EmEx Brings Business Excellence
to Emergency Care

The Concept of Business Excellence

Emergency Excellence (EmEx) was created to bring Business Excellence to emergency care. Business Excellence is a methodology that enables any type of business to achieve “excellence.” The focus is on four distinct areas – business processes, employee performance, public impact, and customer satisfaction. The term “Business Excellence” originated in the early 1980s when the U.S. quality movement was responding to the tremendous quality advancements in Japan. The differentiating characteristic from existing quality programs was the establishment of an award for exceptional achievement in quality improvement. Business Excellence has a solid track record and has been validated by demonstrating significantly greater success in companies of all types and sizes.

Award programs are essential to Business Excellence as they result in defining and sharing best practices. Moreover, they foster a culture of continuous performance improvement and induce healthy competition so that the bar is continually raised. Award applicants are usually scored using a data collection questionnaire followed by an onsite review.

Proof that Business Excellence Really Improves Outcomes

Six-hundred Baldrige award-winning organizations were compared to a control group (companies of similar size and sectors) and this analysis revealed a significant positive difference for the award-winning companies in every key measure. http://mansci.journal.informs.org/cgi/content/abstract/43/9/1258
A European study demonstrated that award-winning companies had much higher sales growth, increased operating income, and a greater growth in assets. http://www.northofenglandexcellence.co.uk/Resources/business_case/BQF%20EFQM%20Research%20Report.pdf
Fifteen manufacturing firms participated in the Australian Quality Awards (not only award winners) and improvements were demonstrated against a range of key performance indicators (KPIs) and there was a strong positive correlation between KPI improvement and total business excellence score. http://bpir-trial.com/business-excellence-bpir.com.htm

The Balanced Scorecard

A “Balanced Scorecard” provides a comprehensive view of the quantitative and abstract measures of true importance to the enterprise. The purpose of the Balanced Scorecard is to accomplish the following:

  • Translate the organization’s vision into operational goals
  • Link the vision and to individual performance
  • Plan the business around its goals
  • Set goal achievement thresholds
  • Obtain feedback so that strategies may be adjusted accordingly

Emergency Excellence Merges Emergency Medicine and Business Excellence

In its 2006 publication, Hospital Based Emergency Care: At the Breaking Point, the Institute of Medicine (IOM) described our overcrowded and underperforming emergency care system and charged leaders to establish evidence-based performance indicators. IOM Recommendation 4.2 specifically stated, “The committee recommends that hospital chief executive officers adopt enterprise-wide operations management and related strategies to improve the quality and efficiency of emergency care.” The IOM call for action affirmed the need for a Business Excellence approach in the delivery of emergency care.

An extensive literature review and dozens of in-depth interviews with emergency department leaders allowed EmEx to identify the factors at play in top performing emergency departments and identify over 100 benchmarks identified as key performance indicators (KPIs). Each KPI provides a relevant, measurable, meaningful, benchmark that can lead to performance improvement.

Each KPI is benchmarked to other participating EDs and subdivided by census, type, and locale. Performance for each KPI is compared to best practice thresholds and when these are met for a particular KPI, the ED receives points towards consideration for the Emergency Center of Excellence designation. Each KPI is weighted differently (more important KPIs are given greater weight).

Some KPI results are based on survey results of key stakeholders, including physicians, nurses, ancillary staff, midlevel providers, medical staff, and hospital administrators. The stakeholder feedback portion deserves special emphasis as each key group is encouraged to offer critical feedback. This introduces hundreds of opinions for consideration.

Each KPI assesses the integrity of one or more of The Seven Pillars of Excellence, our Balanced Scorecard:

  • Safety - Incorporates objective quality of care and outcomes
  • Satisfaction - Relates the patient’s perception of quality
  • Solvency - Addresses financial balance and sustainability.
  • Space - Represents the functionality of the facility and equipment
  • Staff - Incorporates the training, staffing, and professional satisfaciton of physicians, nurses and staff
  • Support - Involves relationships with other departments, hospital administration, and medical staff
  • Systems - Involves emergency department processes, policies, guidelines and care pathways

The strength of each pillar is measured by a number of different KPIs. As visually depicted in the EmEx logo, exceptional performance requires maintaining the integrity of The Seven Pillars of Excellence.

The EmEx-Compare benchmarking solution drives EmEx-Award, a recognition program for high performing emergency departments. Top performing EDs (based on their EmEx-Compare performance) are preliminary eligible for the Emergency Center of Excellence designation, pending on-site verification. Essentially, these two products create a cohesive Business Excellence model for emergency care. To assist emergency departments struggling to achieve excellence, EmEx-Consult was developed. An experienced emergency physician and another operations specialist carefully review the EmEx-Compare findings, provide a two-day on-site consultation, and collaborate to create a custom-made Rapid Improvement Plan to assist the emergency department leadership in coordinating critical operational changes.

EmEx also offers EmEx-Contact, an outsourcing option for patient telephone callback and satisfaction measurement. This takes Business Excellence to a higher level by allowing the primary customers to evaluate their experience and offer timely feedback. This program, lauded by the Robert Wood Johnson Foundation as a best practice, also improves patient care by mitigating risk (e.g., patients that report worsening conditions are instructed to immediately return).

Summary

EmEx believes that successful emergency departments must have the following attributes:

  • Committed leadership
  • Comprehensive evaluation utilizing a Balanced Scorecard consisting of a wide-range of relevant, measurable, meaningful, benchmarks that provide opportunities for performance improvement
  • Customer and stakeholder feedback
  • Stakeholders that are motivated to identify and incorporate best practices
  • A proactive (rather than reactive) response to performance improvement

The benefits of incorporating the Emergency Center of Excellence as a goal for ED performance improvement include:

  • Increased pace of emergency department improvement
  • Improved staff morale, cooperation, and communication
  • Quality and satisfaction become a central, strategic issue Improved reputation and recognition for superior emergency care

References