1 Friday Night at the ER® Prepared for delivery to Taken from Friday Night at the ER ®. Breakthrough Learning [email protected] or 408-779-0701. Information

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Friday Night at the ER®Friday Night at the ER®

Prepared for delivery to

Taken from Friday Night at the ER ® . Breakthrough [email protected] or 408-779-0701. Information

taken from the Friday Night at the ER Guide for Facilitators. Breakthrough

Learning 17800 Woodland Ave., Morgan Hill, California. 95037

Prepared by and Mindy Baccus, HCP and modified by Dennis Rogers, Strategic Development 8/08

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Welcome to Friday Night at the ER Welcome to Friday Night at the ER ®®

Sit at any table with a brown bag• 4 per table• With people you don’t usually work closely

with (if possible, no two from the same unit, etc.)

Friday Night at the ER® is a product of Breakthrough Learning www.fridaynightattheER.com

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Game Set-UpGame Set-Up

1) Roll mat out onto table so that each person is in front of one department

2) Remove contents from brown bag

3) Give each department the cards matching the color of their department (emergency=pink, surgery=green, step down=blue, critical care=purple)


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Game Set-Up (cont.)Game Set-Up (cont.)

6) Stack cards in places labeled on game board7) Distribute paperwork to each dept.– the cheat sheet of

steps each round is shared8) Give each department head a plastic “no beds

available” sign9) Give each department head some round stickers10) Place beads in squares as instructed on next slide–

place clear beads and remaining blue beads in cups in the middle of the board


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BEAD SET-UPBEAD SET-UP

Friday Night at the ER Friday Night at the ER ®®..

Friday Night at the ER® is a product of Breakthrough Learning Friday Night at the ER® is a product of Breakthrough Learning www.fridaynightattheER.comwww.fridaynightattheER.com

STAFF

(white beads)

PATIENTS

(blue beads)

EMERGENCY 18 16

SURGERY 4 3

CRITICAL CARE 13 12

STEP DOWN 24 22

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And now for the game…And now for the game…

Friday Night at the ER Friday Night at the ER ®®Friday Night at the ER® is a product of Breakthrough Friday Night at the ER® is a product of Breakthrough

Learning Learning www.fridaynightattheER.comwww.fridaynightattheER.com

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YOU ARE THE HEAD OF A HOSPITAL YOU ARE THE HEAD OF A HOSPITAL DEPARTMENTDEPARTMENT

• Hospital will operate for 24 hours

• You will keep track of service quality & cost

Your first task as managers is to name your hospital & write it on the yellow sign


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HOW DOES THE GAME WORK?HOW DOES THE GAME WORK? Let’s start with Emergency Dept.

• Two arrows leading into Emergency Dept.= 1.walk-ins and 2.paramedic arrivals

• “Out” arrow = patients discharged from ER

• Pink Arrows = patients transferred from ER to other departments


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3 Departments3 DepartmentsNow for Critical Care, Step Down, and Surgery• “Arrivals” arrow going into your dept.= patients

coming from external sources• Outflow arrows show where patients go when

they leave your Dept.1. Surgery patients go to Critical Care or Step Down2. Critical Care patients all go to Step Down3. Step Down patients all go “Out” of the hospital


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WHAT’S WITH ALL THESE BEADS?WHAT’S WITH ALL THESE BEADS?

• BLUE beads = Patients

• WHITE beads = Hospital Staff

• CLEAR beads = Off-Shift Staff

• Must have 1:1 Staff to Patient ratio


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Walk through 1Walk through 1stst hour… hour…ARRIVALS• Arrivals Display on tables for # arrivals• Take that # of blue beads and place on

inflow arrow into your dept.• If staff available (some white beads w/ no

blue beads), move patients into care• If no staff available, arrival must remain on

inflow arrow


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Walk through 1Walk through 1stst hour… hour… Friday Night at the ER® is a product of Breakthrough Learning Friday Night at the ER® is a product of Breakthrough Learning www.fridaynightattheER.comwww.fridaynightattheER.com

EXIT IS DIFFERENT FOR EACH DEPT.1. Step Down- turn over Ready to Exit card that

shows # patients ready to leave– remove that # of blue beads

2. Critical Care- turn over Ready to Exit card– send # of REQUEST cards to Step Down matching # of patients ready to leave critical care. Stick a sticker on beads you sent requests to move

***EVEN IF STEP DOWN HAS ROOM, THEY CANNOT TAKE PATIENTS UNTIL THE HOUR AFTER THEY RECEIVE A REQUEST

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3. Surgery- Turn over Ready to Exit card. Turn over Destination Card for each patient ready to exit– Issue request cards to appropriate departments- Use colored stickers to denote patients transfers have been requested for

4. Emergency- Turn over Ready to Exit card and take Destination Cards for those ready to exit– If destination cards say “Out”, move that # of blue beads off the board– if destination cards say dept. transfer, issue requests and add stickers to transfer request beads

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CLOSURE

• Must decide each hour… – If full and cannot take more patients, raise “No

Beds Available” sign in your dept. (raise and lower whenever during hour)

– Emergency Dept. closure diverts the next hour’s paramedics to other hospitals (log as paramedic turnaways on score sheet)

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STAFFING• To call in off-shift staff…

– Move Off-Shift card for each off-shift staff you want to call in from “Available” to “Called” position

– Can bring off-shift beads in for each card during next hour of game

– Move cards back to “Available”– Remove any off-shift staff any time as long as

they’re noted on paperwork for at least 1 hour

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Walking through 1Walking through 1stst hour… hour… Friday Night at the ER® is a product of Breakthrough Learning Friday Night at the ER® is a product of Breakthrough Learning www.fridaynightattheER.comwww.fridaynightattheER.com

PAPERWORK

• Form for your department, count & log…– Arrivals waiting (on arrows into dept.)– Request cards waiting to enter your dept.– Off-shift staff in use– Emergency Dept. note paramedic turnaways

and walk-ins waiting

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PERFORMANCE MEASURESPERFORMANCE MEASURES Friday Night at the ER® is a product of Breakthrough Learning Friday Night at the ER® is a product of Breakthrough Learning www.fridaynightattheER.comwww.fridaynightattheER.com

THREE AREAS MEASURED:1. Quality of Service Delivered

2. Financial Performance

3. Timely Game Completion-One-minute timers at each table as guide

-I’ll announce progress along the way

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STEPS EACH HOURSTEPS EACH HOUR•ARRIVALS• EXITS• CLOSURE?• STAFFING?• PAPERWORK

• Friday Night at the ER® is a product of Breakthrough Learning www.fridaynightattheER.com

Steps may be doneIn any order

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EMERGENCY ONLY!!EMERGENCY ONLY!!

# EXTRA PARAMEDIC PATIENT ACCEPTED

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ADD NEW BOX TO PAPERWORK:

THEN SUBTRACT FROM TOTAL PARAMEDIC TURNAWAYS Friday Night at the ER® is a product of Breakthrough Learning www.fridaynightattheER.com

2020

ScoringScoring• Use the worksheets at your table to score

• Use totals from department paperwork you’ve been keeping

• If you have questions on scoring, please ask

• On the yellow note card, please write your team name, quality score, and financial score


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Why We shared the Friday Night at the ER Why We shared the Friday Night at the ER ®® Experience Experience

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At your tables…At your tables…• Was there anything in the game that felt like your job –

felt real?

• What concerns/priorities drove your behavior?

• Which department were you most focused on?

• With the information that you have now, what would you change about how you played the game (improvement strategies?)


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Systems ThinkingSystems Thinking

1. Sharing sense of responsibility for system performance. The parts of a system are

• ( Interdependent).2. The more one focuses on departmental focus,

how does the system likely perform ?

3. Protecting your department from calling in staff results in better financial performance, but causes backlogs and excessive patient waiting time.


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4. High level collaboration is required. Who in the game is responsible for Emergency patient waiting ?º Everyone

5. The market will judge your performance as an organization, not as a department. The “parts” must share an understanding of system goals and what is necessary to make this happen ?• Work across functional boundaries to achieve them.


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Systems ThinkingSystems Thinking6. Collaboration Ladder: What Benefits

would result from moving up a rung (from bottom to top )?

• Share Responsibility• Jointly Plan• Treat Peers as Customers• Communicate Needed Information• Minimal Communication


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7. Mental Models. What assumptions were at play during the exercise ? What rules did you create based upon your assumptions, or past experience?

• Did you share staff ?


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8. Rules: Do we want people to challenge ?

• Can rules affect our behavior? • Do we want people to be open to new

practices and be willing to redesign processes that don’t work ?

• This process of challenging rules and considering redesign of process:

• Innovation


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9. Continuous Learning and Adapting. Use of data: Did you use data to make your decisions on staffing ?

• Did you assume adding off-shift staff would be too costly ?

• The scoring method assigned a relatively low cost to adding off-shift staff and a far greater cost to turning away patients


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Sharing of insights gained from FNER:Sharing of insights gained from FNER:

• What lessons can you take back to your workplace ?

• What can you do to improve collaboration ?

• Example: Force Field Analysis – See handout: What are the driving and restraining forces to collaboration that you deal with ?


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Lessons LearnedLessons Learned• To optimize system performance, the parts must

interact effectively and efficiently in service of the goals of the overall system.

• To excel, individuals must consistently . . .• Collaborate:• See they are interdependent contributors to a

system and share responsibility for system performance.


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Lessons LearnedLessons Learned

• To excel, individuals must consistently . . .

2. Innovate:• Break out of conventional thinking boundaries

to adapt the processes of the system to meet customer needs.


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• To excel, individuals must consistently . . .

3. Drive decisions with data: • Learn what customers want, measure

performance and provide performance feedback throughout the system.


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1. Collaboration without innovation can reinforce the status quo.

2. Innovation without collaboration can be harmful to the other parts;

3. Collaboration and innovation are only meaningful when driven by performance data


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• How does Friday Night at the ER ® link to the SRS Prevention Initiative and Strategic Plan to infuse and integrate prevention into planning, programs, policies and practices ?

• How does Friday Night at the ER ® link to any type of change initiative or process ?


Documents

1 Friday Night at the ER® Prepared for delivery to Taken from Friday Night at the ER ®. Breakthrough Learning [email protected] or 408-779-0701. Information