Excellence to Eminence

What Success Looks Like

Improving the Health of the Emergency Department
Excellence, Openness and Trust

July 26, 2010 

Patients come to the Emergency Department every day expecting high quality care and good communication from their care team. Dr. Mark Moseley and Tammy Moore, RN, knew that, in order to provide the best care for patients, they needed to improve teamwork in the Emergency Department. 

Dr. Moseley and Moore saw that the Emergency Department needed to strengthen its teamwork skills. While they provided excellent patient care, there was an opportunity to improve communication with each other. The communication, and a lower level of teamwork, limited patient satisfaction.

“Emergency medicine is a team sport,” said Dr. Moseley, Medical Director of University Hospitals Emergency Department and Clinical Decision Unit. “Because it’s high pressure and time sensitive, we have to work together well as a team.” 

Last summer, Moore, nursing director for the Emergency Department, and Dr. Moseley took 32 doctors and nurses through an unfreezing retreat to help the group better understand each other, and learn new, high-performing ways to work together. The group spent time focusing on collaboration, how they would interact with each other, and clarifying what’s expected of each other. 

Clearly a lot of operational fixes went into the increases [in our operational measures], but they wouldn't have been possible without the cultural changes that we were working on at the same time.

--Dr. Mark Moseley, Medical Director of University Hospitals Emergency Department and Clinical Decision Unit

The team came back to the Emergency Department with a renewed focus on excellence, and developing trusting relationships with each other through improved communication. 

“We had a new sense of camaraderie, and a focus on working together more effectively,” said Moore. “The stronger sense of teamwork allowed us to increase our focus on patient satisfaction and operational improvement.”

The shift in thinking has paid dividends for the Emergency Department. Patient satisfaction scores have increased to 85.6 percent from a previous 71 percent. Other operational metrics have improved, including the percentage of patients who left the Emergency Department without being seen decreased to 2.8 percent from 7 percent, and ambulance diversion hours dropped from 794 to 12 hours in 2009, the lowest in Columbus.

“During this period, our Emergency Department volume also went up considerably, making these improvements that much more impressive,” Dr. Moseley said. “Clearly a lot of operational fixes went into the increases, but they wouldn't have been possible without the cultural changes that we were working on at the same time.”

These changes have been noticed by peers across the country as well. The group is approaching top quartile performance for similar academic medical centers.

The team recently attended a reinforcement session to reconnect and reaffirm their commitment to building a high-performing team. They’re also looking for ways to introduce their new thinking to others, and are reviewing how they onboard new team members.

Dr. Moseley attributes the increased results and improved working relationships to building a healthy, high performing culture.

“The changes we’ve made are a result of changing our thinking, and living according to our values.” he said. “Taking time to think through how you show up and work together has a big impact on results.”