Making Hospitals More Efficient with Behavioral Systems Analysis

Todd A. Ward, PhD, BCBA-D

bSci21Media, LLC

Kelley and Gravina (2018) recently published a study in the Journal of Organizational Behavior Management in which a successful process redesign produced significantly lower door-to-order and door-to-discharge times in the Emergency Department (ED) of a 150-bed hospital.

Here’s what they did…

The hospital recognized a need to improve ED processes after reviewing comparable measures from other similarly sized hospitals.  Moreover, the authors noted that every minute a patient spends in the ED translates to approximately $1.27 in costs to the hospital, and potentially reduces quality patient outcomes.

The team focused on two dependent variables: door-to-order time, and door-to-discharge time.  The former was “the average time from when a patient entered the ED until the first laboratory or radiology test was ordered.”  The latter was “the average time from when a patient entered the ED until the patient was discharged.”

The team worked in collaboration with hospital staff to refine essential ED work processes to make them more efficient.  For example, the team determined the ten most common reasons for patients entering the ED and developed pre-approved order sets for common procedures like x-rays etc…  The refined process meant more control was given to nurses, and physician time was freed up for more critical cases.  In short, patients no longer had to wait for a physician as nurses were given more autonomy in the process.

Although the new process shortened door-to-order times, the team decided to incorporate daily performance feedback to further ensure everyone was following the new process. The feedback was provided in the form of a graphic depicting average door-to-order times and was posted in the ED.

Overall door-to-order times were reduced from an average of 36.2 minutes before the study, to 22.1 minutes after the intervention.  Moreover, door-to-discharge times were reduces from an average of 182.6 minutes to 159.6 minutes after the intervention.  A cost-benefit analysis revealed that the hospital saved an estimated $137,511.41 across the study.

To read more about the study and its implications for future work, be sure to check out the full article.  Also be sure to subscribe to bSci21 via email to receive the latest articles directly to your inbox!

Todd A. Ward, PhD, BCBA-D is the President and Founder of bSci21Media, LLC, which owns the top behavior analytic media outlet in the world, bSci21.org.  bSci21Media aims to disseminate behavior analysis to the world and to support ABA companies around the globe through the Behavioral Science in the 21st Century blog and its subsidiaries, bSciEntrepreneurial, bSciWebDesign, bSciWriting, and the ABA Outside the Box CEU series.  Dr. Ward received his PhD in behavior analysis from the University of Nevada, Reno under Dr. Ramona Houmanfar.  He has served as a Guest Associate Editor of the Journal of Organizational Behavior Management, and as an Editorial Board member of Behavior and Social Issues.  Dr. Ward has also provided ABA services to children and adults with various developmental disabilities in day centers, in-home, residential, and school settings, and previously served as Faculty Director of Behavior Analysis Online at the University of North Texas.  Dr. Ward is passionate about disseminating behavior analysis to the world and growing the field through entrepreneurship. Todd can be reached at [email protected]