Our Philosophy

The Emergency Department as the Center of the Institution

The ED is a high volume, demanding care environment. Regulatory and reporting requirements are multiplying. Patients are more complicated and their demand for service quality improvement continue to rise. The existing primary care infrastructure is generally insufficient to move patients out of the ED, and we anticipate that recent national trends of increasing ED visits will continue with further implementation of the Patient Protection and Affordable Care Act (PPACA) Despite these challenges, the value-based health care changes that we are already beginning to see will broaden and deepen over the next 5-10 years and force additional change at almost every Emergency Department in the country. Fifteen years ago, an ED could quietly function as an island and was often viewed by administrators as a “loss leader.” The role of the ED is rapidly expanding, and many EDs now find themselves with multiple hospital and community requests for integration into new care processes. Emergency Departments sit in a unique position to coordinate care between community health resources and the in-patient world. Hospitals need their EDs to become more population aware and value-based.

The Emergency Department Model

There are many components of ED infrastructure. These are skills and resources that MedPAQ believes are critical for a successful emergency department regardless of current performance or the perceived timeline for improvement. Most of the infrastructure components are self-explanatory, but others require some comment. Culture is taken in a broad sense and encompasses issues of accountability, transparency, safety and improvement. Complexity and resourcing involves assessing the mission of the department and matching it with the appropriate resources.

MedPAQ believes there are several core competencies that the emergency departments must measure, improve and report in order to serve their patients better and thrive in a value-based healthcare world. Best Practice and value focuses on standardization around evidence-based clinical bundles and pathways, with an emphasis on bringing the right care to the right patient at the right time. Patient Safety requires a strong cultural foundation and solid systems engineering skills. Customer Service and Patient Flow anchor the focus on the patient experience. Hub Function recognizes the position the emergency department holds in the health of its community. Finally a desirable and professionally satisfying workplace must be maintained over the long term.

Physicians as Leaders: Culture change is one of the hardest things for an institution to accomplish. Will be very difficult to achieve and sustain if providers and staff feel like it is “being done to them” – change will not be sustainable unless it is led by the ED itself. Emergency Physicians are leaders of ED, and it MedPAQ firmly believes that EPs must be the driving force behind change in the ED. Emergency Medicine Physician leadership needs to include every physician on every shift, and our focus is primarily on engaging EPs early on by helping them understand the need for change and embracing that challenge.

MedPAQ also believes that the ED can not go it alone. Meaningful change will only occur with support from the institution, and we recognize that change initiatives must be led and supported by 3 key personnel: The ED Physician medical director, the ED Nurse Manager, and a C-suite level lead administrator. These 3 pillars must share a common vision for the ED, and all agree on how to achieve that vision. Additionally, these 3 people must be regularly involved in all change initiatives that involve the ED.