Project Finds Lean Process Improvements Can Benefit the Bottom Line at Safety Net Hospitals

Hospital emergency departments (EDs) are a critical component of our health care system, offering the only guaranteed source of health care available 24 hours a day, 365 days a year.  As ED use in California continues to rise on a per capita basis, there are long waits for treatment, especially in low-income areas where there is a scarcity of providers and urgent care centers.  This results in patients leaving the ED without being seen or treated.

A demonstration project facilitated by the Institute for Medical Quality (IMQ) and funded by the W. M. Keck Foundation has shown that three safety net hospitals in the Los Angeles area successfully used lean process improvement to reduce ED length of stay and/or reduce inpatient discharge times, freeing up beds for ED patients.  Collectively, their EDs serve over 220,000 patients annually.  In addition, all three hospitals found that reducing ED length of stay would enhance financial performance primarily by reducing the number of patients who elope before being admitted for inpatient care and the time the ED diverted ambulances to other hospitals.

This project also found that issues such as lack of timely access to data, analytical capacity and staff incentives slowed the hospitals’ progress.  Health systems that want to improve patient outcomes and their financial performance should provide their hospitals with the leadership and resources they need to prioritize lean process improvements.

The release of the IMQ report is timely.  Kaiser Health News reported in May 2019 that the percentage of patients who left the ER after being seen by a doctor, but before their medical care was complete, increased by almost 60% between 2012 and 2017.  Patients with complex care needs who have been admitted to the hospital often languish in the ED waiting for an inpatient bed, which has been shown to increase their risk of adverse outcomes, medical errors and mortality.  According to the Kaiser Health News ED data analysis, California emergency room wait times remain higher than the national average, and only four states have a longer median wait time.

This highly interdisciplinary work has garnered several honors.  In particular, while being supported by the W. M. Keck Foundation, Hersam was elected to the rank of Fellow in six different professional societies: International Society for Optics and Photonics (SPIE), Materials Research Society (MRS), American Vacuum Society (AVS), American Physical Society (APS), American Association for the Advancement of Science (AAAS), and Institute of Electrical and Electronics Engineers (IEEE).  Hersam was also recognized with the ACS Arthur K. Doolittle Award in Polymeric Materials Science and Engineering and a MacArthur Fellowship for his research on chemically modified graphene and related nanomaterials.

See the full report:

For questions about the report, contact IMQ Program Manager, Kevin Reeder, This email address is being protected from spambots. You need JavaScript enabled to view it., 415-882-5132.

For questions about financial performance data analysis, contact, Lynette Ferrara, Parnassus Consulting, This email address is being protected from spambots. You need JavaScript enabled to view it., 202-352-2993.

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