Recipe for Quality

By Christopher Pepin, RN, CEN, CCRN

National Director of Clinical Services

How does an emergency department management group like NES Health change the face of an emergency department or the quality outcomes? It’s a question that comes up every time we talk with our current hospital partners, sit down for new business development presentations, or when developing strategic plans in the quality department.

When we look across the country at the over 4,000 emergency departments, we would like to think that much of what we do is separated by significant differences in employees, process, and culture. In reality, it’s the subtlest differences in measurement that change the entire outcome. My wife once grabbed a container of salt instead of sugar when making muffins for our kids. This may not have been the slightest change in recipe; nonetheless the outcome was completely different than what was expected. Not to mention my children and their friends held back none when declaring how horrible the muffins were, and will tell the story for years to come.

I use this example because I so often compare the practices in hospitals with that of restaurants. I did this often in a prior position during orientation sessions to new employees in order to drive home the concept of service excellence in a way in which people could relate. The good and bad in healthcare is a personal and memorable experience quite similar to the meals we eat. The great dish prepared by your grandmother or the worst meal you’ve ever had at your hometown eatery create permanent memories, in some ways as much as the birth of a child or the death of a loved one.

This concept was made real to me a couple of years ago when I read an article in The New Yorker magazine titled “Big Med” by Dr. Atul Gawande. It compared the Cheesecake Factory restaurant chain to how we do things in the field of healthcare. It discussed how, if we could model an efficient business aimed at affordable costs and consistent quality, we would get it all right. While I believe this to be true-and have embraced lean methodology, improved efficiency, and customer service along with the rest of the country-it is the right mixture at the right time that yields the looked-for outcome.

While the concept of modeling a successful restaurant or even a successful emergency department should be within reach, the variables that occur from entrance to exit can quickly become staggering. The difference between serving a dish of cold Fettuccine Alfredo or a 7-hour wait for discharge instructions can be but one process out of 1,000 failing, in either example.

Going back to the original question, how does NES Health help to deliver quality outcomes? I don’t think I could say that we should model one specific business or restaurant in order to get it right. We do, however, have the right pieces in place to ensure we aren’t getting it wrong. The ability to deliver key metrics to both our providers and hospital administrators is crucial to delivering quality in each of our staffed emergency departments. Here are some of the quality ingredients we use at NES Health.

List of Ingredients

  1. Client IQ
    Each of our emergency departments utilize Client IQ, which is real-time survey software deployed on touchscreen tablets. This provides immediate data on all of our physicians/mid-levels, nurses they work with, the environment, and overall satisfaction of the hospital. This has recently been improved so that we can receive all of this through an app on smartphones or any of our mobile devices.
  2. ActionCue
    Our data analytics program, ActionCue, provides data to all of our site medical directors, physicians/mid-levels, hospital administrators and the operations staff at NES Health. Some of the benefit of this tool is looking at throughput times and working with staff to ensure they are meeting benchmarks or working on established goals desired by the leaders at our hospitals.
  3. Performance Improvement Teams
    At the heart of our success, is the process of creating performance improvement (PI) teams made up of physicians and nurses to ensure a means by which to implement best practices at each staffed ED. The creation of a successful PI team is an avenue through which to have frontline staff decide what most needs attention in the ED, and then consistently making improvements. Improvement is always an ongoing, never-ending process.

Everyone of our emergency departments may have a different menu, different theme, and use a different model to put “an amazing meal on the table,” so to speak. We do, however, have the same expectations for each and every ED: To always strive to be better than the national averages set forth by standards of care, and to do it in ways that are affordable to our patients, while delivering amazing customer service.

Read Dr. Atul Gawande’s referenced article, “Big Med” here:
www.newyorker.com/magazine/2012/08/13/big-med