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In the first quarter of 2015, the emergency department at Thomas Jefferson University
Hospital in Philadelphia had one of the worst leave-without-being-seen rates (LWBS) in
the country. Hospitals with high LWBS rates usually provide subpar nursing services and
are often avoided by members of the public. The team of doctors and nurses in the
emergency department at Thomas Jefferson Hospital set a goal to bring down LWBS
rates to below the national average and to improve overall service.

To achieve its goal, the team needed to involve and empower all team members—
department leadership, executive physicians, and nurses. The leadership employed the
Delphi Technique to gather information from all team members. The nursing staff was
fully engaged throughout the process. Management sought the perspective of all team
members, recognizing that if it silenced and excluded some members, it would harm the
operation. This cohesive team, with a strong mission, was able to achieve its goal.

Case Questions
1. What types of problems might the hospital have encountered had it

not included the nursing staff in decision making?

1. What was so valuable about seeing management engage in the new
initiative alongside their subordinates?

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