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CASE STUDY:
From Strained to Streamlined – Emergency Department Turnaround with Core Clinical Partners

OVERVIEW

Despite caring for over 45,000 patients a year, a Southeastern Emergency Department (ED) was losing ground. Patients waited over four hours to be seen, 1 in 10 left without care, and staff were overwhelmed. Leadership knew that operational tweaks wouldn’t be enough—this required a complete transformation.

Recognizing the need for systemic change, not just surface-level fixes, the hospital partnered with Core Clinical Partners. Over the course of 10 months, Core worked side-by-side with clinical and administrative teams to reimagine ED operations, foster cultural alignment, and rebuild clinical engagement. The result: measurable improvements in key metrics and a stronger, more coordinated Emergency Department.

THE CHALLENGE

While growing volume was a factor, the root causes ran much deeper. Years of well-intentioned but siloed management had created misalignment between departments, inconsistent expectations, and low clinician engagement.

Key issues included:

  • Disconnected communication between physicians, nurses, and administrators
  • Absence of shared goals or consistent performance metrics
  • Low engagement with the hospital’s mission and values
  • Poor translation of triage data into operational flow
  • Nursing resources poorly aligned with patient acuity
  • Workflow inefficiencies leading to triage, diagnostics, and boarding delays

Despite investments in staff and technology, outcomes were declining—and the ED was losing both patients and revenue.

THE SOLUTION

Core Clinical Partners launched a fully embedded engagement structured around frontline involvement, leadership cohesion, and methodical process improvement.

Phase 1: Ground-Level Assessment

Core began with a one-week, on-site evaluation. Instead of arriving with a static playbook, Core’s team walked the department, observed real-time operations, conducted GEMBA walks, and facilitated discovery sessions to surface root causes.

Phase 2: Building a Multidisciplinary Coalition

Create the Right Climate:

  1. Create a Sense of Urgency
  2. Create a Guiding Coalition
  3. Create a Vision for Change

Engage and Enable Others:

  1. Communicate the Vision
  2. Remove Obstacles
  3. Create Short Term Wins

Implement and Sustain:

  1. Consolidate Improvements
  2. Create the Change

 

Using Kotter’s 8-Step Change Model, Core helped hospital leadership form a multidisciplinary improvement team that included:

  • ED physicians and APPs
  • Nurse leadership
  • Hospital administrators
  • Core’s clinical operations and PI experts

Together, they developed shared goals, created urgency for change, and defined success using hospital-aligned KPIs.

Phase 3: Acuity-Based Zoning

One of the most transformative operational changes was the redesign of ED flow using acuity-based zones:

Zone 1:
High-Acuity/Resuscitation: Stroke, Trauma, Cardiac Emergencies

Zone 2:
Moderate-Acuity: Chest Pain, Abdominal Complaints, Complex Diagnostics

Zone 3:
Low-Acuity/Fast Track: Minor Injuries, Basic Concerns

Each zone was staffed with dedicated teams and optimized nurse ratios. This allowed clinicians to work at the top of their licenses and improved throughput across all acuity levels.

Phase 4: Lean Process Improvements

With the new zoning model in place, Core applied Lean Six Sigma tools to streamline operations:

  • Introduced Provider-in-Triage (PIT) shifts
  • Standardized order sets to reduce variability
  • Addressed bottlenecks in radiology turnaround and boarding procedures
  • Used value stream mapping and root cause analysis to drive improvement

Phase 5: Real-Time Performance and Coaching

Core built dashboards for:

  • Door-to-provider time
  • Length of stay
  • Decision-to-disposition time

These tools provided transparent feedback and were coupled with peer-led coaching sessions focused on improvement, not punishment.

THE RESULT

Within 10 months, the ED achieved major gains across all metrics:

  • 27% decrease in Length of Stay
  • 15% decrease in Doctor-to-Disposition Time
  • 42% decrease in LWBS
  • 25% increase in Clinician Engagement

The department’s performance dashboard below provided a compelling story about transformation.  Previously underperforming indicators across multiple categories were replaced by consistent, high-performing metrics reflected in dashboard greens.

WHY IT WORKED

The success of this turnaround stemmed from Core’s belief that transformation must address both systems and people.

Key success factors included:

  • A committed, multidisciplinary leadership team
  • Acuity-based structural redesign
  • Transparent performance metrics and peer-driven feedback
  • Lean Six Sigma methodology for process improvement
  • Alignment between clinical and administrative leadership

Most importantly, the initiative created a culture of ownership and continuous improvement. Staff were no longer working in silos, but as a coordinated team with shared purpose.

THE TAKEAWAY

This case demonstrates how even long-standing ED challenges can be reversed through structured, collaborative transformation. By embedding change management principles, aligning operational strategy with clinical realities, and fostering a culture of performance, Core Clinical Partners helped build a safer, faster, and more responsive emergency department—without shortcuts or one-size-fits-all solutions.

Better flow. Higher engagement. Measurable results.

Interested in what a transformation could look like at your site? Connect with a Core Expert!