HR: ED performance has improved dramatically in a short timeframe at McLaren. Can you share a bit about your role in the turnaround?

CG: Engagement, transparency and accountability starts at the top of the organization. If improvement is important to the CEO, it's important to everyone else. If it's delegated, then it's perceived as less important.

I began by looking at best performance metrics for other Michigan hospitals and then created some urgency for becoming at least as good as other hospitals in our state and a compelling vision to outperform them. I tried to be visible and break down silos. For example, we had a meeting to kick-off our 30 minutes or less wait time guarantee. We formed a physician and administrator dyad. We talked about how ED throughput is a hospital initiative, not an ED initiative.

HR: How did you gain physician buy-in and engagement in the vision?

CG: I started by inviting the physician leaders of key departments to a kick-off meeting to explain my plans and gather feedback on how we could collectively accomplish the goals. Soon after, ED physicians and I went to dinner so I could outline my vision in person and ask them what they needed to accomplish the goals for our patients. As an example, they asked for ISTAT machines to cut down lab turnaround times and I delivered, even though it wasn't in the budget. That built trust and partnership.

Some things they asked for didn't involve money, though. I want our physicians to be aligned to our goals and out-of-the-box creative thinkers in helping us solve problems. So when they asked if they could help move patients into the back from the reception area at times when they were free instead of waiting for nurses, I was comfortable with that. I see our physicians as the leaders of the team.

HR: You mentioned alignment. Why is it so important everyone in the ED is aligned?

CG: The ED is the front door to the hospital. Seventy percent of our patients come through the ED. While 30 percent of those patients will be admitted, the other 70 percent will go home and take a survey about their experience right away.

We want everyone in the ED focused on reducing their wait time for a better patient experience. When people in our community have a good experience, they stay within the McLaren network which allows us to better control costs and their clinical outcomes. That serves our patients better and helps us avoid unnecessary financial risk.

HR: How did you get the team to own the data?

CG: We are very transparent with it. For example, there's a daily report on how long every ED patient waited in the reception area and to see a doctor. That goes to the executive team, lab and physician chiefs. Other data gets reported up to the Executive Medical Committee and Board of Trustees.

If we don't meet a goal we're tracking, we problem solve at the daily safety huddle. So, for example, when we fell short of our goal to see 95 percent of patients within 30 minutes, we learned that there were some conditions that led to inadequate staffing. So we set up a process to allow for additional staff when these circumstances arose.

HR: Any last thoughts?

CG: Once you've set measurable objectives and goals and key in on them on a regular basis, it's critical to follow up and find ways to solve problems to meet the goal. Creating an environment that allows for flexibility and autonomy for creative problem-solving are important in this process. Ultimately, it's about changing the culture and building trusting relationships.