Using the Collective System Design Methodology to Improve a Medical Center Emergency Room Performance
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Emergency Room (ER) crowding is one of the more complex issues in the healthcare system worldwide. Crowding gives rise to long ER waiting times, patient dissatisfaction, and negative effects on a healthcare systems’ performance. This paper focuses on the utilization of the Collective System Design (CSD) methodology to optimize the performance of an ER, which is of principal importance both from a life-threatening and an economic standpoint. The CSD technique is applied to detect areas of deficiency and to identify the functional requirements of the system to address those issues. The ER and system engineering specialists’ team gathered data from the electronic medical center log and their system observation. The team determined the functional requirements and effective solutions, and implemented a continuous improvement plan to enhance ER performance. From a statistical standpoint, a significant decrease in the median of the door-to-doctor time measure (27 min vs 13 min) and a substantial improvement in the patients’ level of satisfaction with the quality of health care (20th percentile vs 41th percentile) were observed after the implementation of the CSD methodology. The CSD methodology augments the implementation of lean tools by providing a language for defining the requirements and corresponding solutions for a system design. Using the CSD methodology, results in a significant increase in the ER’s capacity to treat patients efficiently.
KeywordsEmergency response Process improvement Resource allocation Quality and system design Health care systems
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study (regarding the patient satisfaction survey).
- 3.Van de Vrugt, M., and Boucherie, R. J., Assigning treatment rooms at the emergency department. ORHC 8:62–70, 2016.Google Scholar
- 6.El-Rifai, O., Garaix, T., Augusto, V., and Xie, X., A stochastic optimization model for shift scheduling in emergency departments. HCMS 18(3):289–302, 2015.Google Scholar
- 15.Elahi, B., Integrated optimization models and strategies for green supply chain planning, Doctoral dissertation, University of Toledo, 14–18, 2016.Google Scholar
- 16.Cochran, D. S., Duda, J., Linck, J., and Arinez, J., A decomposition approach for manufacturing system design. JMSY 20(6):371–389, 2001.Google Scholar
- 17.Franchetti, M., Elahi, B., and Ghose, S., Value creation through sustainable manufacturing: Practical implementation roadmap. First edition. South Norwalk: Industrial Press, 2016, 240–248.Google Scholar
- 19.Cochran, D. S., Schmidt, G., Oxtoby, J., Hensley, M., and Barnes, J., Using collective system design to define and communicate organization goals and related solutions. JET 7:23–39, 2017.Google Scholar
- 20.Elahi, B. and Franchetti, M., A new optimization model for closed-loop supply chain networks. Technology Management Conference (ITMC), 2014 IEEE International, 1–9, 2014.Google Scholar
- 21.Seyedhosseini, S.M., Elahi, B. and Akhlaghy, A., Proposing a non-linear mathematical model for order splitting in a supply chain with perishable products: solving by genetic algorithm. IJBR 11(4):104–111, 2011.Google Scholar
- 22.Cochran, D. S., Elahi, B., and Spurlock, T. System re-design of first tier automotive value stream. Proceedings of the 2017 Industrial and Systems Engineering Conference and Exhibition, Pittsburg, 2017Google Scholar
- 23.Cochran, D. S., Sereno, R., and Aldrich, W., Enterprise engineering of lean accounting and value stream structure through collective system design. Proceedings of the 2014 IIE Engineering Lean and Six Sigma Conference, Orlando, 2014.Google Scholar
- 24.Elahi, B., Franchetti, M., A multi-objective proposed mathematical model for a health care supply chain with perishable product. IIE Annual Conference Proceedings, 1514–1523, 2015.Google Scholar
- 25.Franchetti, M.J., Elahi, B. and Ghose, S., Green Supply Chain, Logistics, and Transportation. In Green and Lean Management. Springer, Cham, 1–16, 2017.Google Scholar
- 26.Emergency Severity Index (ESI): A Triage Tool for Emergency Department Care, 2012 Edition by Agency for Healthcare Research and Quality. http://www.ahrq.gov/professionals/systems/hospital/esi/esi1.html. Accessed 24 July 2018.
- 27.Macauley, R., Responsibility for patients after the handoff. AMA Journal of Ethics 14(5):373–375, 2012.Google Scholar
- 28.Crane, J., and Noon, C., The definitive guide to emergency department operational improvement. First edition. Productivity Press, a CRC Press company, 2011, 174–176.Google Scholar
- 29.Door-to-Doc (D2D) Patient Safety Toolkit. Banner Health and Arizona State University. AHRQ Grant #Hs015921-01.Google Scholar
- 30.Guarisco, J., Slash wait times, maximize resources with novel ED protocol. ED Manag. 21(5):49, 2011.Google Scholar