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A Pediatric Emergency Department At Lynchburg General Hospital Case Solution

Solution Id Length Case Author Case Publisher
1771 2376 Words (8 Pages) Weiss, Elliott N.; Goldberg, Rebecca; Thomson, Chris Darden Business Publishing : OM1523
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Lynchburg General Hospital runs a unit of Emergency Department, which was controlled by the Centra Emergency Services Group. Managed by Chris Thomson and Stowers, the LGH-ED developed at a rapid pace with the help of the Lean Initiatives undertaken. The following report will analyze how Chris led changes in the LGH ED department to improve efficiency and how would these changes impact on the LGH-ED’s ability to open up a Ped-ED and operate it efficiently. The pros and cons of setting up a Ped-ED will be considered based on which a recommendation will be given to determine the future strategy of LGH-ED. This will lastly, be followed by an action plan.

Following questions are answered in this case study solution

  1. Introduction and Problem Identification

  2. Analysis

  3. Alternative Solution 1

  4. Alternative Solution 2 

  5. Recommendation

  6. Action Plan

Case Analysis for A Pediatric Emergency Department At Lynchburg General Hospital Case Solution

However, in 2013, the overall patients’ volumes started declining, both for the hospital and for the ED. These were mainly consistent with national trends. However, it was realized by Thomson, that as the health-care provision to patients would improve, there would be comparatively fewer visits to the Lynchburg General Hospital Emergency Department. Thus, this would not be a sustainable way of moving ahead. Also, considering the uncertain US health market environment, investing to increase physical space to deal with the overcapacity problems did not seem a feasible option. Thus, it was being considered whether to go ahead with a project plan of setting a Pediatric Emergency Department for Children. However, the proposed project came with its associated costs and benefits, which is why Thomas was left to decide the direction in which to steer the future of LGH and LGH-ED.

2. Analysis

LGH-ED underwent many reforms that helped in achieving operational efficiencies within the unit. Considering the percentage decline of Left without being seen patients, from spikes of 7.5% - 8% and a normal average of 3% to 1.5%, it would be right to say that Thomson was able to put an effective mechanism in place that helped the medical staff cater to a large number of patients. This was achieved by reducing the average time spent by a particular patient in the ED. Thus, it positively influenced the revenue level and verified the capabilities of Thomson in successfully implementing lean practices.  

However, the method enabling the emergency department to treat more patients does not seem sustainable. This is because it would require the use of high resources since nurses would prescribe patients a number of tests including those that would not be relevant in the patient's case. Thus, additional cost on the part of the Emergency Department would incur. This might create problems for the hospital in financial terms, which is why a proper cost-benefit analysis would be required considering the ED's loss leadership role. It would be important to see that the revenue generated from transferring patients to the hospital from the emergency unit is higher than the costs incurred by the Emergency department. Similarly, maintaining the quality of the patients’ treatment would also be crucial as after having a range of test reports, the doctor might misdiagnose the reports if the not relevant test has been taken of the patient. Thus, compromising on the quality of the health care services provided by the LGH-ED and leading to a bad reputation. 

The health care industry market has seen a declining trend, which reflected in the declining number of patients for Lynchburg General Hospital also. Furthermore, considering the changing consumer preferences, where rather than attracted by the health care system or emergency departments, people attracted by the idea of utopian medical homes where they receive quality health care. With the advancement in technology, those struggling with health issues prefer to have a single physician who can respond to them at any time without putting them through the hassle of driving to the Emergency Department, which could even potentially threaten the life of the patient.

Thus, it is imperative that with such uncertainty in the market, it would not be a good idea for LGH to invest its capital resources for physical expansion, as by the time it would become operational, the demand for EDs may have further contracted. The recent trends are analyzed to deduce that people have become more health-conscious, which reduces the need for them to visit the emergency department for their health concerns. Rather they have started shifting to a utopian medical home model that is gaining prominence gradually. However, Thomson’s idea of standardizing health care practices would not come into conflict with the current customer trends. This is because he proposed to standardize the operational procedures involving post-operational dressings. These would not directly affect the quality of the service, but instead give them time and resources in the form of cost savings to LGH ED, which it could in turn use to prepare individualistic solutions for patients that would better cater to their health care needs.

However, it can be argued that the current market of LGH-ED comprises of approximately 95000 patients per year, which accounts for the majority of the market share. Looking at the stats, LGH-ED ratio of treating customers has been 2,143 beds per year, with even 1500 being considered unacceptable as per the industry average. This proves the fact that the current capacity of LGH-Ed is limited. Thus, increasing the capacity would help counter this issue and would help achieve the three aims of Thomson, which comprised of quality health care for patients, which can be achieved through Total Quality Management, low costs and access to the majority. The lean process implemented played an important role in ensuring efficiency by reducing the costs and increasing the number of patients attended. Even if technology takes over, LGH-ED could still benefit as there is an approximately 50% shortfall of the patients that need to be accommodated.

Apart from this, the process still needs a lot of improvement to further cut on costs and implement kaizen within the organization (Suárez-Barraza & Ramis-Pujol, 2010). The steps to initiate kaizen were taken which involved meeting with the attendees to discuss the relevant problems and the solutions proposed by them. However, the results of the meetings were not materialized with many projects left in between before their completion, thus the true potential value not being achieved. It will be more effective and productive if cross-functional teams are set up to lead different projects aimed at overcoming the operational inefficiencies within Lynchburg General Hospital-Emergency department (Doolen, Van Aken, Farris, Worley, & Huwe, 2008). Furthermore, conducting monthly meetings will ensure that the respective nurses and physicians in both the ED and the hospital are not working in silos and completely own the vision of LGH in revamping its operations to achieve cost-benefit, build on its competitive advantage of speed and quality, and increase revenue for both of its units.

The design of the RAU unit is a very important aspect of the efficient functioning of the LGH-ED. The onerous paper work required by patients at the time of admission to the hospital gets time consuming, resulting in a large waiting line of in patients. This directly hinders the capacity of the ED to cater to the other new incoming patients. The efficient functioning of the RAU department comprised of trained staff specifically holding expertise in doing repetitive tasks quickly to speed up the transfer process. Therefore, RAU helped overcome administrative and cultural barriers. For the success of ED to effectively deal with patients, the efficient functioning of RAU is important, as it is the backbone of the ED. Therefore, proper location analysis must be done to determine the location of RAU so that as soon as the patients cross the ED stage, they are quickly transferred to the hospital, making room for the new patients.

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