Journal of Medical Systems

, 42:242 | Cite as

Using the Collective System Design Methodology to Improve a Medical Center Emergency Room Performance

  • David Cochran
  • Joseph Swartz
  • Behin ElahiEmail author
  • Joseph Smith
Systems-Level Quality Improvement
Part of the following topical collections:
  1. Systems-Level Quality Improvement


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.


Emergency 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.

Ethical Approval

This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study (regarding the patient satisfaction survey).

Supplementary material

10916_2018_1102_MOESM1_ESM.docx (1022 kb)
ESM 1 (DOCX 1022 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Systems Engineering, College of Engineering, Technology, and Computer SciencePurdue University Fort WayneFort WayneUSA
  2. 2.Department of Business TransformationFranciscan Health IndianapolisIndianapolisUSA
  3. 3.Department of Manufacturing and Construction Engineering Technology, College of Engineering, Technology, and Computer SciencePurdue University Fort WayneFort WayneUSA

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