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Building the Emergency Department...from scratch!

The project I brought to the Harvard Macy Institute Leading Innovations in Healthcare and Education course was to create a model emergency service in Kuwait from what had historically been a clinic run by internists. This emergency service will include an “ideal” emergency department (ED). I had to take a step back and analyze what that means to me - and more importantly - my patients.

To understand the job I was hired to do, I went to seek the help of our patient experience department, a group of dedicated analysts who have conducted numerous surveys and interviews with patients as well as kept feedback logs regarding the emergency services to date. Looking at this data, trends were established. Patients wanted a what they perceived as a “trusted specialist” available at all hours in case of emergencies - a “one stop shop”. To further understand this, I sat in the emergency department waiting room and asked patients what they wanted from the ED in addition to medical treatment and how the ED could facilitate this. Many patients felt that emergency care was not provided by specialized doctors and they were looking for referrals and consultations from in-service departments. This perception from patients is not new. I have heard similar feedback from patients in my previous hospital. Emergency department staff were not seen as specialists but as general practitioners that needed backup from other departments. Many patients felt that they needed to self-refer to in-service departments if they could handle the wait for appointments.

This job meant that we had to ensure that our doctors in the department were updated physicians and that the public needed to be educated to understand this. Having a limited number of board certified emergency physicians in Kuwait, international recruitment partially addressed the challenge. I inherited a hard-working team of internist physicians and nurses who had worked under the prior model. Many of them worked overtime and were on the verge of burning out. They were starting to lose interest in the department, and some had expressed that they were ready to leave the department because they were not hopeful for a future where the system wanted to invest in them. They had some cognitive biases as well as skepticism about change. They did not lack motivation, but they did want someone to believe in them, to invest in their education and give them the protected time and resources for professional development. In ‘Good to Great’, Jim Collins introduces the concept of how to build a new team from one you inherit. Collins describes removing some team members “off the bus” and bringing new team members who have the right knowledge, attitude and skills for the job. In my case however, removing the whole team was not feasible as both their clinical support and knowledge of the healthcare culture was necessary to understanding the system in which I was working. I learned that - for example - patient flow in the department had been changed numerous times. I needed to know the challenges they faced with each change to not repeat the same mistakes.

A departmental needs assessment was necessary to help us understand areas where the prior model worked well and areas where we would need to improve. Through the needs assessment, we recognized that professional development was needed in order to try and form a cohesive care team. The faculty development program aimed to address gaps in medical knowledge and best practices for teamwork and communication. These health care professionals had not had any formal training in emergency medicine, although their educational training included intensive care and internal medicine. They did however, have years of experience in working in the ED. The health care professionals themselves perceived medical knowledge gaps and wanted more practice in procedures that were not common which ended in premature consultation to in-services. Sometimes the clinicians wanted an evidence-based medicine update on certain topics to help them gain confidence in treatment. The professional development program also aimed to re-motivate employees, and second to influence their cognitive biases by using a design thinking session. These sessions gave the healthcare professionals a voice to discuss their concerns in the department and included unearthing cognitive biases that could be discussed in a safe environment and addressed appropriately. An example of this is the belief that resources were not available to serve faculty development, and that the hospital may be so patient-centered that healthcare professionals are believed to be “second class”.

To address the need of patient education, a marketing campaign was developed. Waiting room monitors explaining doctors’ qualifications and how the new ED works have been placed. I conducted TV interviews and they were subsequently uploaded on the hospital’s social media platforms to give awareness to people. An internal marketing campaign to explain to in-service doctors what the new ED department is now capable of was also put into place to help further education of the public.

My Harvard Macy project group offered feedback on the institutes’ intended purpose brand of having the only department that is covered by board certified ED physicians in the country. This theory was first described by Clayton Christensen, which brings the use of an idea that was not readily available to all by creating a new market and value network eventually disrupts an existing market and value network, displacing established market-leading firms, products, and alliances.

Having ED specialists more accessible to the population you serve and transparency to the public offers the opportunity for a unique hospital brand. In providing around-the-clock consultant care tapered to patient’s needs, we will encourage patients to trust the system. It is our aspiration that patients will be satisfied in the level of care, and that they will also trust the system we have developed.

 

References

  1. Collins, J. C. (2001). Good to great: Why some companies make the leap ... and others don't. New York, NY: HarperBusiness.
  2. Watkins, M. (2016). Leading the team you inherit. Harvard Business review.
  3. Lockwood, T. (2009). Design thinking: Integrating innovation, customer experience and brand value. New York, NY: Allworth Press.
  4. Christensen, C. M. (1997). The innovator's dilemma: When new technologies cause great firms to fail. Boston, MA: Harvard Business School Press.
  5. Fullan, M. Principals as leaders in a culture of change. Educational Leadership, Special Issue, May 2002.
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Sunday, 09 December 2018