One community-based hospital, operating in an economically challenged community, experienced significant growth in the volume of Emergency Department (ED) visits. Due to lack of primary care physicians, as well as affordability of non-ED care, ED volume grew from 17,000 visits per year to 26,000. The ED provided over 60% of the hospital’s admissions, but was also a major source of patient dissatisfaction due to waiting times. In fact, patient satisfaction scores had been steadily declining. Compass Clinical Consulting was engaged to help this hospital identify operational changes that would improve patient throughput, resulting in greater patient satisfaction.


Two Compass consultants conducted a two-day on-site assessment of the ED operations relative to service expectations, workflows, and care processes. While on site, the consultants conducted interviews, observed ED operations, and reviewed selected documents. The consultants confirmed inconsistency in operations and the need for greater attention to the drivers of patient satisfaction including length of stay and triage practices.


Based on recommendations from Compass, the hospital implemented a wide range of organizational improvements. In particular, the hospital changed reporting relationships within the department, making it easier for the ED’s medical director to manage physician performance, recruit, and use data to drive changes. Three new physicians were hired to help increase capacity and grow the hospital’s primary care capabilities. Compensation was also restructured to bring physician and hospital interests into greater alignment.

As a result of these and other ongoing changes, patient satisfaction scores, which were previously declining, have risen to an impressive 98%.

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