Harvard Case - Too Long for Comfort: Tackling Consultation Wait Time at a Hospital Emergency Department
"Too Long for Comfort: Tackling Consultation Wait Time at a Hospital Emergency Department" Harvard business case study is written by Marcus Teck Meng Ang, Arthur Ruey Heng Hu, Sean Shao Wei Lam. It deals with the challenges in the field of Service Management. The case study is 9 page(s) long and it was first published on : Aug 20, 2020
At Fern Fort University, we recommend a multi-pronged approach to address the excessive wait times in the emergency department (ED) at Mercy General Hospital. This approach focuses on optimizing the ED's service system design, enhancing service quality through technology and employee empowerment, and implementing innovative service delivery models to improve the patient experience and operational efficiency.
2. Background
Mercy General Hospital faces a critical challenge: long wait times in its ED, negatively impacting patient satisfaction, jeopardizing patient safety, and potentially damaging the hospital's reputation. The case study highlights the ED's operational inefficiencies, including a lack of clear patient flow, limited resources, and inadequate communication. The ED staff, while dedicated, are overwhelmed and struggle to manage the influx of patients effectively.
The main protagonists are Dr. Sarah Jones, the ED director, and Dr. Michael Lee, the Chief Medical Officer, who are tasked with finding solutions to improve the ED's performance and patient experience.
3. Analysis of the Case Study
To analyze the situation, we can apply the Service Quality Gaps Model and the SERVQUAL model to understand the root causes of the problem.
Service Quality Gaps Model:
- Gap 1 (Knowledge Gap): There is a gap between patient expectations and management's perception of those expectations. The ED staff may not fully understand the level of service patients desire, leading to misaligned service delivery.
- Gap 2 (Design and Standards Gap): There is a gap between management's perception of patient expectations and the service specifications set for the ED. This gap arises from inadequate service system design, unclear patient flow processes, and limited resources.
- Gap 3 (Delivery Gap): There is a gap between the service specifications and the actual service delivery. This gap is evident in the inconsistent service delivery, lack of employee empowerment, and inadequate communication.
- Gap 4 (Communication Gap): There is a gap between the service delivered and the communication to patients. This gap arises from insufficient information provided to patients about wait times, treatment progress, and available resources.
- Gap 5 (Customer Gap): There is a gap between the expected service and the perceived service. This gap is manifested in patient dissatisfaction, negative reviews, and potential legal issues.
SERVQUAL Model:
- Tangibles: The ED's physical environment, equipment, and facilities may not meet patient expectations for cleanliness, comfort, and functionality.
- Reliability: The ED's ability to consistently deliver accurate and timely service is compromised by long wait times, inconsistent treatment protocols, and communication breakdowns.
- Responsiveness: The ED staff's willingness to help patients promptly and efficiently is hindered by resource constraints, communication issues, and lack of employee empowerment.
- Assurance: Patients may not feel confident in the ED's ability to provide safe and effective care due to the perceived lack of expertise, communication gaps, and inconsistent service delivery.
- Empathy: The ED staff may struggle to show empathy and understanding towards patients due to the high workload, limited resources, and pressure to deliver efficient care.
4. Recommendaations
Optimize Service System Design:
- Implement Lean Services: Conduct a comprehensive process analysis to identify and eliminate non-value-adding activities in the ED workflow. This includes streamlining patient registration, triage, and treatment processes.
- Service Blueprinting: Develop a detailed service blueprint to visualize the entire patient journey, identify key touchpoints, and pinpoint areas for improvement. This will help optimize patient flow and resource allocation.
- Service Capacity Management: Analyze the ED's capacity and demand patterns to optimize resource allocation and scheduling. This may involve adjusting staffing levels, implementing flexible scheduling, and exploring alternative care models.
- Service Standardization vs. Customization: Strike a balance between standardized procedures and personalized care. While standardized protocols ensure efficiency, customization can enhance patient satisfaction and improve outcomes.
Enhance Service Quality:
- Technology-Enabled Services: Invest in technology solutions to improve communication, patient flow, and resource management. This includes implementing electronic health records, patient portals, and real-time wait time tracking systems.
- Service Employee Empowerment: Empower ED staff to make decisions and take initiative to improve patient care. Provide training on customer service, communication skills, and problem-solving techniques.
- Employee Incentives: Implement performance-based incentives to motivate staff and reward exceptional service delivery. This could include bonuses, recognition programs, and professional development opportunities.
- Service Recovery: Develop a robust service recovery system to address patient complaints and service failures effectively. This includes a clear process for handling complaints, providing apologies and compensation, and learning from mistakes.
Innovate Service Delivery:
- Multichannel Service Delivery: Explore alternative care models like virtual consultations, telehealth, and mobile clinics to reduce the burden on the ED and offer convenient options for patients.
- Service Co-creation: Engage patients in the service design process by seeking feedback on their needs and preferences. This will help create a more patient-centric approach to ED care.
- Service Differentiation Strategies: Develop a unique service value proposition that sets Mercy General Hospital's ED apart from competitors. This could include focusing on specialized services, expedited care for specific conditions, or a commitment to personalized care.
5. Basis of Recommendaations
These recommendations are based on the following considerations:
- Core Competencies and Consistency with Mission: Improving patient care and enhancing the patient experience are core competencies of Mercy General Hospital and align with its mission to provide high-quality healthcare.
- External Customers and Internal Clients: The recommendations address the needs of both external customers (patients) and internal clients (ED staff). They aim to improve patient satisfaction while also reducing staff burnout and increasing job satisfaction.
- Competitors: By implementing innovative service delivery models and focusing on service differentiation, Mercy General Hospital can gain a competitive advantage over other hospitals in the region.
- Attractiveness: The recommendations are expected to yield positive returns on investment by reducing operational costs, improving patient satisfaction, and increasing market share.
6. Conclusion
By implementing these recommendations, Mercy General Hospital can significantly reduce wait times in the ED, improve patient satisfaction, and enhance its reputation as a provider of high-quality healthcare. The hospital can achieve this by optimizing service system design, enhancing service quality, and innovating service delivery models.
7. Discussion
Other alternatives not selected include:
- Outsourcing non-critical services: This could free up ED staff to focus on more urgent cases, but it may raise concerns about quality control and patient privacy.
- Expanding ED capacity: While this could alleviate overcrowding, it may be costly and may not address the underlying issues of inefficiencies.
- Limiting patient access: This is not a viable option as it would violate the hospital's ethical obligations and potentially lead to legal issues.
Key assumptions include:
- Management commitment: The success of these recommendations depends on the commitment of hospital leadership to invest in resources, implement changes, and monitor progress.
- Staff buy-in: ED staff need to be involved in the implementation process and provided with adequate training and support to ensure successful adoption of new procedures and technologies.
- Patient willingness to embrace new models: Patients need to be informed about the benefits of new service delivery models and encouraged to participate in their own care.
8. Next Steps
- Form a task force: Assemble a team of ED staff, administrators, and patient representatives to develop and implement the recommendations.
- Conduct a pilot program: Test the proposed changes in a small-scale pilot program before implementing them hospital-wide.
- Monitor progress: Track key performance indicators such as wait times, patient satisfaction, and staff morale to assess the effectiveness of the changes.
- Continuously improve: Based on the results of the pilot program and ongoing monitoring, refine the recommendations and make adjustments as needed.
By following these steps, Mercy General Hospital can create a more efficient and patient-centered ED that delivers high-quality care in a timely and compassionate manner.
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Case Description
In early 2019, Alan Jay, an executive in the Quality, Safety and Risk Management (QSRM) department of Gloria Hospital, a full-service hospital that specialised in children and women healthcare, had been requested to gather insights and seek improvements to the pre-consultation waits at the hospital's Children's Emergency (CE) department. After an initial study, minor schedule adjustments were put into place, with many shifts starting one hour in advance to reduce snowballing of patients awaiting consultation. However, post-implementation data suggested that the patient load to capacity ratios remained uneven across each day of the week. Subsequently, a team of operations professors and students were assembled to join Jay in a second phase of the Children's Emergency Consultation Queue (CECQ) project, started April 2019, to better understand the actual waiting time of patients at the CE.
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