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A decision to improve the performance of an emergency department (ED) often begins with redesigning its work flow processes that do not work as well as they might. Management conferences can provide valuable information and advice based on presenter's experience, but knowing where to start can be challenging. The essential element in orchestrating a change is not knowing a specific solution. It is rather realizing from the outset that a team implementing a redesign must work not only to change some processes but also to change the organization's culture and to some degree the people's attitudes who work in it.

Organizational and cultural change is necessary to reach the project's goals. Achieving such change, however, is not easy, as obstacles can block the way. These obstacles can be overcome, and this chapter will show how. As an ED changes its culture and develops new processes, its efficiency and effectiveness will increase. The services it provides will improve in quality and the morale of the team members will rise to such a degree that patient satisfaction scores will soar.

Creating a Vision

Leading lasting change begins with creating or revisiting the organization's mission, vision, and values statements, or as many refer to it, “the vision statement.” (This topic is addressed in more detail in Chapter 2.) It is surprising to note how many EDs have never taken the time in the first place to define their goals or their work as a team; or if they have, how many statements created are now invisible to current staff as they hang on a wall in the ED gathering dust. Vision statements do not inspire and motivate staff without the staff buying it from the start and their continuous use of its principles. Vision statements are created to embody the organization's core ideology.1

An ED's

  • Mission is the answer to the question, “What is the ED attempting to do?
  • Vision answers, “Why does the ED exist?”
  • Values express how the team members will treat each other on the journey to create a new workplace or “Which core and fundamental beliefs guide the ED?”

The vision statement must not only describe why the department exists but also where it has been historically. This written document should be the steering wheel for the organization and its elements should guide every decision.

Anyone changing an organization in this way must start by questioning what they want, that is,

  • What are the team members committed to in their respective roles?
  • What characteristics would a department have that was effectively and efficiently delivering high-quality, safe care?
  • What would stand out to patients about their care in such a facility, and what would draw them to it?
  • What would constitute a satisfactory experience within this high-performing facility?
  • What would an ED look like if physicians, nurses, lab technicians, ...

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