“I like everything about it … you can really make an impact on people here,” said Surreira, manager of the Emergency Department at Mercy Medical Center. “I enjoy the fast pace and I love dealing with patients. Then, there’s the diversity, which comes in many ways; you see people of many different ethnic groups and every socio-economic category, and we deal with every age group — pediatrics to geriatrics and everything in between.”
And there’s something else, as well — what Surreira calls the public relations factor.
She described the ER as the front door of the hospital, one where introductions are often made and critical first impressions formed.
“You’ve got about 30 seconds to make or break that visit,” she explained. “That’s why emergency room nurses, especially, have the ability to impact that person’s experience and, therefore, their relationship with the facility.”
Making first impressions as favorable as possible is one way to describe the work Surreira does as ED manager, a post she assumed about a year ago. There are others. “You might say I help replace chaos with organization,” she explained, noting that the medical center and its leadership have made a strong commitment in recent years to the ED and continuously improving the delivery of care there.
The initiative included an extensive renovation project completed last year that was designed to streamline patient flow and improve overall customer satisfaction, a term Surreira likes to use when describing her work.
“People who come to the ER are more than patients, they are customers.” She said. “We want to treat those customers in a way that will make them feel positive about their experience here. No one wants to be in the ER, but we can make their visit more bearable.”
Efforts to improve service to patients have contributed to a sharp rise in the ED census from 2004 to 2005, when the number rose from about 45,000 visits to nearly 55,000, or about 150 per day.
“Part of that results from a national trend — in general, numbers are up,” she explained. “And I’d like to think that some of it is due to the fact that we’re doing a better job and our reputation is steadily improving.”
As department director, Surreira does far less hands-on care delivery than she did several years ago, although she still does some, especially when the unit is busy, which is often. In her administrative role, her passion for the patients remains, but takes on a different, broader scope.
Wait-reduction Exercises
Surreira told BusinessWest that waiting is a fact of life in the emergency room.
People wait to see a triage nurse, for registration, to see a doctor, to receive test results, for a bed in the hospital … every step of the process, she explained. The waiting cannot be eliminated, she continued, not at Mercy or any other ED, but it can minimized and also be made more palatable.
“People have told me that they expect to wait, but they want information as to why they are waiting,” she said. “As long as I kept them updated, they were fine.”
Reducing wait times and improving the overall ED experience have been the focal points for Surreira since she became ED director, and, in many ways, since she first started working in that critical area of health care.
That was roughly a year after she graduated from the nursing school affiliated with what is now Baystate Health. Surreira told BusinessWest that, growing up, she knew that she wanted to work with people and impact their lives.
This is what drew her to nursing and, specifically to the ED.
“In emergency room nursing, there is good deal of autonomy, which I like, and also a good deal of patient-teaching, which I also enjoy,” she explained. “I just find this work very rewarding — you feel as though you’re making a difference.”
Baystate did not have any openings in the emergency department, so she left that system for Mercy in 1986. She worked as an ED nurse there for several years, before advancing first to the role of clinical nurse supervisor and then ED director.
In the former, she said, her charge was essentially patient flow during her shift. In the latter, meanwhile, she says, there is more accountability and direct leadership.
“I don’t like to think of myself as a manager,” she explained. “I like to think of myself as a leader.”
Her current assignment is one with a broad job description, one that includes everything from managing payroll for the 70 staff members in the ED to creating classes in customer service for those nurses, orderlies, and other professionals.
But she boils it down to just a few words.
“I’m the ultimate communicator,” she explained, noting that she acts as intermediary between the medical center’s administration and the ED staff, and also plays a key role in coordinating care and developing policies and procedures.
Surreira said broad changes in the health care environment, specifically the rising numbers of uninsured and underinsured individuals, has made the ER the first, and sometimes the only, option for people seeking care.
This phenomenon is reflected in the rising numbers of people visiting the ED, at Mercy and elsewhere, she said, adding quickly that while there are access-to-care issues impacting all providers, the emergency room has always played a key role in serving a specific population.
“Even if you have a doctor and you have insurance, that doctor may not be able to see you for several days,” she said, adding that the ED often becomes a second, critical source of primary care. “We’re really good at what we do … we can see you, do your tests, and give your results all at once.
“So we’re good at customer service, which is how American culture is today,” she continued. “It’s one-stop shopping, sort of speak.”
Bed-time Stories
Improving that shopping experience has been an ongoing obsession for Surreira, her staff, and Mercy administrators. It’s an process, she says, that involves taking the ED visit, breaking it down step by step, and initiating efforts to improve each of them.
And while reducing wait times is a critical piece of the initiative, there are other goals, she said, adding that the general mission is to reduce stress and anxiety from what can often be a traumatic experience.
It starts when the individual enters the door. “We greet every person on arrival,” she said, adding that, for their duration of their stay, staff members are committed to keeping patients and family informed and, in a word, comfortable.
That’s why, for example, the department added what are known as ‘patient
advocates’ to the roster of care providers. These individuals work in the waiting room as liaisons between staff and family members, facilitating the flow of communication and updating patients as to why they are waiting.
“If they see someone who is dissatisfied, angry, or anxious,” she said, “they intervene immediately and do what we call a “service recovery and address the issue at that moment.”
The broad process-improvement effort involves dissecting each step, crafting solutions, and measuring results to confirm progress. “The line is, ‘if you can measure it, you can change it,’ and we have measures in place for all of these steps.”
Listing them, she said the first is the time from when one walks in the door until he or she sees a triage nurse; the second is from that moment until registration is complete; then it’s from registration until one is placed in a room; from that moment until one is seen by a doctor; from the doctor’s visit to the booking for administration; and, finally, the time until one is actually admitted.
Improvement has been achieved at each of these intervals, from the time it takes to see a triage nurse to the time an individual must wait for a bed in the hospital, she said, noting that with the latter, the period has been reduced from 24 hours or more to less than two hours.
“In some cases, that’s a dramatic turnaround,” said Surreira, attributing it to a system-wide commitment to the ED. “It stems from this administration understanding the true value of the ER — this is the public relations door to the hospital — and dedicating itself to making it a real asset to the community and this facility.”
That commitment includes ‘Project 10,000.’ That was the first name given to the series of renovations that took place last year and included everything from enlarging the waiting area to making the triage room more private to increasing the ED bed count from 24 to 29. The name stems from a stated goal of increasing the ED census by 10,000, a goal that has largely been reached, said Surreira, adding that it was later called ‘Project 10’ to connote the highest score on customer-satisfaction surveys.
Bringing up those scores has been a labor of love for Surreira, who came back to her point about chaos and eliminating it.
“This can be a very chaotic environment — the key is to make it organized chaos,” she explained. “And when you truncate every step in the process and make it a system, then chaos goes away and organization takes over.”
The Bottom Line
As she talked about life in the emergency room, Surreira said she sees many familiar faces during her rounds of the department.
These patients, or repeat customers, as she called them, have in some ways become extended family, individuals she has come to know and care about.
This is the where the public relations component of work in the ED meets the part about impacting people’s lives.
“That’s why I’m passionate about emergency room nursing and taking care of emergency room patients,” she said, “and why ER nurses are very special people.”
































