This is an excerpt from a member-only article. To read the article in its entirety, please login or subscribe.

North Mississippi Medical Center (NMMC) in Tupelo had a problem with its emergency department (ED). Patient and community surveys showed that the hospital's reputation was suffering from long wait times in the ED-often four to six hours from door to discharge or admission. So NMMC-the largest rural hospital in the United States, with 650 beds, 3,955 employees, and $460 million in annual revenue-embarked on a quality-improvement campaign that focused in part on the ED. Some improvements were simple, such as adding TVs to individual patient waiting rooms and correcting structural issues that were hampering patient flow.