It is always great to hear stories of best practices in action, and the positive experience that you relate is one that I find personally inspiring. Something that stood out for me in reading your post was that the standards were already very high, but this did not dampen enthusiasm for improvement. Increased efficiency was related to reduced costs and decreased overtime, which is fantastic, but the most dramatic result was the seven percent (7%) increase in patient satisfaction. This was in addition to team engagement and morale boosting potential of the method. Fantastic! I note that, as you describe, this was not a simple exercise and the initiative took considerable time and persistence in order to reach its goals.

Something which was not mentioned, although I suspect it was a factor in the success of the process flow mapping exercise, was the existing team cohesion of the staff. The ability to work together as a team has considerable benefits with regard to change management (Chan, 2016). When I consider various parallel initiatives, it is a concern that I have with regard to context and setting where I work. This same initiative may not have worked nearly as well if your team did not already have the shared success of high standards as well as a good working environment.

Your experience has made me eager to use the process flow mapping technique, and to use it to also work towards successful outcomes such as that which occurred in your emergency department. I do have two questions, relating back to my assumption regarding the existing work environment. Do you feel that there was a good context for working together for change, in that there was already a good morale and working conditions? If so, how do you feel that the initiative might have turned out differently had that not been the case?