The Elephant in the Emergency Department

I am a big fan of Liz Jazwiec and her 2009 book Eat That Cookie! Make Workplace Positivity Pay Off for Individuals, Teams and Organizations. In it, she talks of her time as the manager of a busy Chicago emergency department where the motto seemed to be “I’m here to save your ass, not kiss it.”

I first heard of Liz when the hospital I was working for at the time hired her to give a talk to our managers and directors. She had been a patient experience cynic who thought the whole thing was ridiculous. The president of her hospital told her she had to get her patient experience scores up or she’d be looking for another job. At first, she resisted but soon realized he was serious.

Like so many nurse managers I’ve met, she thought patient experience was fluff stuff and had no place in healthcare, especially a busy ED where things were quite literally life and death. She sneered at the smile police who told her to “just be nice” while she was working hard to bring people back from the brink of death.

To Liz, many of her patients were cranky, ungrateful whiners who were tough to deal with. But as she started being nicer, she was surprised that they started being less cranky, showed some appreciation, and were easier to deal with.

Eventually, Liz not only got her patient experience scores up, she became a believer in the patient experience movement, even becoming a coach for The Studer Group. I love her story and if you haven’t read her book, you really should.

Something else to consider when it comes to the ED is throughput and the effect it has on the nurses.

Much of the dissatisfaction in the ED comes from waiting too long with no idea of what’s happening and why. Staff can certainly help by keeping patients informed but when things are backed up, staff start feeling the pressure, too. When there’s no available bed on the floor, an ED nurse has to now be a telemetry nurse, something they don’t particularly enjoy.

ED nurses are trained to stabilize and either discharge or admit. Once the decision has been made, the ED nurse moves on to the next patient. To have a bunch of patients on gurneys lining the hallway needing ongoing care makes ED nurses anxious. They want the patients to get up to the floors as much as the patients do.

Additionally, there are patients in the ED who need specialized care that the hospital may or may not provide. Sometimes, getting a surgeon or psychiatrist to come in can be a challenge and getting a patient transferred to another facility can take hours. These situations, too, can make staff anxious; they have to manage the questions and complaints but they’re powerless to actually fix them.  

Without efficient discharge processes on the floors, patients can end up staying a day or two longer than needed and that means longer waits in the emergency department for patients who need an inpatient bed. Case managers, social workers, hospitalists, attending physicians, and house supervisors all play a role that affects wait times, and, subsequently, patient experience in the ED.

Nothing can take the place of a warm greeting, staff that meet and even anticipate your needs, and physicians that explain things in a way you can understand. But when it comes to patient satisfaction in the ED, you have to include throughput and inpatient discharge processes in your efforts or you’re only solving part of the problem.

Author: Kate Kalthoff

It's simple: leave people, places, and things better than I found them. For more than 20 years, Katherine Kalthoff has been working to improve the way healthcare organizations connect with the people they serve. She began her career at Gift of Hope, the organ procurement organization for Illinois, approaching families and securing their consent to donate a loved one’s organs for transplant. Through compassionate, empathetic listening, Kate led the Family Services team to one of the highest consent rates in the country. From there, Kate went to Advocate Health Care, Illinois’s largest healthcare system, as a Physician Relations and Business Development Manager, improving physician satisfaction and strengthening the relationships of both the employed and independent physicians with the system as a whole. Just prior to joining Northwest Community Healthcare as the Patient Experience Officer, Kate was the first Manager of Patient Experience at DuPage Medical Group where she built a platform of organization-wide service excellence through her inspiring brand of education, training, and one-on-one coaching. A much sought-after speaker and trainer, Kate has a very simple approach to her work: leave people, places and things better than you found them.

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