A Relentless Commitment to Improvement: The Guelph General Hospital Experience

P atient experience is now accepted as a key element of quality care.In one of two interviews that touch on the patient experience with Esther Green (EG), Richard Ernst (RE) -the CEO of Guelph General Hospital -talks about the full range of efforts that his organization has used to achieve and sustain excellent patient experience ratings.The interview underlies the importance of an organization-wide approach to improvement that touches on processes, human resources, and culture as well as a relentless commitment to improvement that is manifested through regular meetings that track progress.EG: Guelph General Hospital has seen some positive results with respect to improving the patients' experience.Could you tell me, Richard, what you think are the key factors that have really contributed to the change?RE: I'll start by mentioning that we've been tracking patient satisfaction indicators on a dashboard since 2007.Prior to that, we were certainly reporting the information that came out of the hospital report on a regular basis.A key factor was not just tracking the outcomes but also focusing on opportunities for improvement that are routinely identified through these reports.The organization itself has made a commitment to improving our patient experience, and I think one of the best examples is what's transpired in our Emergency Department over the past couple of years.Emergency, as you know, is an entry point to the hospital.Ninety percent of medical patients admitted to our hospital come through our Emergency Department.That's 55,000 ED patients each year, and it's an area of significance to us relative to patient satisfaction.Starting in about February 2009, Guelph General Hospital became involved in a program of process improvement launched by the Ministry of Health and Long-Term Care.The ministry invested resources in providing consultants to help hospitals in the Waterloo-Wellington LHIN try to move the bar on some of the metrics in the Emergency Departments.In our hospital, we introduced a concept of Lean methodology -value-stream mapping.Using front-line staff, we were able to start to make some changes.For example, when we looked at value-stream mapping, one of the key elements is, you don't do things that don't add value to either care providers or care receivers.If you're not doing things that add no value to patients, you are, by default, improving the patient experience.Throughout that time, we had great physician leadership, and we had nurses from the Emergency Department shadowing nurses up in the Medical Unit and vice versa, so they could walk a mile in someone else's shoes.This led to an acknowledgement that patients who come to the hospital aren't Emergency Department patients and they're not Medical Unit patientsthey are our patients.And it wasn't just those two nursing areas either; it was the diagnostic areas, environmental services, and bed allocation.Everybody who's involved in the process that Geulph General Hospital Quality Comittee: (l-r) Eileen Bain, VP Patient Services and Chief Nursing Executive,

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