Finals Case Analysis:
Name of Student:
Assigned Case Studies: City Hospital Emergency Room
Date: June 13, 2025
I. Point of View
The case is viewed from the perspective of Dr. Bill Russell, Director of the City Hospital
Emergency Room, who is directly responsible for ER operations and concerned about patient
service quality and internal efficiency.
● Time Context
The time context is Saturday night in August, just before a Monday staff meeting with
consultants from Bulldog Consulting Group.
● Statement of the Problem
How can City Hospital’s Emergency Room improve its service delivery and reduce patient wait
times without compromising care quality, especially during peak hours, while addressing the
skepticism and concerns of ER staff and leadership?
● Statement of the Objectives
1. To improve the quality of service in the ER and reduce patient waiting time.
2. To enhance patient satisfaction by treating patients as customers.
3. To align ER operations with principles of Continuous Quality Improvement (CQI).
4. To effectively engage staff and leadership in the reengineering initiative.
5. To evaluate Bulldog Consulting Group’s proposals for feasibility and impact.
● Areas of Consideration
- Overcrowding and long wait times in the ER, especially during weekends.
- Staff burnout and morale.
- Dr. Russell’s skepticism about reengineering being more cost-cutting than
service-oriented.
- Patients’ growing expectations of customer-centered care.
- Application of CQI and lessons from the hospitality industry (e.g., listening to the “voice
of the customer”).
- Role and approach of the Bulldog Consulting Group.
VI. Assumptions
1. ER visits will continue to increase during weekends and nights.
2. Bulldog Consulting Group will recommend changes involving process redesign, not just
cost reductions.
3. Staff are open to improvements but may resist change if not beneficial.
4. Implementation of CQI principles can positively impact ER operations.
VII. Alternative Courses of Action (ACA)
ACA 1: Fully Collaborate with Bulldog Consulting Group
● Pros: Access to expert guidance; may lead to long-term improvements.
● Cons: May be perceived as top-down or disruptive by staff.
ACA 2: Initiate Internal Improvement Using CQI Tools Without Consultants
● Pros: Empowers staff; may reduce resistance.
● Cons: May lack the structure and experience needed to make significant changes.
ACA 3: Pilot a Hybrid Approach (Consultants + Internal CQI Team)
● Pros: Balances external expertise and internal buy-in.
● Cons: Takes time to coordinate and may dilute accountability.
VIII. Conclusion/Recommendation
Recommended Course of Action: ACA 3 – Pilot a Hybrid Approach. City Hospital ER should
combine internal efforts with Bulldog’s external expertise to co-create solutions. This hybrid
strategy leverages both CQI principles and change management insights while promoting staff
involvement and ownership of improvements.
IX. Plan of Action
1. Monday Staff Meeting: Introduce Bulldog consultants and align expectations.
2. Form a CQI Task Force: Include ER staff, admin, and Bulldog reps.
3. Conduct a Rapid Assessment: Map patient flow and identify major bottlenecks.
4. Listen to the Voice of the Customer: Use patient surveys and feedback tools.
5. Pilot Interventions: Implement quick wins like triage redesign or wait time boards.
6. Monitor and Adjust: Track KPIs such as wait time, patient satisfaction, and staff
feedback.
7. Evaluate and Scale: Roll out successful strategies ER-wide.
