Case:

Patients are waiting over 2 hours to be seen by a provider in the General Hospital Emergency Room (ER) and once they have been seen it is another 2 hours for the provider to disposition the patient (admit to the hospital or discharged home). The patient Left Without Being Seen rate (those who leave the ER before being seen by a provider) is at 6%....triple the National average. A recent employee satisfaction survey identified that morale is the lowest it has been in years and the department manager just quit. The administration just hired a new ER manager who was the ER manager at another hospital's Emergency Department 3500 miles away.

You are this new manager. Upon arrival, you received some data run by some of the best informatics staff in the country. The data identified the following: 1. 75% of staff are regularly 15 minutes late for their shift. This impacts change of shift, nurse-to- nurse report/patient hand-off communication (when nurses relay patient care information to the next nurse coming on). This also results in significant overtime expenses for the department, and employee satisfaction to be the lowest in years. 2. The care teams are not staffed based on patient demand by the hour of the day. The data shows the department is busiest from 10a - 10p, however additional nurses and providers are not added until noon. So by the time the ER gets additional support, they are already behind in patient care. 3. The hospital is losing thousands of dollars from the patients leaving without being seen. This is directly correlated to the > 2-hour wait time to get into the department and be seen by a provider. "Delay to be seen" is the top reason for discontent among patients identified on the most recent Patient Satisfaction Survey.

How can you introduce change management to reduce Emergency Room Wait times using the ADKAR model and the 3 C's (Culture, Controls & Commitment), and increase staff motivation?