1. Friday Night at the ER®
Prepared for delivery to
Taken from Friday Night at the ER ® . Breakthrough Learning
or Information taken from the
Friday Night at the ER Guide for Facilitators. Breakthrough Learning Woodland Ave., Morgan Hill, California
Prepared by and Mindy Baccus, HCP and modified by Dennis Rogers, Strategic Development 8/08
Friday Night at the ER

2. Welcome to Friday Night at the ER ®
Sit at any table with a brown bag
4 per table
With people you don’t usually work closely with (if possible, no two from the same unit, etc.)
Friday Night at the ER® is a product of Breakthrough Learning

3. Game Set-Up
Roll mat out onto table so that each person is in front of one department
Remove contents from brown bag
Give each department the cards matching the color of their department (emergency=pink, surgery=green, step down=blue, critical care=purple)
Friday Night at the ER® is a product of Breakthrough Learning

4. Game Set-Up (cont.) Stack cards in places labeled on game board
Distribute paperwork to each dept.– the cheat sheet of steps each round is shared
Give each department head a plastic “no beds available” sign
Give each department head some round stickers
Place beads in squares as instructed on next slide– place clear beads and remaining blue beads in cups in the middle of the board
Friday Night at the ER® is a product of Breakthrough Learning

5. STAFF (white beads) PATIENTS (blue beads) EMERGENCY 18 16 SURGERY 4 3
BEAD SET-UP Friday Night at the ER ®. Friday Night at the ER® is a product of Breakthrough Learning
STAFF
(white beads)
PATIENTS
(blue beads)
EMERGENCY 18 16
SURGERY 4 3
CRITICAL CARE 13 12
STEP DOWN 24 22

6. And now for the game… Friday Night at the ER ®
Friday Night at the ER® is a product of Breakthrough Learning

7. YOU ARE THE HEAD OF A HOSPITAL DEPARTMENT
Hospital will operate for 24 hours
You will keep track of service quality & cost
Your first task as managers is to name your hospital & write it on the yellow sign
Friday Night at the ER® is a product of Breakthrough Learning

8. HOW DOES THE GAME WORK? Let’s start with Emergency Dept.
Two arrows leading into Emergency Dept.= 1.walk-ins and 2.paramedic arrivals
“Out” arrow = patients discharged from ER
Pink Arrows = patients transferred from ER to other departments
Friday Night at the ER® is a product of Breakthrough Learning

9. 3 Departments Now for Critical Care, Step Down, and Surgery
“Arrivals” arrow going into your dept.= patients coming from external sources
Outflow arrows show where patients go when they leave your Dept.
Surgery patients go to Critical Care or Step Down
Critical Care patients all go to Step Down
Step Down patients all go “Out” of the hospital
Friday Night at the ER® is a product of Breakthrough Learning

10. WHAT’S WITH ALL THESE BEADS?
BLUE beads = Patients
WHITE beads = Hospital Staff
CLEAR beads = Off-Shift Staff
Must have 1:1 Staff to Patient ratio
Friday Night at the ER® is a product of Breakthrough Learning

11. Walk through 1st hour… ARRIVALS
Arrivals Display on tables for # arrivals
Take that # of blue beads and place on inflow arrow into your dept.
If staff available (some white beads w/ no blue beads), move patients into care
If no staff available, arrival must remain on inflow arrow
Friday Night at the ER® is a product of Breakthrough Learning

12. Walk through 1st hour… Friday Night at the ER® is a product of Breakthrough Learning
EXIT IS DIFFERENT FOR EACH DEPT.
Step Down- turn over Ready to Exit card that shows # patients ready to leave– remove that # of blue beads
Critical Care- turn over Ready to Exit card– send # of REQUEST cards to Step Down matching # of patients ready to leave critical care. Stick a sticker on beads you sent requests to move
***EVEN IF STEP DOWN HAS ROOM, THEY CANNOT TAKE PATIENTS UNTIL THE HOUR AFTER THEY RECEIVE A REQUEST

13. Walk through 1st hour… Friday Night at the ER® is a product of Breakthrough Learning
3. Surgery- Turn over Ready to Exit card. Turn over Destination Card for each patient ready to exit– Issue request cards to appropriate departments- Use colored stickers to denote patients transfers have been requested for
4. Emergency- Turn over Ready to Exit card and take Destination Cards for those ready to exit– If destination cards say “Out”, move that # of blue beads off the board– if destination cards say dept. transfer, issue requests and add stickers to transfer request beads

14. Walk through 1st hour… Friday Night at the ER® is a product of Breakthrough Learning
CLOSURE
Must decide each hour…
If full and cannot take more patients, raise “No Beds Available” sign in your dept. (raise and lower whenever during hour)
Emergency Dept. closure diverts the next hour’s paramedics to other hospitals (log as paramedic turnaways on score sheet)

15. Walk through 1st hour… Friday Night at the ER® is a product of Breakthrough Learning
STAFFING
To call in off-shift staff…
Move Off-Shift card for each off-shift staff you want to call in from “Available” to “Called” position
Can bring off-shift beads in for each card during next hour of game
Move cards back to “Available”
Remove any off-shift staff any time as long as they’re noted on paperwork for at least 1 hour

16. Walking through 1st hour… Friday Night at the ER® is a product of Breakthrough Learning
PAPERWORK
Form for your department, count & log…
Arrivals waiting (on arrows into dept.)
Request cards waiting to enter your dept.
Off-shift staff in use
Emergency Dept. note paramedic turnaways and walk-ins waiting

17. PERFORMANCE MEASURES Friday Night at the ER® is a product of Breakthrough Learning
THREE AREAS MEASURED:
Quality of Service Delivered
Financial Performance
Timely Game Completion
-One-minute timers at each table as guide
-I’ll announce progress along the way

18. STEPS EACH HOUR ARRIVALS EXITS CLOSURE? STAFFING? PAPERWORK
Friday Night at the ER® is a product of Breakthrough Learning
Steps may be done
In any order

19. EMERGENCY ONLY!! ADD NEW BOX TO PAPERWORK:
# EXTRA PARAMEDIC PATIENT ACCEPTED
IIII
THEN SUBTRACT FROM TOTAL PARAMEDIC TURNAWAYS
Friday Night at the ER® is a product of Breakthrough Learning

20. Scoring Use the worksheets at your table to score
Use totals from department paperwork you’ve been keeping
If you have questions on scoring, please ask
On the yellow note card, please write your team name, quality score, and financial score
Friday Night at the ER® is a product of Breakthrough Learning

21. Why We shared the Friday Night at the ER ® Experience

22. At your tables…
Was there anything in the game that felt like your job – felt real?
What concerns/priorities drove your behavior?
Which department were you most focused on?
With the information that you have now, what would you change about how you played the game (improvement strategies?)
Friday Night at the ER® is a product of Breakthrough Learning
As a Team, reflect together on these three questions:
What felt real? : Time pressures; uncertain demand rates; unpredictable rates; department expenses; dependency on other departments; inadequate knowledge about consequences of decisions; uneven work loads; “rules” that don’t make sense; not sure of the rules. Question: Notice any similarities with work ?
What drove your behavior? Desire to minimize patient waiting time; desire to minimize expenses; a team-developed plan; game instructions; mind-set and interpretations of the rules or instructions. Drivers of behaviors: values; assumptions; data and policies
3. Improvement strategies? Equip team with data about the relative value of alternate decisions or policies; develop a shared team vision or a collaborative plan; share staff across departments; treat ED patients in hallways; move some patients from more-busy to less-busy departments; double up patients and staff in rooms. COMMMENT: after such a learning experience, we can identify improvement / process improvement strategies - ; Question: are they transferable to your work ?
Friday Night at the ER

23. Systems Thinking
Sharing sense of responsibility for system performance. The parts of a system are
( Interdependent).
The more one focuses on departmental focus, how does the system likely perform ?
Protecting your department from calling in staff results in better financial performance, but causes backlogs and excessive patient waiting time.
Friday Night at the ER® is a product of Breakthrough Learning

24. Systems Thinking
High level collaboration is required. Who in the game is responsible for Emergency patient waiting ?
Everyone
5. The market will judge your performance as an organization, not as a department. The “parts” must share an understanding of system goals and what is necessary to make this happen ?
Work across functional boundaries to achieve them.
Friday Night at the ER® is a product of Breakthrough Learning

25. Systems Thinking
6. Collaboration Ladder: What Benefits would result from moving up a rung (from bottom to top )?
Share Responsibility
Jointly Plan
Treat Peers as Customers
Communicate Needed Information
Minimal Communication
Friday Night at the ER® is a product of Breakthrough Learning

26. Systems Thinking
Mental Models. What assumptions were at play during the exercise ? What rules did you create based upon your assumptions, or past experience?
Did you share staff ?
Friday Night at the ER® is a product of Breakthrough Learning

27. Systems Thinking 8. Rules: Do we want people to challenge ?
Can rules affect our behavior?
Do we want people to be open to new practices and be willing to redesign processes that don’t work ?
This process of challenging rules and considering redesign of process:
Innovation
Friday Night at the ER® is a product of Breakthrough Learning

28. Systems Thinking
9. Continuous Learning and Adapting. Use of data: Did you use data to make your decisions on staffing ?
Did you assume adding off-shift staff would be too costly ?
The scoring method assigned a relatively low cost to adding off-shift staff and a far greater cost to turning away patients
Friday Night at the ER® is a product of Breakthrough Learning

29. Sharing of insights gained from FNER:
What lessons can you take back to your workplace ?
What can you do to improve collaboration ?
Example: Force Field Analysis – See handout: What are the driving and restraining forces to collaboration that you deal with ?
Friday Night at the ER® is a product of Breakthrough Learning

30. Lessons Learned
To optimize system performance, the parts must interact effectively and efficiently in service of the goals of the overall system.
To excel, individuals must consistently . . .
Collaborate:
See they are interdependent contributors to a system and share responsibility for system performance.
Friday Night at the ER® is a product of Breakthrough Learning

31. Lessons Learned To excel, individuals must consistently . . .
Innovate:
Break out of conventional thinking boundaries to adapt the processes of the system to meet customer needs.
Friday Night at the ER® is a product of Breakthrough Learning

32. Lessons Learned To excel, individuals must consistently . . .
Drive decisions with data:
Learn what customers want, measure performance and provide performance feedback throughout the system.
Friday Night at the ER® is a product of Breakthrough Learning

33. Lessons Learned
Collaboration without innovation can reinforce the status quo.
Innovation without collaboration can be harmful to the other parts;
Collaboration and innovation are only meaningful when driven by performance data
Friday Night at the ER® is a product of Breakthrough Learning

34. Lessons Learned
How does Friday Night at the ER ® link to the SRS Prevention Initiative and Strategic Plan to infuse and integrate prevention into planning, programs, policies and practices ?
How does Friday Night at the ER ® link to any type of change initiative or process ?
Friday Night at the ER® is a product of Breakthrough Learning