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How one pediatric ED increased patient satisfaction by 15%—in just one quarter

Dominic Lucia, MD, recognizes the unique challenge that a pediatric emergency department (ED) faces.

“Nobody ever wants to be in the emergency room, period,” he says, “and that’s especially true for a child. There’s a nuance to consider when treating pediatric patients.”

Dr. Lucia is the Medical Director of the emergency department at McLane Children’s Medical Center in Temple, Texas. Recently, he set out to improve the patient and family experience by improving how care is delivered there.

“I thought, if we can make care delivery smoother, if we can make it less frightening, if we can communicate well, that will benefit the child as a whole,” he said.

The efforts paid off. In one quarter, McLane’s ED team managed to increase overall patient and family satisfaction by 15%. That’s a quick, dramatic acceleration in performance over just a few months—nearly double the usual organizational rate of improvement across an entire year. But more importantly, the team has also been able to maintain their new high mark of success.

So how did Dr. Lucia and his team accomplish this? Here are three important steps they took.

Renewing focus—every day

First, the ED team fixed its attention on patient and family experience. Instead of waiting for monthly or quarterly meetings to share results from experience surveys, the team discussed these results during daily huddles.

Though these meetings last only five minutes each day, they have an outsized impact on the whole team’s approach to work throughout the day and across shifts. The daily huddle reminders unify staff around serving patients. This way, they never forget how their actions affect patients’ feelings.

Daily huddles also became a focal point for broader leadership in the hospital. Now, as part of their “Gemba Walks”—once a month, when executives join the huddles—the entire staff shares patient-experience data and goals. This way, executives can ensure that ED team members have everything they need to perform their jobs successfully.

Forming the TEAm

Dr. Lucia wanted to hear from a broad representation of the staff disciplines conducting emergency-department functions. He took an interdisciplinary tack, recruiting from all arenas—from first- and second-year residents to respiratory therapists, nurses, and receptionists, all along the staff continuum—then he gathered these people, with their diverse perspectives, into what is now referred to as a TEAm.

The TEAm name comes from a metaphor Dr. Lucia likes to use to describe the group. Just as a teabag in hot water distributes its flavor into the cup, he says, the TEAm disseminates important information around the entire ED.

A respiratory therapist in the TEAm, for example, is responsible for letting other therapists know about pending changes coming to the department. This ensures that every staff-member on the floor gets first-hand communications about what TEAm members discuss—and they hear about it from people who share their perspective.

The first TEAm meeting served as an open forum. Staff members started by clarifying their positions, which helped everyone to understand each other’s roles in the care process, and built a sense of alignment. In every subsequent TEAm meeting, the group is then able to address patient feedback, raise concerns, and address problems as a unified TEAm. The meeting format allows them not only to uncover ways they can improve, but also to see where they’ve excelled in their care. That’s critical for staff morale.

Building a new foundation of service

Finally, the TEAm took one more important step to clarify service expectations: they drafted an ED Core Values statement.

This was no small task. The TEAm wanted to make sure that the new statement struck a sincere chord with the entire department. So they drafted a statement on a whiteboard and left it there for weeks, inviting feedback from everyone across all shifts who wanted to contribute.

After several weeks of whittling and refining, a clear statement of values finally took shape: “We strive to treat every child as if they were our own.”

This simple sentence set a foundation for the ED’s care. The TEAm used it to form seven core principles that the ED staff commits to. Then, they made their commitment conspicuous.

They posted the ED Core Values statement everywhere—including areas of high patient/family traffic. Exam rooms, hallways, and waiting rooms now all remind staff members to hold each other accountable. Even better, patients and family members can see these posters, too—so they can hold McLane’s ED accountable to its promise of care.

The core of it all: transparency

Making their promises public shows both the staff’s and Dr. Lucia’s commitment to openness with patients.

“I have children, I have extended family with children, so I know what it feels like to care for them,” Dr. Lucia says, “and I want us at McLane to do what I know, in my heart of hearts, is best for them.”

And at McLane Children’s Medical Center’s ED, that means building a culture of transparency that spurs improvements in patient experience, loyalty, employee engagement, and quality of care.


Want to learn more about Dr. Lucia and his work at McLane Children’s?  Check out the 2017 Symposium presentation Driving Staff Engagement in the Emergency Department with Patient Experience Data.