Tuesday, August 21, 2012

Friday night lights = Friday Night Clinics

CoxHealth is again offering Friday Night Clinics to all area high school athletes with sports-related injuries, beginning Friday, Aug. 17, at 9 p.m. The clinics offer an alternative to crowded emergency rooms when care is needed for a non-emergent injury sustained during play. 

The clinics will be held in The Bone and Joint Center, 3555 S. National, Suite 200, in Springfield. Each Friday Night Clinic team is led by an orthopedic surgeon and includes a nurse, certified athletic trainer, radiology tech and clerical staff. Minor radiology exams are also available on-site to assist the physician with patient evaluation.

Insurance claims will be filed. Coaches and athletic trainers can refer an athlete to the clinic by calling 417/269-7778. The final sports injury clinic of the season will be Thursday, Oct. 26. For more information about Friday Night Clinics, visit http://www.coxhealth.com/body.cfm?id=2869.

CoxHealth Fitness Centers offers Just Lose It weight loss challenge to the community – for free

For the past three years, CoxHealth Fitness Centers has offered the Just Lose It weight loss challenge program – and participants have combined to lose more than 4,000 pounds. This year, the program is being offered to everyone in the community ages 12 and up, for free, in an effort to help improve obesity rates in adults and children in the Ozarks. 

A recent study by the CDC shows that Missouri is one of the 12 most obese states in the nation. This statewide trend holds true in the Ozarks, too, where every county in CoxHealth’s 22-county service area has an obesity rate equal to or greater than the state average of 30.3 percent.

“With programs like Just Lose It, we hope we can begin to help reverse that trend,” says Ashly Stelling, with CoxHealth Fitness Centers. “The program focuses on nutrition and exercise, so participants can learn everything they need to make healthy choices and live a healthy life.”

Just Lose It kicks off 6 - 8 p.m., Thursday, Aug. 30 at The CoxHealth Meyer Fitness Center, 3545 S. National. During this Kick-Off Expo, participants can register, talk to CoxHealth health and wellness professionals, and complete their initial weigh-in. Program participants who choose to join CoxHealth Fitness Centers during the expo will get two months of membership for free. (Weigh-ins will also be held Sept. 2 - 8 at any CoxHealth Fitness Center location.)

Just Lose It includes nutrition challenges, cooking demonstrations, weekly guided wellness walks at locations throughout Springfield and the Ozarks, weekly motivation and education via email, and more. The overall male and female winners will receive a 6-month membership and a $50 gift card to CoxHealth Fitness Centers. For more information about the program, to see the full list of nutrition challenges and wellness walks, and to read success stories from past participants, visit http://www.coxhealth.com/JLI.

Thursday, August 2, 2012

CoxHealth earns ‘Most Wired’ honors

CoxHealth has been recognized as one of the nation’s Most Improved Most Wired hospitals, according to the results of the 2012 Most Wired Survey released recently by Hospitals & Health Networks magazine. 

The organization was awarded for adopting technology solutions that have improved patient care, safety and efficiency, says Bruce Robison, CoxHealth vice president and CIO.

“We have undertaken a number of key projects that had a bearing on this award. We’re pleased to have received it, and I’m proud of the Information Technology staff, and all of our stakeholders, whose hard work has been recognized,” he said.

Robison pointed to several recent IT projects that helped win the recognition, including:

· automated medication dispensing cabinets

· bar-coded patient wrist labels and handheld wireless medication administration software

· Computerized Provider Order Entry

· automated capture of vital signs for inclusion in the electronic clinical record

· patient access through the CoxHealth Express portal, including the ability to self-scheduled appointments, view lab results, have an electronic visit with the provider, maintain personal health information, participate in chronic disease management and more

· secure remote access to clinical records for caregivers.

Health Care’s Most Wired Survey, conducted between Jan. 15 and March 15, asked hospitals and health systems nationwide to answer questions regarding their IT initiatives. Respondents completed 662 surveys, representing 1,570 hospitals, or roughly 27 percent of all U.S. hospitals. The H&HN story detailing results is available at www.hhnmag.com.

Moms and daughters: laugh and learn about life’s changes at fun event

Shepherding daughters through the changes of puberty takes patience and knowledge. Thankfully, The Women’s Center at CoxHealth is here to help with the annual “Mother/Daughter Luncheon and Back-to-School Fashion Show” event.

During this program, women’s health educator and experienced mother Robin Housley, RN, will present a candid and sometimes humorous age-appropriate discussion of puberty for moms and their daughters ages 10-13.

This program will be held Saturday, Aug. 18, from 11 a.m. – 1 p.m., in Foster Auditorium at Cox South, and will include a back-to-school fashion show featuring fashions from Old Navy. There is a $12 per person fee. Call The Women’s Center at 269-LADY to register.

Wednesday, August 1, 2012

HUG Fund continues Neil Wortley’s legacy

A message from Lisa Alexander, CoxHealth Foundation: 
Former CoxHealth administrator Neil Wortley was known for many things. Among the most notable: his compassionate heart and readiness with a hug. Today, these two hallmarks of Neil Wortley are coming together in a new fund that will carry on his legacy of helping patients in need.

The Neil Wortley Help for the Uninsured Grant (HUG) Fund will wrap its arms around those patients who are uninsured for critical health care needs that affect their ability to recover from an illness or injury.

Over the years, the CoxHealth Foundation has assisted with funds that can pay for medical bills and medications. Each year the need increases: Applications for help through our Good Samaritan Fund, for example, have risen to 70-90 requests a month, up from 15-20 a few years ago. But it’s the unusual, unfunded requests for support that are now the daily norm.

More patients need help with the kinds of things for which there is no insurance coverage or state/federal aid; often it is medication or pressure garments for post-surgical patients to treat lymphedema; home-support aids for the bathroom; or special masks that screen out particles that made a patient sick. The requests are as diverse as the patients who request help.

The HUG Fund will help us meet those needs. We chose to name the fund in honor of Neil Wortley (seen above in two historical photos and alongside his son, Dave Wortley, and grandson Jason Wortley in 2006) because of how fondly he is remembered for his “patient first” philosophy. In the 1950s, Wortley used to run down the street to the corner pharmacy to pick up medications for patients unable to buy them for themselves. He taught us all how to love our patients and make them family.

What sets this fund apart is its ability to empower patients, physicians and staff. When a patient has an unfunded need, a staff member can make a phone call to the Foundation and the HUG Fund can help. Discharges that are held up because a patient can’t be released without a medication, or even a ride home, can now be funded by the HUG Fund.

Our goal for 2012 is to raise $100,000 to start this fund, which will be the only known resource of its kind currently in our region.

Neil Wortley’s generous spirit is part of the legacy of CoxHealth and you can carry on the tradition of helping those in need by supporting the HUG Fund.

To make a gift to the HUG Fund, go to coxhealthfoundation.com and pick Wortley HUG Fund from the drop-down box on the Donate Now page. Gifts can be made by payroll deduction for CoxHealth employees. Watch for updates on the fund on our website! 

Striving for excellent patient care

On 700 East, PCAs Megan Cloyd and CJ Rogers respond to a call light above the door to a patient room. Many areas will soon add “no pass” zones, which remind all staff members to respond to call lights in person, regardless of their role on the unit. 

Yvette Williams has worked closely with CoxHealth's Experience Excellence team to research the best tactics for providing great service. In this column from CoxHealth Connection, she details a few ways we're working to offer patients the best service:

Thinking about CoxHealth’s stroke care, two words come to mind: compliance and consistency.
Earning national recognition as a Joint Commission accredited Primary Stroke Center and becoming one of only 91 health systems in the nation to earn the Stroke Gold Plus Performance Achievement Award doesn’t happen by accident. It requires every single person who works with patients to have a high degree of consistency and compliance with a set of evidence-based practices. The goal for our stroke care is zero defects, which means providing the same high standard of care to every patient, every time. 

We can apply the same formula of compliance and consistency as we strive for excellence in service. Given CoxHealth’s strategic goal to be in the top 10 percent nationally in HCAHPS patient perception survey scores and that survey’s emphasis on the Top Box score of “Always,” the goal once again is zero defects. 

Reaching and sustaining our service goals will require everyone’s compliance with a set of behaviors and attitudes found in the delivery of excellent customer service and everyone’s consistency with those behaviors with every patient and family member, every time. 

How can we successfully shape patient perceptions of our care? The HCAHPS survey is behavior based, asking patients how often certain behaviors were performed and CoxHealth’s goal is to have the answer be “always.” Meeting that goal means the emphasis will be on us, our words, actions and behaviors. This will definitely take a team effort, which is exactly the direction Dr. John Duff, CoxHealth senior vice president and chief hospital officer, gave to a group of Experience Excellence team members. 

The group was asked to research best practice behaviors that have been shown to improve patient perceptions around certain HCAHPS dimensions, focusing first on two key areas – responsiveness and quietness. An education program was developed that included two videos, one for each dimension. The videos feature staff members in skits that demonstrate the six responsiveness tactics and five quietness tactics we identified. 

This spring, 300 nursing, ancillary and support services leaders were trained on these tactics. Then, leaders were asked to hold staff meetings to introduce them to employees and begin to monitor their use. Later this year, more educational programs will be developed to focus on the other key HCAHPS dimensions. 

Fortunately, these tactics are not new to CoxHealth. As you’ll see, these behaviors have already been implemented to some degree in several areas of our hospital services. The key now is to apply these tactics consistently among the entire patient care team. 

During a shift change in the Emergency Department at Cox North, nurses Tiffany Schneider and Nick Osborn talk with Hugh Harvey and his daughter, Devannie. Staff members in the North ED are now conducting bedside shift handoffs so patients can meet their new nurse and ask any questions they may have. 

Patients equate quality care in part with our responsiveness and courtesy. How quickly staff members respond to patient requests and needs throughout the hospital stay is one of the top predictors of overall patient satisfaction. An emphasis on improving responsiveness is already under way in several hospital units. 

Tactic No. 1 – Face-to-face response to call lights. One way of making responses more personal for the patient is to respond directly to a patient’s room to turn off the call light instead of answering the call light at the nurses’ station. 

400 West put this tactic into practice earlier this year. Donna Miller, unit secretary, says the change was difficult at first, but staff now see how this tactic is making a difference in the unit’s responsiveness. 

“We’d find that sometimes we’d answer the phone and then on the way to the room, we’d get sidetracked by another patient need,” says Miller. “Now we’re more responsive and able to respond to all our patients’ needs much faster.” 

Tactic No. 2 – No pass zones. All hospital units will become no pass zones where everyone on the floor is asked to respond to call light needs without passing by a room except when isolation or security reasons exist. Patient care assistant Sherri Elkins says a version of this tactic is already in use on 700 East. 

“We really look out for each other,” says Elkins. “If we see call lights going off and it’s not ours and we’re passing by, we just stop and answer it, that way we help each other out. We’re a team up here.”
To deploy this tactic, staff from ancillary and support services departments will be asked to respond to call lights. Phlebotomist Jamie Mast says she already responds when she’s on the way out of a unit. 

“I just walk in and introduce myself and turn off the call light. Then I ask the patient what they need. Usually it’s something I can take care of but if not, I tell the patient I have to get the nurse or PCA. I always come back and tell the patient what I did and that help is on the way,” says Mast. 

For those of you who might be uncomfortable answering call lights, it’s important to know that research shows 80 percent of the call light needs can be taken care of by anyone. Phlebotomist Rowena Hull finds this to be true. When she’s finished drawing blood, she asks if there’s anything else she can do. 

“Sometimes they have something little they want, like they can’t reach their tray, or their cell phone has fallen on the floor or they can’t reach their phone or their menu,” says Hull. 

Ancillary and support services staff should respond to call lights only after taking care of the patient they were helping originally. You can tell when a call light has been activated when the white light on the top of the light bank above a patient’s door is on. 

Tactic No. 3 – Caring rounds. This tactic is Nursing’s hourly rounding protocol. Consistent use of hourly rounding can actually reduce call lights. 

Coby Smith, nurse at the Meyer Orthopedic Center, says his goal through caring rounds is to keep patients informed. “I introduce myself and tell them a little bit about myself to make them feel comfortable. I tell them what they can expect for the day and about the time frames. I always ask them what else I can do for them in that moment, whether it’s bathroom, position, pain needs or just to find out if they have a concern about anything. It usually puts them at ease and shows that I do care.” 

Tactic No. 4 – Key words. Smith uses another tactic during his caring rounds: key words at key times and the AIDET method of communication, which stands for Acknowledge, Introduce, Duration, Explanation and Thank you. 

Key words are verbal signals of actions being taken for the patient that explain what you are doing and why. CCU/MICU nurse manager Lenny Shepard says his staff is getting into the habit of using AIDET in critical care, where families generally experience anxiety related to not knowing what the machines and monitors do or what the alarms mean. 

After acknowledging the patient and the family and introducing themselves, staff members are describing and explaining what they are doing and how long an intervention should take. They also encourage questions. Our consistency with key words and explanation can positively influence patient perceptions. 

“I just had the wife of one of our patients stop me to tell me how wonderful and how at ease she has been since all the nursing staff has explained everything happening and every medication they are giving,” says Shepard. “I have witnessed AIDET throughout the unit and I’m very excited about the success.” 

Tactic No. 5 – Check before you go. This tactic asks staff to assess a patient’s bathroom needs before leaving the room or before transporting a patient to another area. 

Tactic No. 6 – Bedside shift report. This tactic involves holding the shift handoff at the bedside to reassess and engage the patient regarding how well we’re responding to their needs. Staff members in the North Emergency Department were reluctant at first to use this tactic, but patient care manager Rachel Wells says they now see the value in it. 

“It forces us to have more face time with the patient and then the patient knows who to ask for as soon as the switch is made,” says Wells. “Patients seem to like it because they’re more informed.”

Rest is an important part of a patient’s recovery, but hospitals can be noisy places. Patients who can’t sleep due to noise or bright lights may be more irritable and anxious, which may negatively affect healing and a patient’s overall experience. Several departments have already deployed these tactics and others to promote a healing environment. 

Tactic No. 1 – Close the doors. Unless a safety concern exists, staff should close doors to protect privacy and reduce noise. 

Tactic No. 2 – Bunch tasks when possible. When possible, staff should “bunch” certain nighttime tasks so they can be performed at the same time. Patients won’t have to be repeatedly disturbed and our care will appear more coordinated. 

Tactic No. 3 – Offer sleep kits. Sleep kits are available on hospital units and should be offered to patients routinely. These kits provide tools such as ear plugs and masks to help patients get better rest.
700 East nurse manager Kim Cash says after hearing about this tactic, staff began offering them to patients. “I’ve seen multiple patients on the floor with those sleep masks, so I’m excited to see them wearing them even in the afternoon!” 

Tactic No. 4 – Reduce staff noises. Sometimes the cause of the noise is us. Staff voices can be very loud, especially at night and we can play a major role in reducing noise by keeping voices down when speaking in patient care areas. Nurse manager Lorinda Rehagen says night staff members on 700 West do a good job of helping each other keep noise levels down. 

Tactic No. 5 - Key words at key times. This tactic can also help staff explain why we care about maintaining a quiet environment and why some activities must be performed at night. 

Some units aren’t stopping at these tactics to offer a quiet environment. Several hospital units offer nap times, when lights are dimmed and staff voices are subsequently lowered, during the day. In a pilot project, nurses on 700 East wear pagers that send specific instructions about patient needs to nursing staff without the use of overheard paging. This also im
proves responsiveness. On 900 West, new sound-masking machines are helping decrease noise. 

Just imagine what our patient care areas will look and feel like if everyone is practicing these same behaviors and tactics. Our patients will see and feel a consistency in our efforts to create an experience that emphasizes responsiveness and quietness, making it more likely that their perceptions will be that we always made these important factors in their care a priority. 

Pedestrians, drivers need to exercise caution

CoxHealth Trauma Services has noted an increase in the number of vehicle vs. pedestrian accidents over the past few months in Springfield and surrounding communities. A number of these cases have been fatal.
“Most of the victims have been in their teens and early 20s,” says Jami Blackwell, CoxHealth Trauma Services coordinator.
Blackwell attributes the increase to a number of factors, including warmer temperatures and healthier lifestyles causing more people to walk, run and bike along area roadways. That, combined with drivers who are often distracted by texting or talking on cellphones, can lead to serious, and sometimes fatal, accidents.
“We want to remind everyone of the precautions they can take to stay safe,” she says.
Blackwell also urges staff driving on CoxHealth property to exercise caution.
“There have been several close calls in our parking lots, particularly at Cox South along the southern edge of the parking lot immediately north of James River Freeway,” she says. Blackwell says cars routinely drive this route at speeds in excess of 20 mph, and there have been several instances where cars have nearly been hit when pulling out of parking spaces, and when employees walking to their cars have almost been struck by vehicles passing by too quickly. 

Safety tips for walkers, runners and bike riders:

• Be aware of your surroundings, and make eye contact with people driving vehicles near you.
• Avoid texting, talking on your cellphone and listening to music.
• Cross at crosswalks and obey all traffic signals and signs.
• Wear bright, reflective clothing, especially at night.
• Don’t step off the curb between parked cars.
• Parents should be near small children at all times when outside in areas where moving vehicles may be present.

Safety tips for drivers:

• Don’t text or talk on a cellphone while driving.
• Pay attention to your surroundings and make note of any pedestrians in your vicinity.
• Be especially mindful in neighborhoods where children may play outside and in parking lots. 

Improving the ER flow at Cox Monett

In the Cox Monett ER, charge nurses Julia Eden and Margaret Kleiboeker check the patient tracking board, which offers an at-a-glance view of work under way in the department. The board was recently expanded to include more details about what tests have been ordered and which are complete. The changes were one part of a lean project aimed at coordinating care in the department. 
The culture of an emergency room is, by definition, fast-paced; when problems present themselves, people move quickly to solve them. That approach is ideal when you’re dealing with acute, immediate issues like injuries and illnesses. But taking on broad challenges, like improving patient flow in a busy ER, requires a different approach.
Since February, staff members in Cox Monett’s Emergency Department have been improving the way they work through a lean project that is focused on throughput and workflow efficiency. For those who have built a career in emergency care, the systematic approach of lean has been a major shift of gears. 
“The pace is very logical and methodical, but you have to do it,” says Beverly Morris, nurse manager in the ER. “It’s tough for fast-paced ER types to slow down and take a step back.” 
Over the past few months, the lean team has helped staff members do just that. They’ve been examining how patients experience care in the ER and looking at ways to streamline their work to reduce wait times. At the same time, staff members have become versed in the methodology of lean, which requires carefully mapping all the steps in a process and looking for waste that can be eliminated. The team has gathered people from a variety of departments to look for ways they can work together to improve care and the patient experience. 
“We’ve spent a lot of time understanding the current situation,” says Genny Maroc, president of Cox Monett. “This is a very data-driven approach to build the business case for the project.” 
The lean project continues this summer, but so far the measured, big-picture approach is paying off for staff members and patients. 
When the project began last winter, it was designed to improve throughput and efficiency in the ER. About 1,200 patients visit the Cox Monett ER each month and that number is up by 5.2 percent over this time last year. As the volumes rise, so does the number of patients who leave without being treated. If the lean team could find efficiencies and reduce that number, it would have a two-fold benefit: improving satisfaction, for both patients and employees, and capturing revenue for the system. 
Early on, Morris says it was clear that the issue of throughput was an “elephant-sized” problem; to address it, it would need to be broken into smaller parts. The lean team began looking at the door-to-door times: how long it took from a patient’s initial arrival at the ER until they were discharged or admitted. 
Maroc says the data indicated that if total door-to-door time could be improved by 20 percent, it would cut out 30 minutes from each visit. That, in turn, would allow the ER to serve 700 more patients per year. 
To begin getting a handle on how to make that improvement, the team further broke down the patient experience. They focused on the first half of that door-to-door process: the time spent between patient arrival and the work done by ancillary services such as laboratory, radiology and respiratory care. That timeframe, called “door-to-ancillary complete,” would be the first target for improvements. 
In a relatively small facility like Cox Monett, many ancillary departments multi-task, managing their own outpatient volumes and duties in the hospital with working in the ER as needed. 
It can be tough to coordinate the ancillary work in the ER, especially if a patient needs assistance from multiple departments. 
“When respiratory care, lab and X-ray all respond at the same time, it can disrupt a smooth patient flow,” Morris says.  
The lean team identified two major solutions, or countermeasures, they could put in place to improve that flow: an enhanced computerized tracking board and adding a patient flow coordinator. 
The ER already had a computerized tracking system, but the team worked with staff members to identify improvements that could make it a more effective tool for coordinating all of the work that takes place in the department. 
Jeff Graham, applications technology manager in IT, worked with the team to add new features that offer more detail about what tests have been ordered and how close they are to completion. 
The ER tracking board now shows four new icons: CT/ultrasounds; urinalysis orders; in-house labs; and labs that have been sent out. In the past, a column for labs on the tracking board might have shown, for example, that eight labs had been ordered and six were back. What it didn’t make clear is that the remaining two were sent out- of-house. Now, the board shows how many labs have been ordered; a hospital icon indicates they are in-house, while a bus icon indicates they have been sent out. 
“The tracking board has been a great success,” Morris says. 
The icon for urinalysis orders provides a quick visual cue for everyone in the department, letting them know which patients require a urine sample. Staff members can then easily check in with waiting patients and collect the sample when patients need to use the restroom.  
In addition to the new levels of detail, ancillary departments can now see tracking board information from their desktops, which helps staff members see when the ER is getting busy and where the ER staff is in its workflow. 
“They can see our volumes and know when to expect orders,” Morris says. “They used to look at individual orders on the computer, but now they can just pull up the whole tracking board.” 
As a second countermeasure to help coordinate care, the department was getting set to try a new position beginning in late June: an ER flow manager. The flow manager (a nursing staff member) will be responsible for knowing the status of all patients in the ER and triaging the workflows; knowing which patient the physician needs to see next and coordinating the work of ancillary departments for maximum efficiency. 
“In the past, you’ve had three nurses telling the doctor information; one nurse doesn’t know what the others have shared,” says Heidi Clark, house supervisor. “This position, with one person aware of everything, may fix that.” 
The flow coordinator will also have access to a new push-to-talk phone system similar to the ones in use in the Cox North and Cox South ERs. The phones will allow the ER to have instant communication with ancillary staff members.  
“When the patient orders go in, the flow manager can push a button and talk to lab and X-ray staff together and instruct lab to come first, followed by X-ray. There is no phone call to interrupt workflows,” Morris says. 
In late June, the department was going to do three test periods with a flow manager to collect data to see how much difference the position makes. 
In addition to the major countermeasures, the lean project has also uncovered some simple fixes that have made work flow more smoothly. One example involves the location of printers that produce the printed orders for lab and radiology. In the evenings, there are fewer techs in those departments and they may be working in the back and miss an order that prints out in the front of the office. The solution? Move a printer into the back of the department, so orders print where staffers are in the evenings. 
Charge nurse Julia Eden says those simple changes that make things smoother for employees can do a lot to improve employee satisfaction. 
“Sometimes, patient frustrations are more easily seen, but it’s frustrating for staff, too, when there are delays and inefficiencies,” she says. “A lot of these changes help us work smarter, not harder.” 
Pat Blamey, director of Radiology, says the lean team meetings were a chance to boil down the steps in the patient experience and better understand the challenges faced by  each department. Just by talking to one another, the group was able to find ways to be more efficient. 
For example, Blamey says ER staff members had developed a workaround to cope with the wait times for radiology films to be read. After a test was completed, the film would be read at Cox South. ER staff get the results by calling a dictation line, but staff members reported that they often had to listen to a couple of unrelated results to get to the one they needed. 
“When I heard that, I asked them, ‘Are you using the shortcuts?’” Blamey says. “It turns out that they had lost those instructions. So we printed new ones!” 
Also, ER staffers didn’t know how quickly their films would be read. They didn’t want to call twice, so they would wait to make sure the results would be ready by the time they called, which caused delays.
“Someone else in the room pointed out that there is a fix for that – an IT solution that would group your orders and let you see when they have been completed,” Blamey says.
Staff members say the opportunity to sit down with co-workers from across a variety of departments to talk about the patient care process and work on solutions together is a big part of the power of a lean project. 
“It’s eye-opening for everyone to see how things affect other departments. As much as areas like lab, ER and radiology work together in the interest of the patient, we tend to work in our own segmented groups; we know our processes but we don’t know 100 percent what their processes are,” Clark says. “Very seldom do we have meetings with all of those entities present at the same table. You get a better understanding of what everyone has to do and it makes it easier to work together as a team for the patient.” 
Having everyone at the table working together has produced a clear understanding of the ER’s needs and it has allowed the team to prioritize the improvements they’re considering. Meanwhile, the lean project has provided a data-driven framework for assessing those needs and tracking the effectiveness of the countermeasures, which justifies the investment some improvements require. 
“Some of these ideas are ones people have had for a while, but lean has allowed the right people to be involved to make these changes,” Clark says. “It’s allowed us to move forward and make those ideas a reality.” 
In the coming months, ER staff will be studying the success of improvements like the tracking board and the flow coordinator. They’ll also be working on smaller changes, such as adding color-coded flags for each patient room, to indicate quickly and visually where a patient is in the process.
As the project heads into its final stages, participants say the fast pace of their daily work is improving as a result of decisions made in the methodical lean process. Their advice for other departments who are about to embark on a lean project? Be ready to change the way you think and be willing to follow where the lean process takes you.
“You have to let the process guide you. With the meetings and the tools you’re given, it’s like the lean team is in a boat, in a river, and it will take you there; you have to not paddle against it,” Morris says. “I’m used to paddling, but you have to float.”
 Going with the flow of a lean project is easier when everyone remembers that the goal is to keep the patient at the center of everything we do.
“You have to be open-minded,” Eden says. “People are afraid of change, but this is about a better work environment and it ultimately will make patients happier.”
About lean 
Lean thought has its roots in a process improvement discipline developed by Toyota. While it began in the world of manufacturing, the lean approach can be used to examine and improve a variety of work processes. Here are a few of the terms you’re likely to hear as lean projects are deployed at CoxHealth:
Muda: A Japanese term for an activity that is wasteful and doesn’t add value.
Gemba walk: When leaders examine first-hand how work is done on the front lines. They’re visiting “gemba,” or “the real place” in Japanese.
Value stream: All the steps in a process of producing or delivering a product or service. Value streams are mapped to show the flow of information and work in the process. How work is carried out at the beginning of a lean project is defined on a current state map while a goal for how processes could be improved is spelled out in a future state map.