Is Emergency Room Expansion Really Necessary?

A recent news story about a hospital construction project concerns me, as I fear it may be an example of a healthcare organization that doesn’t get lean – and may have spent a lot of money unnecessarily as a result.

            The story in the Houston Chronicle involves Memorial Hermann Northeast Hospital near Houston and the construction either planned or recently completed there.

            The story describes how the 255-bed hospital, which employs 1,200, is going to be spending almost $9 million to improve or repair the roof, boilers, chillers and other equipment. No problem there.

            The plans announced by new CEO Keith Alexander also include spending as much as $10 million on computer updates. I’m a bit skeptical about that, but it may be perfectly legitimate and justifiable.

            However, the information that really raised my eyebrows was this:

            The hospital recently completed a $2.5 million expansion to the emergency department, which now has 40 treatment bays.

'With these improvements we hope to dramatically reduce the waiting time in emergency care,' he said.

            The article doesn’t say how many treatment bays there were before the expansion, but clearly the number has increased.

            The problem is the mindset that appears to be behind the expansion: If patients spend too much time waiting in the emergency room, it must be because there aren’t enough treatment bays.

            I’m guessing it never occurred to the people in charge at this hospital that capacity has as much to do with flow as with physical facilities. They may have no understanding at all that waiting times can be reduced without any expansion.

            In fairness, the hospital was also recently recognized as one of the top 100 hospitals in the country that, according to a news release,


            …have made the greatest progress in improving hospital-wide performance over five consecutive years (2001-2005). According to the award criteria, the 2006 Thomson 100 Top Hospitals®: Performance Improvement Leaders have set national benchmarks for the rate and consistency of improvement in clinical outcomes, safety, hospital efficiency, financial stability, and growth.


            However, that award doesn’t necessarily mean the hospital is a leader in applying lean principles. And if they felt a need to expand facilities to reduce emergency room waiting times, I suspect they aren’t.

            What you don’t know about lean can hurt you. Ignorance is not bliss.



Ralph Bernstein said...

8/31/2007 1:30:58 PM
Re: Is Emergency Room Expansion Really Necessary?
By: dcbliss

Expansion doesn't necessarily mean that Lean principles aren't in place. Demand for ER services has increased dramatically in some markets, largely due to uninsured patients who don't have a primary care physician. There are also ER facilities closing in some markets, which places more demand on the remaining facilities. In our market, demand has steadily risen, and is forecasted to continue rising, so both hospitals have been expanding their capacity, as well as applying Lean principles to improve patient flow and decrease wait times.

Ralph Bernstein said...

8/31/2007 5:26:13 PM
Re: Is Emergency Room Expansion Really Necessary?
By: matt

Normally speaking, adding beds would not be advisable before exploring other options. I think, though, that a little historical perspective is good. In terms of efficient and quick delivery of emergency care, Dr. Red Duke at Hermann and Dr. Kenneth Mattox at Ben Taub (right next door) revolutionized the way emergency care is delivered. Houston basically set the standard. Hermann's standards raised those of Memorial when they merged. While Memorial Hermann's practices, as any other's, could always use improvement, I'd be very surprised if beds were added if they weren't really needed. Memorial Hermann also has an active and growing Lean group.<br><br>But then, sometimes bad decisions still get made without consulting the right people.

Ralph Bernstein said...

9/6/2007 12:18:49 PM
Re: Is Emergency Room Expansion Really Necessary?
by: mgraban

It's hard to tell based on the information, but it's certainly wise to look at the entire patient journey / value stream first. There are far too many cases where ED overcrowding is a SYMPTOM of a different problem. Often, the problem is traced back to problems with the hospital discharge process, something that can be fixed for far less cost and disruption than $2.5M. Problems with the discharge process make it hard to get patients into rooms, which backs up the ED. We need to look at value streams, not departments.