Skip to main content
Springer Nature Link
Log in

Using the Collective System Design Methodology to Improve a Medical Center Emergency Room Performance

  • Systems-Level Quality Improvement
  • Published:
Journal of Medical Systems Aims and scope Submit manuscript

Abstract

Emergency Room (ER) crowding is one of the more complex issues in the healthcare system worldwide. Crowding gives rise to long ER waiting times, patient dissatisfaction, and negative effects on a healthcare systems’ performance. This paper focuses on the utilization of the Collective System Design (CSD) methodology to optimize the performance of an ER, which is of principal importance both from a life-threatening and an economic standpoint. The CSD technique is applied to detect areas of deficiency and to identify the functional requirements of the system to address those issues. The ER and system engineering specialists’ team gathered data from the electronic medical center log and their system observation. The team determined the functional requirements and effective solutions, and implemented a continuous improvement plan to enhance ER performance. From a statistical standpoint, a significant decrease in the median of the door-to-doctor time measure (27 min vs 13 min) and a substantial improvement in the patients’ level of satisfaction with the quality of health care (20th percentile vs 41th percentile) were observed after the implementation of the CSD methodology. The CSD methodology augments the implementation of lean tools by providing a language for defining the requirements and corresponding solutions for a system design. Using the CSD methodology, results in a significant increase in the ER’s capacity to treat patients efficiently.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Boudreaux, E. D., and O’Hea, E. L., Patient satisfaction in the emergency department: A review of the literature and implications for practice. J. Emerg. Med. 26(1):13–26, 2004.

    Article  Google Scholar 

  2. Wiler, J. L., Griffey, R. T., and Olsen, T., Review of modeling approaches for emergency department patient flow and crowding research. Acad. Emerg. Med. 18(12):1371–1379, 2011.

    Article  Google Scholar 

  3. Van de Vrugt, M., and Boucherie, R. J., Assigning treatment rooms at the emergency department. ORHC 8:62–70, 2016.

    Google Scholar 

  4. Ding, R., McCarthy, M. L., Li, G., Kirsch, T. D., Jung, J. J., and Kelen, G. D., Patients who leave without being seen: Their characteristics and history of emergency department use. Ann. Emerg. Med. 48(6):686–693, 2006.

    Article  Google Scholar 

  5. Hoot, N. R. et al., Forecasting emergency department crowding: An external, multi-center evaluation. Ann. Emerg. Med. 54(4):514–522, 2009.

    Article  Google Scholar 

  6. El-Rifai, O., Garaix, T., Augusto, V., and Xie, X., A stochastic optimization model for shift scheduling in emergency departments. HCMS 18(3):289–302, 2015.

    Google Scholar 

  7. Liu, Z., Rexachs, D., Epelde, F., and Luque, E., A simulation and optimization-based method for calibrating agent-based emergency department models under data scarcity. Comput. Ind. Eng. 103:300–309, 2017.

    Article  Google Scholar 

  8. Brandao de Souza, L., Trends and approaches in lean healthcare. Leadersh. Health Serv. 22(2):121–139, 2009.

    Article  Google Scholar 

  9. Dickson, E. W., Singh, S., Cheung, D. S., Wyatt, C. C., and Nugent, A. S., Application of lean manufacturing techniques in the emergency department. J. Emerg. Med. 37(2):177–182, 2009.

    Article  Google Scholar 

  10. Holden, R. J., Lean thinking in emergency departments: A critical review. Ann. Emerg. Med. 57(3):265–278, 2011.

    Article  Google Scholar 

  11. Shen, X., and Wang, X., Improving the health-care delivery process at hospital emergency services by a better use of inpatient bed information. Electron. Commer. Res. Appl. 14(1):14–22, 2015.

    Article  Google Scholar 

  12. Ng, D., Vail, G., Thomas, S., and Schmidt, N., Applying the lean principles of the Toyota production system to reduce wait times in the emergency department. CJEM 12(1):50–57, 2010.

    Article  Google Scholar 

  13. Hicks, P. C., McGovern, P. T., Prior, G., and Smith, I., Applying lean principles to the design of healthcare facilities. Int. J. Prod. Econ. 170:677–686, 2015.

    Article  Google Scholar 

  14. D’Andreamatteo, A., Ianni, L., Lega, F., and Sargiacomo, M., Lean in healthcare: A comprehensive review. Health Policy 119(9):1197–1209, 2015.

    Article  Google Scholar 

  15. Elahi, B., Integrated optimization models and strategies for green supply chain planning, Doctoral dissertation, University of Toledo, 14–18, 2016.

  16. Cochran, D. S., Duda, J., Linck, J., and Arinez, J., A decomposition approach for manufacturing system design. JMSY 20(6):371–389, 2001.

    Google Scholar 

  17. Franchetti, M., Elahi, B., and Ghose, S., Value creation through sustainable manufacturing: Practical implementation roadmap. First edition. South Norwalk: Industrial Press, 2016, 240–248.

    Google Scholar 

  18. Elahi, B., Pakzad-Jafarabadi, Y., Etaati, L. and Seyedhosseini, S.M., Optimization of supply chain planning with considering defective rates of products in each echelon. TI 2(3): 211–212, 2011.

    Article  Google Scholar 

  19. Cochran, D. S., Schmidt, G., Oxtoby, J., Hensley, M., and Barnes, J., Using collective system design to define and communicate organization goals and related solutions. JET 7:23–39, 2017.

    Google Scholar 

  20. Elahi, B. and Franchetti, M., A new optimization model for closed-loop supply chain networks. Technology Management Conference (ITMC), 2014 IEEE International, 1–9, 2014.

  21. Seyedhosseini, S.M., Elahi, B. and Akhlaghy, A., Proposing a non-linear mathematical model for order splitting in a supply chain with perishable products: solving by genetic algorithm. IJBR 11(4):104–111, 2011.

  22. Cochran, D. S., Elahi, B., and Spurlock, T. System re-design of first tier automotive value stream. Proceedings of the 2017 Industrial and Systems Engineering Conference and Exhibition, Pittsburg, 2017

  23. Cochran, D. S., Sereno, R., and Aldrich, W., Enterprise engineering of lean accounting and value stream structure through collective system design. Proceedings of the 2014 IIE Engineering Lean and Six Sigma Conference, Orlando, 2014.

  24. Elahi, B., Franchetti, M., A multi-objective proposed mathematical model for a health care supply chain with perishable product. IIE Annual Conference Proceedings, 1514–1523, 2015.

  25. Franchetti, M.J., Elahi, B. and Ghose, S., Green Supply Chain, Logistics, and Transportation. In Green and Lean Management. Springer, Cham, 1–16, 2017.

    Google Scholar 

  26. Emergency Severity Index (ESI): A Triage Tool for Emergency Department Care, 2012 Edition by Agency for Healthcare Research and Quality. http://www.ahrq.gov/professionals/systems/hospital/esi/esi1.html. Accessed 24 July 2018.

  27. Macauley, R., Responsibility for patients after the handoff. AMA Journal of Ethics 14(5):373–375, 2012.

    Article  Google Scholar 

  28. Crane, J., and Noon, C., The definitive guide to emergency department operational improvement. First edition. Productivity Press, a CRC Press company, 2011, 174–176.

  29. Door-to-Doc (D2D) Patient Safety Toolkit. Banner Health and Arizona State University. AHRQ Grant #Hs015921-01.

  30. Guarisco, J., Slash wait times, maximize resources with novel ED protocol. ED Manag. 21(5):49, 2011.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Systems Engineering, College of Engineering, Technology, and Computer Science, Purdue University Fort Wayne, 2101 East Coliseum Boulevard, Room 229 B, Fort Wayne, IN, 46805-1499, USA

    David Cochran & Joseph Smith

  2. Department of Business Transformation, Franciscan Health Indianapolis, 8111 S Emerson Ave, Indianapolis, IN, 46237, USA

    Joseph Swartz

  3. Department of Manufacturing and Construction Engineering Technology, College of Engineering, Technology, and Computer Science, Purdue University Fort Wayne, 2101 East Coliseum Boulevard, Room 221 H, Fort Wayne, IN, 46805-1499, USA

    Behin Elahi

Authors
  1. David Cochran
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Joseph Swartz
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Behin Elahi
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Joseph Smith
    View author publications

    You can also search for this author inPubMed Google Scholar

Corresponding author

Correspondence to Behin Elahi.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study (regarding the patient satisfaction survey).

Additional information

This article is part of the Topical Collection on Systems-Level Quality Improvement

Electronic supplementary material

ESM 1

(DOCX 1022 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cochran, D., Swartz, J., Elahi, B. et al. Using the Collective System Design Methodology to Improve a Medical Center Emergency Room Performance. J Med Syst 42, 242 (2018). https://doi.org/10.1007/s10916-018-1102-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s10916-018-1102-7

Keywords