Based on the emergency department HCAPHS data, it is evident that the department needs to improve on the average time spent by patients in the emergency department after the doctor has decided to admit them and before they leave the department to their inpatient room. Patients spend a total of 65 minutes which is way higher than the state and national average that is 60 and 48 minutes respectively.
According to Kotter's change model, the emergency department should start by creating urgency to reduce the time that patients have to spend in the department before they go to their inpatient rooms ( Salman& Broten, 2017) . The urgency should be in line with making sure that the hospital performance is beyond that of the state and national average. For instance, the management should work closely with the doctors to ensure that they can understand the impact that high performance has with the CMS disbursement. For a change to take place, then around 75% of the management should buy into the change.
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The second step is to form a strong coalition or a team. What is evident is that the team should not necessarily come from the hierarchy but change leaders across the organization ( Robinson, Sampson, & Ticgelaor, 2016) . The change leaders should be committed towards the goals set for the change process. All the weak points in the team should be addressed as a way of making sure that the team can convince the rest of the organization to board the change process. The third step in the change process is the creation of a clear vision ( Salman& Broten, 2017) . The employees should be aware of where the organization is heading to with the change. Consequently, they need to understand the role they have to play for the desired outcomes to be attained. The vision should clearly outline the future of the emergency department in regards to the time spent by patients after a decision to admit them has been made ( Lopez, & CENP, 2016) . Moreover, the department also needs to have a strategy to execute the vision. During the design of the vision, the organization needs to ensure that the change team or coalition can describe the vision to the rest of the organization.
The other step in the change process is to communicate the vision to the team members. The management should ensure that all the practitioners working in the emergency department understand the need for change ( Lopez, & CENP, 2016) . In some cases, the change process may encounter resistance from some of the members of the department. The change team needs to walk the talk and demonstrate to the nurses and physicians the kind of behavior needed in the department. The management should ensure that they address the concerns that people have openly and honestly. It is only through addressing the concerns that resistance to change can reduce ( Revere, Ratanatawan, Donderici, Miller, & Morgan, 2016) . The vision should be applied to all aspects of operations especially from the training to performance reviews. The fifth step is to remove obstacles change while empowering the members to implement the change. For example, the organization can look at some of the reasons for resistance from employees. If they lack skills, training will be essential in filling the skill gaps.
The sixth step is to create short-term wins that everyone can follow and understand the path the organization wants to follow. Huge targets should be avoided at the start. In particular, the emergency department should start with small strides that do not require much training such as behavioral change ( Lopez, & CENP, 2016) . The seventh step will involve building on the change by setting goals to boost the momentum established through previous wins. The organization can apply Kaizen, which is the idea of developing continuous improvement. Ideas from the organization should be added to the change process ( Revere, Ratanatawan, Donderici, Miller, & Morgan, 2016) . The organization also needs to ensure that they change incorporated into the culture of the organization. Therefore, the change becomes part of what defines the department, and any new member has to understand every element right from the start.
Strategies
The organization needs to come up with an efficient flow model that keeps vertical patients vertical due to the limited number of beds. The model should also ensure that emergency department spaces are only used for active care management coupled with the existence of people who are dedicated to meet demand ( Revere, Ratanatawan, Donderici, Miller, & Morgan, 2016) . The department should have caretakers at each point in the transition to avoid hiccups during the process. For example, the happy should think the right patients at the right place and who have been provided with the right resources.
Clear and frequent communication helps in ensuring that all employees understand what they have to do to achieve the right results. Nurses need to communicate effectively with physicians on how to reduce the time spent by patients in the department. The communication should start with the contact nurse who conducts a quick look assessment ( Revere, Ratanatawan, Donderici, Miller, & Morgan, 2016) . The transition of patients to the results waiting area should also be done promptly after the initial tests have been conducted. When decisions are made to transfer the patients to inpatient, then a team should be ready for the transition process.
References
Lopez, D. N. P., & CENP, B. C. (2016). An Architectural Framework for Evidence-Based Practice Diffusion, Dissemination, and Institutionalization . Doctor of Nursing Practice (DNP) Projects. 87. https://repository.usfca.edu/dnp/87
Revere, F. L., Ratanatawan, A., Donderici, E. Y., Miller, D., & Morgan, R. (2016). The Dark Side of Autonomy: Employee Job Design for Improved HCAHPS. Journal of Healthcare Management , 61 (6).
Robinson, M., Sampson, A., & Ticgelaor, J. (2016). 77 FastER Care in the Emergency Department Leads to Improvement in Emergency Department Throughput Metrics as well as Improved Patient Experience. Annals of Emergency Medicine , 68 (4), S32-S33.
Salman, Y., & Broten, N. (2017). Leading Change . Macat Library.
