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Charles T. Cash, Jr., M.D.Chief of Obstetrics and Gynecology Oakwood Hospital & Medical CenterDearborn, Mich.In 2003, inefficiences at 632-licensed-bed Oakwood left some patients lingering in triage for as long as six hours. Cash and his team adopted a "high-leverage opportunity" approach in which more than 100 labor and delivery staff members and 35 physicians created teams to pinpoint areas where care was delayed. The results yielded greater efficiency and garnered national recognition for care-delivery innovation.Cash: The project's goal was to leverage opportunities we weren't taking advantage of. We presented staff with the proposition of improving safety, quality and satisfaction in a different way. Rather than just making recommendations for improvements, they set up experiments to see what changes might work. It might be adding an extra triage room or moving a stretcher, but if we had an idea that might change our process, we'd test it and modify it as we went along.The solutions come from people in the department. We couldn't allow them to say, "We need to build a $20 million addition and that's our experiment," but we did simpler things. For example, faxes weren't getting put in charts because charts were assembled in triage where there was no fax. Bringing in a fax machine reduced the amount of time to assemble charts. Little things like that help to make shorter, higher-quality visits.-Kara Olsen