Removing the Wait: Cannon Hospital begins lean program

Article Published: Dec. 23, 2009 | Modified: Sep. 7, 2011
Removing the Wait: Cannon Hospital begins lean program

Cannon Memorial Hospital in Linville began its lean transformation within the past year in the emergency department, and the ER staff created a new standard of patient care. Key participants in this change are (from left) CEO Chuck Mantooth, RN Debi Hagna, CNA Lori English, RN Christine McKinney, Lean Coordinator Tiffany Mullis Brittain, and Director of Patient Services Carmen Lacey. A federal training grant through the Workforce Investment Act will help the hospital continue its lean journey.

We all have expectations about hospital emergency rooms, and one of them is the seemingly endless wait times. But what if, instead of sitting for hours in the waiting room, you were immediately assisted into a treatment room? What if, instead of describing your symptoms to the triage nurse and then waiting a few more hours to see a doctor, the doctor was present during your triage and immediately began treatment?

Such patient-focused care is standard operating procedure in the emergency room at Charles A. Cannon, Jr. Memorial Hospital in Linville.

This startling change in the way the emergency department operates is relatively new-it has just been implemented within the past year-and is the result of looking at existing practices in an entirely new way to determine if there's a better way to do things. That new way of looking at things is called going lean, and it is being increasingly applied across a spectrum of industries, from manufacturing plants to offices to hospitals.

"Cannon Memorial Hospital is a great place with great people," said CEO Chuck Mantooth. "Our patient satisfaction scores are through the roof, but an inherent problem in every hospital is the process. You have lots of people working together for one patient. Those people are thinking about their specific job, and that job becomes the focus instead of the patient. We wanted to look at ways to keep the process focused on the patient."

The lean program started at Cannon Memorial when Jeff Spade, executive director of the North Carolina Rural Health Center, recruited the hospital to be one of five in a collaborative to pioneer lean practices in small rural hospitals.

Grant funding helped pay for five lean events at Cannon Memorial within the past year, and administrators decided to focus initial activity in the emergency department. "Ten thousand people per year come through our emergency department, and 80 percent of our hospital admissions come from there," Mantooth said, "Our emergency department is the face of Cannon Memorial Hospital in the community."

Looking at the emergency operation in a new way led to questions about the old way:
"If we have a room available in the emergency department, why send the patient to triage and then back to the waiting room? Why not take the patient to the treatment room immediately and do the triage there?"

"The triage nurse just repeats what the patient has said to the doctor, so why not have the doctor present during triage so care can begin immediately?"

And that's the way it works at Cannon Memorial Hospital now.

"Once we got a taste of this," Mantooth said, "we wanted more. We realized we should be doing 60 or 70 of these lean events each year instead of 5, but the training is very expensive."

Thanks to a federal incumbent worker training grant funded by the Workforce Investment Act and awarded through the N.C. Division of Workforce Development, Cannon Memorial Hospital now has $25,000 to spend on additional lean training in the coming months. The High Country Workforce Development Board administers the grant that was awarded in a statewide competition.

With the federal grant funds, Cannon Memorial can train more staff in other departments, teaching more people how to ask the right questions to eliminate waste and process frustration, how to implement measurable changes quickly and how to keep a laser-like focus on the hospital's mission of providing consistently exemplary patient care. "Your care shouldn't be determined by who's working that day," Mantooth said.

In addition to the obvious benefits for patients, going lean also empowers the staff by putting them in charge of change.

"Lean is an investment in the 200 people who work here," said Cannon Memorial's lean coordinator Tiffany Mullis Brittain. "It's life changing; it really is. The best thing we can do is help people learn to see waste and to become impatient with it-to have a sense of urgency about eliminating it. It's rapid improvement for a reason. The decisions are not being made in conference rooms by committee."

"Bureaucracy and red tape are words you won't find in any lean books," Mantooth said.

Cannon Memorial Hospital's federal training grant award coincides with a significant milestone for the hospital. December 2009 marks the tenth anniversary of the "new" Charles A. Cannon, Jr. Memorial Hospital. In the past 10 years, Cannon Memorial has provided more than 100,000 inpatient days of care, more than 100,000 emergency visits and more than 800,000 outpatient visits.

With the implementation of lean practices, the next decade holds great promise for this community hospital and the patients it serves.

"We want to change the culture here and go from good to great," Mantooth said. We want to always be on a quest to get better."

Charles A. Cannon, Jr. Memorial Hospital is a member of Appalachian Regional Healthcare System, along with Watauga Medical Center in Boone, N.C. and Blowing Rock Hospital in Blowing Rock, N.C. For more information, click to

Federal Dollars Aid Local Businesses
Grants such as the one Cannon Memorial Hospital has received are awarded in a statewide competitive process. Federal dollars fund these incumbent worker grants, and applications are submitted through the High Country Workforce Development Board. The board also administers the federal funds.

Cannon Memorial Hospital ($25,000) received one of three incumbent worker grants approved in the High Country during the most recent funding cycle. The other approvals are Carolina Timberworks in Boone ($21,000) and the Ashe County Division of Gates Corporation ($12,500). In total, these three grants bring $58,500 in training funds to the High County to help increase workers' skills and to help local businesses remain in business.

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