CitationThis initiative required all facilitiesʼ EDs to achieve door to doctor time <30 minutes, ancillary turnaround time (TAT) <60 minutes, total length of stay (LOS) <150 minutes, left without being seen (LWBS) <1%, and Emergency Department Patient Experience of Care (ED-PEC) Top Box >70%. AHMC utilized prospective improvement process tools such as LEAN, monthly site visits, best practice and quality meetings, and social media reviews. AHMC implemented an internal centralized online data collection tool through all facilities and AHMC corporate with the ability to track Centers for Medicare and Medicaid Services (CMS) mandated metrics.Results: By the end of FY 2016, AHMC hospitals reduced their LOS from over 200 minutes to 180 minutes, LWBS rates decreased from 3-5% to less than 1%, door to doctor times decreased to an average of 31 minutes, and EDPEC satisfaction scores increased from 44% to 50%. Conclusion: AHMC's EDsʼ significant improvement demonstrated the strong potential of replicating their efforts on improving patient experience and quality measures to other departments and community hospitals.

The Affordable Care Act (ACA) has significantly altered the American healthcare system. Through the establishment of the ACA, Centers for Medicare and Medicaid Services (CMS) introduced Value-Based Purchasing (VBP), a pay-for-performance program, to the hospital payment system. From a community hospital's standpoint, a multifaceted approach to quality and patient satisfaction on better managing the health of the community was recognized: what begins in the community ends in the hospital as a valuable indicator for each individual's well-being. This article depicts the process of utilizing a six-dimensional approach on engaging stakeholders to improve quality of care and patient satisfaction: (1) inpatient, (2) emergency department, (3) employee, (4) physician relationships, (5) outpatient, and (6) community. As the effect of the ACA becomes more prominent, hospitals should maintain their organizational flow and care coordination through the six-dimensional approach to bring patients and their families back to the center of their care.