No patients waiting in corridors at Dunedin Hospital's emergency department (ED) should be part of the hospital's vision, Mike Hunter says.
Mr Hunter, the hospital's intensive care clinical leader, has been clinical leader of a project called "' 6 Hours - It Matters!", taking an organisation-wide approach to improve the staying times for ED patients.
In a report outlining what he learned from visiting other EDs, at Middlemore, Auckland City and Christchurch, Mr Hunter said it was clear all three hospitals were well ahead of Dunedin in achieving the target of 95% of patients spending no longer than six hours in the ED.
Their patients also had a better experience and were probably safer being managed in or through EDs which were no longer overcrowded, he said.
He called for a clear statement from the top of the organisation identifying a vision, what was required to reach it and a time for doing that.
As well as no patients in corridors, the vision should spell out that all patients turning up at the ED would be transferred or discharged within six hours unless there was a strong clinical reason not to do so.
Further, all patients who needed acute operations would receive it on the same day or be booked immediately on a specified list within a time suited to their condition.
All services managing acute patients would also have a comprehensive plan that ensured prompt, efficient and safe assessment, treatment, admission and discharge processes for those patients.
All changes should be based on the best available data, or , if this was not possible, relevant data should be gathered.
Most of Mr Hunter's time was spent at Middlemore Hospital, where four years ago the situation was "undeniably chaotic", he said. Writing about Middlemore, and its clear leadership and emphasis on quality improvement from the top, Mr Hunter acknowledged that proposals for change were initially greeted with "howls of protest" from some but that now "almost everybody" seemed to perceive the changes made as improvements.
All he had spoken to said they enjoyed their work far more than before.
ED nurses had experienced a huge surge in morale, sick leave had plummeted and nurses wanted to work there - "there are no vacancies".
"Most of all, the patients are far more satisfied with their experiences in the ED and on their acute journey through the hospital."
Mr Hunter noted the crucial role key people "on the floor" had in driving the process of change at Middlemore.
"They watched, measured, cajoled, begged, nagged, shamed and inspired people to change the way they did business and truly delight their patients".
