
- Consider implementing team traige (MD, RN, tech) or triage-advanced orders to begin care in the waiting room when no ER beds are available.
- Recruit and retain the best talent. Hire owners not renters ("clock punchers"). This is where great companies start.
- Adapt your leadership style to accommodate different staff if it will make the team stronger.
- Preempt call lights by anticipating patients' needs.
- Create a results-waiting area where appropriate patients can wait for results without tying up a bed.
- Cross train. When possible train one person to do two jobs rather than two people to do two jobs.
- Hold a contest to determine the best ideas for decreasing delays.
Source
Mayer, T. and Jensen, K. Hardwiring Flow: Systems and Processes for Seamless Patient Care
