Developing High-Quality Patient-Centered Care

It was important to make the distinction between what was an unorganized "collection of activities" and the goal of an "orchestrated process," Pratt says.

"People didn't understand that this collection of activities was a process and that we could map it as a flow. Just in defining it in a flow diagram, we could often see immediately what was wrong," Pratt says. Throughput in the emergency department was among the first processes to go through process mapping, and what they found was that physicians and nurses were not working in tandem as well as they could and that much of the patient experience was waiting.

"What we needed was an orchestrated process driven by a team where everybody understood everybody else's roles," Pratt says. "They knew what they were going to do. They knew the rough time frame they were going to do it in, and they accomplished it and got to a conclusion. And it happened so much faster because of that."

Blind process improvement for the pure sake of efficiency, however, is not the goal. Often process improvement efforts identify process waste that has an underlying patient safety or satisfaction reason, such as duplicate time spent with patients to make certain they understand their follow-up care plan. What has made the results sustainable has been that all process improvement is weighed against "what is value-added and what is not value-added to patient experience," says Susan Stone, vice president of patient care services and chief nursing officer for Sharp Memorial Hospital.