Instructions EDSP 360One portion of an IEP (Individualized E.docx

Instructions EDSP 360
One portion of an IEP (Individualized Education Plan) is
writing goals for students to master within the year of the IEP.
For this assignment, you will practice writing goals for a
student with a disability, based on the present level of
performance given to you. This would be the same thing you
would have to do as a special educator receiving a new student
on your case load. Review the sample Present Level of
Performance on Jackson in the Reading & Study folder of
Module/Week 3. This is the type of information you would be
given on a student from an eligibility meeting, where the
assessment team would compile their results and determine the
disability. Write four goals based on this information, two for
reading and two for written language in the attached template.
writing goals for students to master within the
year of the IEP. For this assignment, you will practice writing
goals for a student with a disability, based
on the present level of performance given
to you. This would be the same thing you would have to do as
a special educator receiving a new student on your case load.
Review the sample Present Level of
Module/Week 3. This is the type of
informa
tion you would be given on a student from an eligibility
meeting, where the assessment team

would compile their results and determine the disability. Write
four goals based on this information, two
for reading and two for written language in the attached t
emplate.
writing goals for students to master within the
year of the IEP. For this assignment, you will practice writing
goals for a student with a disability, based
on the present level of performance given to you. This would be
the same thing you would have to do as
a special educator receiving a new student on your case load.
Review the sample Present Level of
Module/Week 3. This is the type of
information you would be given on a student from an eligibility
meeting, where the assessment team
would compile their results and determine the disability. Write
four goals based on this information, two
for reading and two for written language in the attached
template.
Case Study: Emergency Department Congestion
Access and read Emergency Department Congestion at
Saintemarie University Hospital.
Write a paper that critically analyzes and reflects on these four
questions.
1. What are challenges and impact of emergency department
utilization?
2. What operational problems is the ED facing? What is your
assessment of the current performance and what is driving these
problems?
3. What additional (or alternative) measures would you
recommend for improving this ED performance, reducing ED

congestion and improving patient outcomes?
4. What is the significance of measurement and analytics in
providing quality patient care?
Your paper should meet the following requirements:
· Be 3-4 pages in length, not including the cover or reference
pages.
· Be formatted according to the CSU-Global Guide to Writing
and APA.
· Include a minimum of three references with associated in-text
citations. The CSU-Global Library is a good place to find these
references.
Thanks,
Barb.
Running head: INSERT FIRST 50 CHARACTERS OF TITLE 1
SAMPLE PAPER
Identifying the Best Practices in Strategic Management
Gertrude Steinbeck
ORG500 – Foundations of Effective Management
Colorado State University – Global Campus
Dr. Stephanie Allong

August 6, 2015
Page numbers
should be inserted
in the top right
corner.
The Running head is required for CSU-Global
APA Requirements. The title page should
have the words, Running head: followed by
the first 50 characters of the title in call
caps. Use the template paper located in the
Library under the “APA Guide & Resources”
link for a paper that is already formatted in
APA.
Papers should be
typed in a 12 pt,
Times New Roman
font with 1 inch
margins on all 4
sides and the entire
paper is double
spaced.
Information on the Title
Page is centered in the
top half of the paper. All

major words should be
capitalized and not bold.
IDENTIFYING THE BEST PRACTICES IN STRATEGIC 2
Identifying the Best Practices in Strategic Management
Strategic management and corporate sustainability are two
important dynamics of
modern-day organizations. It is important for organizational
leaders to have an understanding of
the theoretical applications of strategic management as a means
of addressing corporate
sustainability. The purpose of this paper is to provide
definitions and an understanding of
strategic management and corporate sustainability. An overview
of the Walgreen Company, the
organization of study, is also provided in order to understand
how the company has utilized
strategic management to implement sustainability initiatives for
long-term financial performance.
Strategic Management
The function of management is to plan, organize, lead, and
control the operations of an

organization (Robbins & Coulter, 2007) and includes strategic
management. Strategic
management is an approach in which organizations create a
competitive advantage, enhance
productivity, and establish long-term financial performance.
Chandler (as cited in Whittington,
2008) defines strategy as “the determination of the basic
long-term goals and objectives of an
enterprise, and the adoption of courses of action and the
allocation of resources necessary for
carrying out these goals” (p. 268). Similarly, Wheelen and
Hunger (2008) define strategic
management as the managerial decisions and actions of an
organization that achieve long-run
performance of the business, with benefits such as:
The Strategic Management Model (SMM) provides the
framework for integrating strategic
planning into an organization so that the aforementioned
benefits are realized.
All subsequent pages should

only have the first 50
characters of the paper’s title
in all caps for the running head.
Repeat the title of your paper at the
beginning. This is not a header;
therefore it is not to be bold, but all
major words are capitalized. Do not add
a header at the beginning of your paper
as the first paragraph should clearly
identify the objective of your paper.
Each paragraph
should be indented
½ inch or 5 spaces
from the left
margin.
A level 1 header should be bold,
centered and all major words
capitalized. See
https://owl.english.purdue.edu/owl
/resource/560/16/on how to
format headings in APA.
If you using a source (Whittington) that is
citing another author (Chandler), use the
author’s last name found in your source
(Chandler) at the beginning of your
sentence followed by the citation - (as

cited in Your Source, year). Only the source
you are reading (Whittington) will be listed
in your references. See
https://owl.english.purdue.edu/owl/resour
ce/560/09/for more information
Spell phrase out the first
time in document with
acronym in parentheses.
From that point forward,
the acronym can be used.
https://owl.english.purdue.edu/owl/resource/560/16/
Strategic Management Model
Research indicates as the concept of strategic management
evolved, many
theoretical models were proposed. Ginter, Ruck, and Duncan
(1985) identify eight
elements of the normative strategic model: vision and mission;
objective setting; external
environmental scanning; internal environmental scanning;
strategic alternatives; strategy
selection; implementation; and control. Long (as cited in Ginter

et al., 1985) stated that
normative strategic management models are an “explicit,
intentional, planned and rational
approach” (p. 581) to management. Similar to Ginter et
al., Wheelen and Hunger (2008)
established the SMM (see Figure 1) which includes four main
elements: environmental
scanning, strategy formulation, strategy implementation, and
evaluation and control.
Environmental scanning is the monitoring, evaluating, and
extracting of information from
the external and internal environments in order for management
to establish plans and
make decisions. Strategy formulation includes creating long-
term plans for the
organization, including the mission, objectives, strategies and
policies. Strategy
implementation is the process of executing policies and
strategies in order to achieve the
mission and objectives. Evaluation and control require
monitoring the performance of the
organization and adjusting the process as necessary in order to
achieve desired results
(Wheelen & Hunger, 2008).

The SMM assumes the organizational learning theory, which
states that an
organization adapts to the changing environment and uses
gathered knowledge to
improve the fit between itself and the environment. The SMM
also assumes the
organization be a learning organization in which the gathered
knowledge can be used to
change behavior and reflect new knowledge (Wheelen &
Hunger, 2008).
This is an example of how to cite authors
using a narrative citation. The year must
follow the author’s last name in parentheses.
The authors are being used as a part of a
sentence, therefore the word “and” is used
and not the symbol “&.”
A level 2 header should
be bold, left-justified
and all major words
capitalized.
When citing 3-5 authors, list all the
authors the first time (see above)
and then use et al. for the following
in-text citations. If you have 6 or
more authors, use et al. for all in-

text citations.
When quoting, you must include the
page number or the paragraph
number of where you found the
quote and cite the source and/or page
number immediately after the
quotation marks even it if it is in the
middle of a sentence.
Environmental
Scanning
Strategy
Formulation
Strategy
Implementation
Evaluation
and
Control
External:
Opportunities
Threats

Mission
Objectives
Strategies
Policies
Programs
Budgets
Procedures
Performance
Societal
Environmental
Task Environmental
Internal:
Strengths
Weaknesses

Structure
Culture
Resources
Figure 1. The strategic management model was adapted from
Strategic management and business policy
(11th ed.) by T. L. Wheelen, & J. D. Hunger, 2008, Upper
Saddle River, NJ: Pearson Prentice Hall.
Corporate Sustainability
In addition to enhancing financial performance through strategic
management,
organizational leaders have the responsibility of increasing
shareholder value through
corporate sustainability (Epstein, 2008). Corporate
sustainability is defined in a variety of
ways. Hollingworth (2009) described a sustainable
organization as “one that strives for
and achieves 360-organizational sustainability” (p. 1). The
author claimed an
organization is sustainable when it can endure, or maintain,
over a long-term without
permanently damaging or depleting resources including: the
organization itself; its human
resources (internal and external); the community/society/ethno-
sphere; and the planet’s

environment. He then claimed that if one of the four resources
is not sustainable, issues
with the remaining resources will eventually develop
(Hollingworth, 2009). Brundtland
(as cited in Epstein, 2008) described sustainability as the
economic development that
addresses the needs of the present generation without depleting
resources needed by
When using a Figure in your paper, make sure there
is no title above the figure. Underneath the figure
you must have the word, “Figure” italicized and the
figure number in your paper followed by a period.
Then mention where the information was adapted or
general information about the figure. Follow the
example above. Notice it does not follow the
reference citation format.
1
2
3
When you are using the same source for a
paragraph, you need to start the paragraph with
a 1- narrative citation, 2- refer to the author
again so your reader knows you are still talking
about the same author (try not to use pronouns

such as “he” or “she” as APA believes this could
lead to a gender bias, and 3-end the paragraph
with a parenthetical citation.
future generations Epstein (2008) adds to the definition from a
business perspective by
including corporate social responsibility. Epstein also states
that organizations have a
responsibility to stakeholders to improve management practices
in order to add value by
addressing corporate social, environmental and economic
impacts (Epstein, 2008).
Organizational leaders are the strategic decision makers of a
company and have a
responsibility to stakeholders (Wheelen & Hunger 2008).
Therefore, it is important to
have an understanding of why corporate sustainability is
important, and how the nine
principles of sustainability performance guide strategic
management.
Importance of Corporate Sustainability
In addition to making a profit, organizations have a

responsibility to society,
which includes addressing its economic, social, and
environmental impacts, otherwise
known as social responsibility. Friedman and Carroll had two
opposing views of
corporate social responsibility. Friedman argued that the sole
responsibility of business
was to use resources and activities that enhanced profits
(Wheelen & Hunger, 2008).
Carroll (1979) argued that social responsibility included much
more that making a profit;
he proposed businesses must include the economic, legal,
ethical and discretionary
categories of business performance.
services to meet the
needs/wants of society in order to make a profit;
company is expected to
abide by;
statements, but also
include the norms and beliefs held by society;

This is another example of
narrative citation. The year must
follow the author’s last name. If
there was a quotation, the page or
paragraph number would be listed
immediately after the quote in
parentheses.
This is an example of a parenthetical
citation. It includes the authors’ last
names and the year. If there was a
quotation, a page or paragraph
number would also be included.
Notice that the period is at the end
of the parentheses.
on by the
organization including voluntary activities and philanthropic
contributions
(Carroll, 1979).
The importance of corporate sustainability, therefore, is that an
organization is

responsible for financial performance, but it also has additional
responsibilities to
stakeholders and society in general.
The Nine Principles of Sustainability Performance
The nine principles, as presented by Epstein and Roy (2003)
(see Table 1), further
define sustainability, are measureable, and can easily be
incorporated into strategic
management (Epstein, 2008). These principles include ethics,
governance, transparency,
business relationships, financial return, community
involvement, value of products and
services, employment practices and protection of the
environment.
A table or figure should fit all on one
page even if there is a gap left in
your paper. It is easier for the reader
to view the table or figure when
presented as a whole instead of split
on two pages.

Table 1
The Nine Principles of Sustainability Performance
1. Ethics The company establishes, promotes, monitors and
maintains ethical
standards and practices in dealing with all of the company
stakeholders.
2. Governance The company manages all of its resources
conscientiously and effectively,
recognizing the fiduciary duty of corporate boards and managers
to focus
on the interests of all company stakeholders.
3. Transparency The company provides timely disclosure of
information about its
products, services and activities, thus permitting stakeholders to
make
informed decisions.
4. Business
relationships
The company engages in fair-trading practices with suppliers,
distributors
and partners.
5. Financial return The company compensates providers of
capital with a competitive return
on investment and the protection of company assets.
6. Community
involvement/

economic
development
The company fosters a mutually beneficial relationship between
the
corporation and community in which it is sensitive to the
culture, context
and needs of the community.
7. Value of
product and
services
The company respects the needs, desires and rights of its
customers and
strives to provide the highest levels of product and service
values.
8. Employment
practices
The company engages in human-resource management practices
that
promote personal and professional employee development,
diversity and
empowerment.
9. Protection of the
environment
The company strives to protect and restore the environment and
promote
sustainable development with products, processes, services and
other
activities.

Note. There should be a general note about the table here.
Adapted from “Improving
sustainability performance: Specifying, implementing and
measuring key principles” by M.
Epstein, & M. Roy, 2003, Journal of General Management,
29(1), pp.15-31.
Walgreens Company
Walgreens Company is a retail drugstore that is in the primary
business of prescription
and non-prescription drugs, and general merchandise including
beauty care, personal care,
household items, photofinishing, greeting cards, and seasonal
items (Reuters, 2010). More
recently, the organization diversified its offerings through
worksite healthcare facilities, home
care facilities, specialty pharmacies, and mail service
pharmacies (Walgreens Company, 2010).
When using a Table in your paper, make
sure you use the word “Table” with the
Table number. Then insert the title of the
Table in italics, with all major words
capitalized. Underneath the Table you must
have the word, “Note” italicized followed by
a period. Then mention where the
information was adapted from or general

information about the Table. Follow this
example. Notice it does not follow the
Reference citation format.
Walgreen Company established a strong organizational culture
focusing on consumer and
employee satisfaction. The mission of Walgreens is:
We will provide the most convenient access to consumer goods
and services . . .
and pharmacy, health and wellness services . . . in America. We
will earn the trust
of our customers and build shareholder value. We will treat
each other with
respect and dignity and do the same for all we serve. We will
offer employees of
all backgrounds a place to build a career. (Walgreens, 2010a,
para. 1)
Walgreens was established in 1901 by pharmacist Charles R.
Walgreen Sr. (Walgreens, 2010b).
Prior to establishing the company, Mr. Walgreen struggled with
the direction the pharmacy
industry was headed; the lack of quality customer service and

care for people concerned him.
Today, Walgreens is the largest drugstore chain in the United
States employing over 238,000
people. Sales in 2009 exceeded $63 billion, in which 65% of
sales were from prescriptions
drugs. The organization has expanded into all 50 states, as well
as the District of Colombia and
Puerto Rico, for a total of 7,496 stores and 350 Take Care
clinics (Walgreens Company, 2010,
para. 3).
Conclusion
Strategic management and corporate sustainability are two
important practices in today’s
competitive global environment. In order to effectively
implement strategic management in light
of corporate sustainability, leaders must have an understanding
of such concepts. This paper has
provided a background and understanding of strategic
management and corporate sustainability.
An overview and history of Walgreen Company was also
presented in order to identify best
practices in strategic management that enhance corporate
sustainability.

If you are using information from
multiple web pages from one
website, you need to distinguish
which citation came from which
web page. You can distinguish each
page, by putting the letters, “a,”
“b”, etc. with the year.
If a quotation is longer than 40 words, it
must be in a block format. The block
format is indented ½ inch (or 5 spaces
from the left) from the left margin. Do not
use quotation marks for this quote.
References
Carroll, A. B. (1979). A three-dimensional conceptual model of
corporate performance. The
Academy of Management Review, 4(4), 497.
Collins, J. (2001). Good to great. New York, NY: HarperCollins
Publishers Inc.
Epstein, M. J. (2008). Making sustainability work. San
Francisco, CA: Greenleaf

Publishing Limited.
Epstein, M., & Roy, M. (2003). Improving sustainability
performance: Specifying, implementing
and measuring key principles. Journal of General Management,
29(1), 15-31.
French, S. (2009). Critiquing the language of strategic
management. The Journal of Management
Development, 28(1), 6-17. doi: 10.1108/02621710910923836
Ginter, P., Ruck, A., & Duncan, W. (1985). Planners’
perceptions of the strategic management
process. Journal of Management Studies, 22(6), 581-596.
Hollingworth, M. (2009, November/December). Building 360
organizational sustainability. Ivey
Business Journal, 73(6), 2.
Walgreens. (2010a). Mission statement. Retrieved from
http://news.walgreens.com/article_display.cfm?article_id=1042
Walgreens. (2010b). Our past. Retrieved from
http://www.walgreens.com/marketing/about/history/default.html
Reuters. (2010). Walgreen Co. Retrieved from

http://www.reuters.com/finance/stocks/companyProfile?symbol
=WAG.N
Robbins, S. P., & Coulter, M. (2007). Management (9th ed.).
Upper Saddle River, NJ: Pearson
Prentice Hall.
Walgreens Company. (2010). 2009 Annual report. Retrieved
from
List sources in
alphabetical order.
The word, References
should be capitalized,
centered, but not bold.
When a citation
runs over to the
second line,
indent 5 spaces to
the right. This is a
“hanging indent.”
Make sure that the links
are not live (you should
not be able to click on
them to go to the
website). If they are live,
in Word, right click and
then click on “Remove

Hyperlink.”
If you are using information
from multiple web pages
from one website, you need
to be able to distinguish
what information came from
each web page. To do this,
you need to add the letters,
“a,” “b,” etc. to the year of
each citation.
http://investor.walgreens.com/annual.cfm
Wheelen, T. L., & Hunger, J. D. (2008). Strategic management
and business policy (11th ed.).
Upper Saddle River, NJ: Pearson Prentice Hall.
Whittington, R. (2008). Alfred Chandler, founder of strategy:
Lost tradition and renewed
inspiration. Business History Review, 82(2), 267-277.
Note: Level Headers 3, 4, and 5 are also used but much less
frequently. Click here for

more information on their format and use.
For more information on CSU-
Global APA requirements for
formatting in APA, and examples of
in-text and reference citations, see
the CSU-Global Guide to Writing
and APA Requirements.
References
Carroll, A. B. (1979). A three-dimensional conceptual model of
corporate performance. The
Academy of Management Review, 4(4), 497. [This is a journal
article citation. Articles
from the Library databases are based on print journals so the
citation will end with page
numbers.]
Collins, J. (2001). Good to great. New York, NY: HarperCollins
Publishers Inc. [This is a book
citation.]

Epstein, M. J. (2008). Making sustainability work. San
Francisco, CA: Greenleaf
Publishing Limited.
Epstein, M., & Roy, M. (2003). Improving sustainability
performance: Specifying, implementing
and measuring key principles. Journal of General Management,
29(1), 15-31.
French, S. (2009). Critiquing the language of strategic
management. The Journal of Management
Development, 28(1), 6-17. doi: 10.1108/02621710910923836
[This is a journal article
citation from a Library database. Include a doi number if
available.]
Ginter, P., Ruck, A., & Duncan, W. (1985). Planners’
perceptions of the strategic management
process. Journal of Management Studies, 22(6), 581-596.
Hollingworth, M. (2009, November/December). Building 360
organizational sustainability. Ivey
Business Journal Online. Retrieved from
http://www.iveybusinessjournal.com/article.asp?intArticle_ID=
868 [This is a journal that
is published online, so you would include the URL.]

Reuters. (2010). Walgreens Co. (WAG.N). Retrieved from
http://www.reuters.com/finance/stocks/companyProfile?symbol
=WAG.N
Walgreens. (2010a). Mission statement. Retrieved from
http://news.walgreens.com/article_display.cfm?article_id=1042
[This is a website citation
with a corporate author. If you retrieve information from
various pages of this particular
website, you need to cite each web page. However, because the
author and the year will
be exactly the same, the lowercase letters, “a,” “b,” etc.
need to be added to the year. The
in-text citation would be: (Walgreens, 2010a).]
Walgreens. (2010b). Our past. Retrieved from
http://www.walgreens.com/marketing/about/history/default.html

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PUBLISHED ON
MAY 20, 2014
Emergency Department Congestion at Saintemarie
University Hospital
B Y L AU RE NT HUB LE T * , OM AR B E SB E S † , AND
C AR RI CH AN ‡
Introduction
In late 2009, Marc Dupont, CEO of Saintemarie University
Hospital, had just ended an
extremely tense phone conversation with the state secretary of
health. The secretary was very
concerned about the wait time in the hospital’s emergency
department (ED). The recent
coverage of these problems in the local press, which repeatedly
echoed complaints of
patients and their families, was making things worse:
It took them 18 hours to take care of my mother when she was
admitted to
the emergency department in the Saintemarie University
Hospital —
Saintemarie Tribune (March 2009)
On September 8, Nancy (86 years old) had to wait eight hours in
the ED with
a broken leg before seeing a doctor — Saintemarie Tribune
(September 2009)
Saintemarie was a midsize European city with a population of
512,000. A few private clinics
in the area provided urgent care (i.e., treatment which does not
require hospitalization), but

were unable to handle acute emergencies. The hospital’s ED
was the only emergency care
unit available in the Saintemarie metropolitan area. The only
alternative to it was a hospital
located 50 miles away; patients had to be transferred there by
helicopter, which happened
rarely because such transfers were extremely expensive. Given
its central role, Saintemarie
University Hospital was under the constant scrutiny of local and
state officials.
ED congestion can have significant repercussions on a
hospital’s ability to provide quality
care for patients, many of whom require immediate attention.
The secretary of health
recognized that the long delays at the city’s primary ED were a
substantial public health
Author affiliation
*MBA ’12, Columbia Business School
†Assistant Professor, Columbia Business School
‡Assistant Professor, Columbia Business School
Laurent Hublet has worked as a consultant to the healthcare
industry.
Copyright information
© 2011-2014 by The Trustees of Columbia University in the
City of
New York. This case includes minor editorial changes made to
the
version originally published on December 26, 2011.
This case is based on a real business scenario; the names, dates,
and
data have been altered for the purposes of the case.This case is

for
teaching purposes only and does not represent an endorsement
or
judgment of the material included.
This case cannot be used or reproduced without explicit
permission
from Columbia CaseWorks. To obtain permission, please visit
www.gsb.columbia.edu/caseworks, or e-mail
[email protected]
This document is authorized for use only in Kris Michaelson's
HCM520-WI17D course at Colorado State University - Global
Campus, from January 2018 to July 2018.
issue since they jeopardized the public’s having timely access to
medical treatment. He made
his demands clear: the status quo was not sustainable and wait
times at the hospital’s ED had
to be reduced. He requested an action plan and measurable
progress before the end of the
month.
Sitting in his office, Dupont stared at his workforce schedule. In
a time of scarce resources in
which he was already pressured to limit costs, how could ED
wait times be reduced? How
many people would he need to hire and how could he balance
the cost of such additions?
Were there changes he could make without adding more staff?
Dupont’s first decision was to task Patrick Leterme, the head of
the ED, to identify the root

causes of the wait time and to devise a concrete set of
improvement actions.
Challenges in the Healthcare Industry
Hospitals and other healthcare delivery systems in Europe and
other parts of the world had
faced strong pressure to reduce costs and improve operations for
several years. For example,
in the United States, because of a growing and aging
population, demand for healthcare had
steadily increased. Meanwhile, partially due to an effort to
reduce soaring healthcare
spending, the supply of hospital beds, physicians, nurses, and
other healthcare resources had
been relatively stagnant. Indeed, there was already a nursing
shortage, 1 and physician
shortages were predicted in the coming years.2 As a
consequence of these trends (growing
demand and inadequate supply), congestion in the healthcare
system continued to grow,
resulting in delayed access to care. This problem was most
evident in hospital EDs, attracting
attention at all levels. In 2009, the issue was raised in a report
to the Chairman of the
Committee on Finance of the US Senate.3
Congestion in the ED and its Effects
In a 2002 survey, 91% of EDs in the United States reported
overcrowding as an issue, and
40% of them reported that it was a daily occurrence.4 From
1997 to 2004, the median wait
time to see an ED physician increased from 22 minutes to 30
minutes. The most time-critical
patients—those diagnosed with acute myocardial infarction
(AMI) (i.e., heart attacks)—saw
their wait time increase from eight minutes to 14 minutes over

the same seven-year period5
(see Exhibit 1). This was particularly troubling because delays
of even a few minutes can
increase the mortality rate for AMI patients.6
Numerous studies suggest that ED delays increase mortality and
hospital length of stay for
critically ill patients.7 In a 2010 study, patients who were
“boarded” in the ED (i.e., those who
waited in the ED after the decision to admit them as inpatients)
were seen to have longer
inpatient lengths of stay (LOS) (see Exhibit 2).8 Of the 13,460
adult visits to a large teaching
hospital in Ontario, Canada, between April 1, 2006, and March
30, 2007, 11.6% of the
admitted patients experienced boarding delays of more than 12
hours. The LOS for those
patients was on average 12.4% higher than for patients who did
not experience delays, which
resulted in a cumulative total of 2,183 additional hospital days.
In monetary terms, that
Emergency Department Congestion at Saintemarie University
Hospital | Page 2
BY LAURENT HUBLET*, OMAR BESBES†, AND CARRI
CHAN‡

translated into an increase of 11% ($1,216) per patient, or more
than nearly $2 million, to
provide care for delayed patients within a single year.
When delays in the ED are long, more patients leave without
having been seen. 9 Such
patients are often in the least critical condition; however, many
still do require some care. In
1990, a randomized study considered the causes and
consequences of patients leaving
without being seen at a public hospital’s ED in California (see
Exhibit 3). Over a two-week
period, 46% of patients who left without being seen
subsequently required immediate
medical attention, with 29% requiring care within 24 to 48
hours. Many patients said that
long wait times were a reason that they had left before having
been seen (see Exhibit 4). Of
the patients who left without being seen, 11% were hospitalized
within one week, while only
9% of those who waited to be seen required hospitalization.
Moreover, this phenomenon
negatively impacts a hospital’s bottom line; in August 2011 the
Wall Street Journal reported,
“revenue of about $450,000 is lost if even 1% of patients walk
out of an emergency
department with an annual volume of 50,000 patients.”10
While ambulance diversion was not a common occurrence at
Saintemarie Hospital, the
increasing backlogs in the EDs had led many hospitals to
increase their diversion rates.11
Saintemarie University Hospital

With more than 2,000 beds, Saintemarie University Hospital
was a large healthcare complex,
even by global standards. Located in the center of Saintemarie,
it was the only hospital in its
metropolitan area to provide all ranges of care (from primary to
tertiary) in all medical
disciplines to all types of patients (pediatric, adult, and
geriatric). Working in close
collaboration with the faculty of medicine of the State
University of Saintemarie, the hospital
had a world-class reputation in numerous medical fields. It was
able to attract local and
international talent, and was one of the largest employers in the
Saintemarie region.
Marc Dupont was appointed CEO in 1995. He was an energetic
and charismatic leader.
During his first years at the helm of the hospital, he was able to
turn around its profitability
by cutting costs by more than 15%, while maintaining high
standards of quality and good
motivation among staff.
EMERGENCY DEPARTMENT
The ED was one of the largest departments in the hospital,
employing more than 250 people,
including:
x 60 doctors, half of whom were interns who required
supervision by the 25 junior
specialist doctors and six senior specialist doctors. Every day
from 11:00 a.m. to
approximately 11:45 a.m., one of the senior doctors gave a
lecture to the interns. The
rest of the supervision took place in the field. On average, the
interns stayed in the

ED one year before moving to another service in the hospital.
x 150 nurses, approximately 50% of whom had a specialized
degree in emergency care.
The nursing team was managed by Christine Colin, a dynamic
and experienced
specialist nurse, who was highly regarded by her staff. She was
assisted by six head
Page 3 | Emergency Department Congestion at Saintemarie
University Hospital
CHAN‡
nurses, who spent most of their time on planning, staff
allocation, and absenteeism
management.
x 40 administrative staff, who registered the patients, provided
secretarial assistance to
the doctors, and took care of administrative follow-ups (such as
writing letters to
general practitioners).
In addition to the staff formally assigned to the ED, many
doctors from other departments
contributed to the activity of the service, in particular by giving

advice about the most
complex cases.
The activity was organized in two 12-hour shifts, one from 7
a.m. to 7 p.m. and the other
from 7 p.m. to 7 a.m. Staffing, especially of specialist doctors,
was a bit lighter at night.
Doctors and nurses met separately at the beginning of each
shift, mainly to ensure the
transmission of ongoing cases to the next team.
Patrick Leterme, the current head of the hospital’s ED, had been
appointed two years before
by the faculty of medicine. Although he was a specialist in
internal medicine with an
outstanding publication record in the field and a strong
academic reputation, some hospital
staff—mostly surgeons—had opposed his appointment, citing
his lack of managerial and
operational experience.
Patients Coming to the ED
Over the last several years, the inflow of patients coming to the
ED of Saintemarie remained
relatively stable, at around 165 patients per day, or
approximately 60,000 patients per year
(see Figure 1). No seasonal or weekly trend was observable in
the arrival of patients, except
that Mondays tended to be slightly busier, and Sundays tended
to be slightly calmer.
FIGURE 1. PATIENT INFLOW (DAILY AVERAGE
PLUS/MINUS ONE STANDARD DEVIATION)
Approximately one-third of the patients arrived to the ED by

ambulance; the remaining two-
thirds came on their own or were brought in by a relative.
Data on patient arrivals showed a recurrent pattern of inflows
during the day (see Figure 2):
the number of patients arriving each hour grew steeply in the
morning and reached a peak
around 11 a.m. The inflow remained high and stable in the
afternoon and only started
183 177 183 175
166 161 166 161
149 144 149 147
0
50
100
150
200
250
2006 2007 2008 2009
Hospital | Page 4
CHAN‡

decreasing significantly in the evening. Two-thirds of the
patients arrived between 9 a.m.
and 7 p.m.
FIGURE 2. HOURLY PATIENT INFLOW.
Once patients arrived at the ED, they were all seen by a first-
line nurse who performed a task
known as triage: he or she determined the patient’s degree of
emergency and the subsequent
type of ED room to which the patient would be assigned (the
“path” in the ED). This
preliminary examination usually took two to three minutes.
Only experienced specialized
nurses triaged patients. During the day, physicians were also
supposed to triage patients;
their role was to redirect nonurgent cases to more appropriate
care settings. Unfortunately,
the triage physician was often busy taking care of patients in the
ED rooms. Moreover,
physicians were quite reluctant to perform this task, which they
perceived as bearing huge
responsibility. As a physician said in an interview: “[Triage] is
at odds with why I am a
doctor. My job is not to make quick decisions with minimal
information and then tell

patients to get treatment elsewhere.”
Once triage was performed, patients were officially registered
by the administrative staff
(which took 10 minutes); registration of acute patients was
performed while they were
already in a room.
DEGREE OF EMERGENCY
Patients coming to the ED were classified in four groups,
depending on the acuteness of the
case:
x Degree 1: vital emergencies that needed to be treated by
doctors immediately (8
patients/day)
x Degree 2: acute emergencies with no vital risk that needed to
treated within 20
minutes (33 patients/day)
x Degree 3: nonacute emergencies that needed to be treated
within two hours (119
patients/day)
x Degree 4: patients who did not require any urgent care (5
patients/day)
University Hospital
CHAN‡

ED ROOMS (PATHS)
Depending on their symptoms and the degree of emergency,
patients were assigned to one
of the ED paths:
x Red path (70 patients/day): for acute nonamublatory patients
who would likely be
hospitalized after their stay in the ED. All degree 1 and most
degree 2 patients were
directed to the red path.
x Orange path (40 patients/day): for nonacute patients (mostly
degree 3) with
nonsevere medical symptoms (e.g., stomach pain or strong
headache) who were able
to move independently and were unlikely to require
hospitalization.
x Green path (30 patients/day): for nonacute patients (mostly
degree 3) who required
light surgical intervention (e.g., bone setting or stitches) but
who were unlikely to be
hospitalized.
x Psychiatric path (10 patients/day): for patients who primarily
required psychiatric
treatment (e.g., for alcohol abuse or suicidal symptoms).
Over time, a fifth (unofficial) grey path emerged, for geriatric
patients who required long-

term hospitalization (5 patients/day).
Each path had dedicated rooms, nurses, and doctors, but all
paths shared technical resources
(such as x-ray equipment, CT scanners, and a transportation
team). Nursing staff rotated
from one path to another on a weekly basis. The ED had a total
of 40 examination rooms
(also called boxes), 25 for acute and psychiatric care (red and
psychiatric paths) and 15 for
outpatient care (orange and green paths). Although the ED ran
24/7, the outpatient (“orange”
and “green”) rooms were closed from 11 p.m. to 8 a.m., so
during those hours all non-
psychiatric patients were treated in “red” rooms.
PROCESS MAPPING
The resources and actors involved varied for each patient.
Nevertheless, the overall process
was similar for all patients; Exhibit 5 provides a summary of the
broad process map in the
ED.
The full process took an average of five hours and could be
divided into three steps:
1. Initial wait: after sorting and registration, patients waited in
a dedicated area at the
entrance of the ED, under the supervision of a nurse, until a
room became available.
On average, patients waited an hour and 10 minutes for a room,
but the wait time
could be as high as 10 hours. A nurse was responsible for
assigning patients to the ED
rooms. That nurse’s role was very central, as she or he
determined the priority given

to each patient and managed the workload of the different areas
in the ED. Only
experienced specialized nurses with good leadership skills were
staffed in this
position.
Management also found that because of the long wait time,
approximately five
patients per day left the ED before they were seen by a doctor.
Hospital | Page 6
CHAN‡
2. Patient management: the patient-management phase took on
average three hours
and 10 minutes. This process was highly variable: benign
interventions might require
only a few minutes, whereas acute cases where resuscitation and
stabilization of the
patient as well as a complex diagnostic are necessary might
require more than 10
hours.

Typically, the following steps occurred during the patient-
management phase:
x A nurse brought the patient to a room, took his or her vital
signs, and called
the intern when the patient was ready for examination.
x A first examination was performed by the intern, who called a
supervisor if
necessary. For acute cases, specialist doctors took care of the
patient
immediately.
x In approximately 40% of the cases, doctors required
laboratory tests to
establish their diagnosis. Once the tests had been prescribed,
samples were
sent to the central laboratories; for cost and quality reasons,
those labs
performed all the tests. The samples were then processed and
the results were
published through the labs’ IT application. On average, two
hours elapsed
between the prescription of the tests and the publication of the
results.
x Some patients required a radiology exam, in most cases either
a conventional
x-ray (30% of the patients) or a CAT scan (CT) (15% of the
patients). The ED
had a dedicated CT scanner located close to the examination
rooms. The CT
itself took about 30 minutes, which was in line with
international benchmarks.
However, doctors complained that getting the results took three
hours. They

blamed both the lack of resources (“one CT is not enough for
our ED”) and
the inefficiency of the technical staff for the delay. The
technical staff,
however, said that they conducted exams and processed the
results as fast as
possible, and blamed the nurses for being too slow in
transporting patients.
The scanning process was as follows: once the exam was over,
the CT
technician called the nurse assigned to the patient. The nurse
then took the
patient out of the scanner, after which the technician called
another nurse to
bring the next patient in for the exam. As a result, the CT
scanner remained
empty for ten minutes between each patient.
x For the most complex cases (approximately 25% of the
patients), the ED
medical staff sought advice from another specialist in the
hospital. Each
department had a dedicated phone line for the ED, with an
intern on call to
visit emergency patients. Obtaining advice from a specialist
added on average
two hours to the patient management time: one hour for the
specialist to come
down to the ED (generally because he or she had other tasks to
perform at the
same time) and one hour for the specialist to examine the
patient, reach out to
a supervisor if necessary, and give advice to the ED medical
staff.
x Once all the results had been reported, on average 45 minutes

elapsed before
the medical team made a decision about the next steps in patient
care. Interns
were responsible for a few patients at a time and were
sometimes busy with
University Hospital
CHAN‡
patient B when the results arrived for patient A. Moreover,
interns generally
discussed or backed up their decision with their supervisor, who
might also
have been busy with another patient.
The mission statement of the ED clearly stated that patient
management in the
emergency room should be terminated once the patient had been
stabilized and a
diagnosis had been established. Nonetheless, the teams
sometimes initiated treatment
steps to improve the quality of patient care or ease the job of
the inpatient staff.
3. Patient discharge: On average, the actual delay between the

diagnostic and the
moment the patient left the examination room was 40 minutes.
There were three
possible destinations for patients once they had been diagnosed:
x Home (60% of patients): it took on average 30 minutes for the
medical and
nursing teams to prepare paperwork and provide patients and
families with
the necessary information for discharge.
x The observation unit (20% of patients): some patients required
short-term
monitoring before discharge. Instead of occupying a regular
inpatient bed,
these patients remained in a dedicated area of the ED called the
observation
unit (OU) for a maximum of one night. Although it was located
within the
ED, transferring patients to the OU required heavy
administrative paperwork
(full transcription of patient status, description of treatment for
the night) and
coordination between two different teams. As a result, on
average one hour
was necessary for the transfer. Moreover, in reality many
patients who were
sent to the OU were waiting to be admitted to the hospital as
inpatients to a
department that was either full or to which transfers were not
possible at the
night. As a result, the 32 beds in the OU were often full.
x Another department of the hospital (20% of patients): as in
many other
hospitals, Saintemarie’s ED was a major point of entry for

inpatient
admissions. Each of the six other departments had an
administrative team
managing patient in- and outflow.
Once the diagnosis had been established, the ED contacted the
appropriate team and
asked for a bed in that department. However, the hospital had a
high occupancy rate
(approximately 90%); therefore, as described above, the
requested bed was not
always immediately available. Transfer procedures varied by
service. For instance,
despite a general rule that the ED was responsible for
determining the destination of
the patient, some departments still required that one of their
own doctors examine
the patient before the transfer. In addition, some services did
not accept patient
transfers after certain hours. When a bed became available, the
ED was informed. ED
nurses then called their colleagues in the destination service to
briefly explain the
patient’s diagnosis and medical requirements. (In some
instances, nurses in the
destination department asked to delay the transfer if their
workload did not allow
them to receive the patient immediately.) Finally, ED nurses
contacted the central
transportation team, which was responsible for taking the
patient from the ED to the
Hospital | Page 8

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destination service. On average, the full transfer process took
slightly more than one
hour.
Patients spent an average of three hours and 50 minutes in the
ED for patient management
and discharge. Because of the variety of cases that were treated,
the standard deviation of the
time spent in the ED was relatively high (three hours). If wait
time was also included,
patients spent on average five hours in the ED after they had
been registered, excluding time
spent in the OU.
Concerns about ED Operations
The inflow of patients had been stable for several years.
However, the time spent by patients
in the ED had increased considerably, from four hours in 2006
to five hours in 2009.
During a first meeting, Leterme and Dupont identified their key
concerns about the ED:
x Quality: although the wait-time targets for highly acute

(degree 1) patients were fully
met, only two-thirds of degree 2 patients were seen by a doctor
within the established
maximum delay period of 20 minutes. This raised patient safety
and quality-of-care
issues, two elements crucial to the hospital’s reputation. The
fact that five patients per
day left the ED without being seen by a doctor was also a
concern.
x HR: morale among the ED staff had recently worsened, and
some experienced nurses
and young doctors had resigned over the last months. They all
mentioned an increase
in their stress level as a reason for their decision. They also
blamed severe patient
dissatisfaction as well as their own frustration at having no
control over the situation.
x Economic: the long wait time had negative effects on revenues
because some
profitable outpatient emergency cases went to private clinics
and because some
patients left without being seen by a doctor. Wait time also
raised personnel costs:
additional staff was needed to supervise the patients who were
waiting, and overtime
hours were at a historical high. Moreover, the risk of medical
complications was
higher when patients had to wait longer, which could
significantly increase treatment
costs.
Leterme and Dupont were clear about the serious consequences
of the wait times in the ED
but still struggled to decide which measures they should take to

address the issue and to
what extent these would mitigate the growing wait times.
University Hospital
CHAN‡
Exhibits
Exhibit 1
Median Wait Time to See an Emergency Department (ED)
Physician
1997–2000 and 2003–2004 (United States)
Notes: “All patients” are those age eighteen and older. “Patients
with AMI” are those with an ultimate
ED diagnosis of acute myocardial infarction. “Emergent triage
group” are those age eighteen and older
assigned to this group, which should be seen within fifteen
minutes. In 2001 and 2002, the NHAMCS
did not record wait times.
Source: Andrew P. Wilper et. al., “Waits to See an Emergency
Department Physician: U.S. Trends and

Predictors, 1997–2004,” Health Affairs 27, no. 2 (2008): 84–95,
doi: 10.1377/hlthaff.27.2.w84.
Originally published in National Hospital Ambulatory Medical
Care Survey (NHAMCS) database,
National Center for Health Statistics, 1997-2000 and 2003-
2004.
Hospital | Page 10
CHAN‡
Exhibit 2
Impact of Waiting Time on Hospital Length of Stay

TIMELINE OF HOSPITAL TREATMENT DIVIDED INTO ED
AND INPATIENT EPISODES OF CARE
Notes: ED TTD, the emergency department time to decision to
admit, is the time patients spend in ED
from arrival at triage until admission to an inpatient unit (i.e.,
medical/surgical ward, ICU, operating
room).
IP LOS, the inpatient length of stay, is the time patients spend
in the hospital following ED treatment.
ESTIMATES OF THE PROBABILITY OF SPENDING MORE
THAN A GIVEN LENGTH OF STAY
(LOS) FOR NONDELAYED AND DELAYED PATIENTS
Notes: A patient was considered delayed if the ED TTD was
more than 12 hours. As shown above, the
probability of a long IP LOS is higher for delayed patients than
for nondelayed patients. For instance,
the probability of having an IP LOS greater than 25 days was
approximately 9% for nondelayed

patients, while it was approximately 13% for delayed patients.
Source: Qing Huang et. al, “The Impact of Delays to Admission
from the Emergency Department on
Inpatient Outcomes,” BMC Emergency Medicine 10, no. 16
(2010): 1–6, doi:10.1186/1471-227X-10-
16.
University Hospital
CHAN‡
Exhibit 3
Patient Population Study: Patients Who Leave ED without
Being
Seen
PATIENT CHARACTERISTICS
Characteristic
Patients Who Left
Without Being Seen*
(n = 159)
Patients Who Waited

Until Seen
(n = 211)
Age, y 35.0 36.8
Sex, % male 51.6† 39.3
Race
% black 25.6 29.9
White 26.3 24.2
Latino 41.0 40.8
Other 7.1 5.1
Insurance Status
% Medicare 5.9 1.9
Medi-Cal 12.5 7.7
Private insurance 2.0 3.4
Other 1.3 2.0
Uninsured 78.3 85.0
* Only includes patients who arrived at the emergency
department between 7 am and 11 pm.
† P = .02. All other comparisons were not significant.
CHIEF COMPLAINTS
Chief Complaint
Patients Who Left
Without Being Seen*
(n = 150)
Patients Who Waited
Until Seen
(n = 202)

Chest pain 4.7 3.5
Abdominal pain 12.0 11.4
Musculoskeletal pain 18.0 16.8
Headache 3.3 3.5
Trauma or injury 4.7 8.9
Laceration 2.7 3.0
Soft-tissue infection 5.3 6.9
Cough 3.3 2.0
Vaginal bleeding 0.0† 7.9
Other 46.0 36.1
department between 7 am and 11 pm whose
medical records were available.
† The lack of cases of vaginal bleeding in the group that left
without being seen may be due partly to
incomplete reporting of these cases from the obstetrics and
gynecology area.
Hospital | Page 12
CHAN‡

Exhibit 3 (continued)
ACUITY RATINGS, TRIAGE ASSESSMENT, AND HEALTH
STATUS SCORES
department between 7 am and 11 pm whose
medical records were available.
† All values reported are the mean ± SE. The range of possible
values for the scales are as follows:
overall health, 14 through 58; physical limitations, 6 through
18; psychological distress, 3 through 15.
On all three scales, higher scores indicate worse health.
Source: David W. Baker, Carl D. Stevens, and Robert H. Brook,
“Patients Who Leave a Public
Hospital Emergency Department without Being Seen by a
Physician: Causes and Consequences,”
JAMA 266, no. 8 (1991): 1085–1090.
Patients Who Left
Without Being Seen*
(n = 150)

Patients Who Waited
Until Seen
(n = 202)
Acuity rating, %
Level 1, needs immediate evaluation 46.0 40.3
Level 2, evaluate within 24 to 48 h 26.7 27.9
Level 3, can wait > 48 h 24.7 28.9
Level 4, no symptoms 1.3 2.5
Triage nurse urgency assessment, %
Emergent 2.1 4.1
Urgent 22.6 29.1
Nonurgent 75.3 66.8
Health status scores (n = 107) (n = 210)
Usual overall health impairment 23.9 ± .9 23.9 ± .6
Health impairment on presentation to
emergency department 34.9 ± .9 36.5 ± .7
Usual physical limitations 8.3 ± .3 8.4 ± .2
Physical limitations on presentation to
Usual psychological distress 5.8 ± .3 5.8 ± .2
Psychological distress on presentation to
University Hospital
CHAN‡

Exhibit 4
Patients’ Reasons for Leaving ED without Having Been Seen
Questions
Patients Who
Answered Yes, %*
(n = 140)
1. Did you leave because you felt too sick to sit in
the waiting room any longer? 53
2. Did you have to go home to take care of small
children or someone else in your family? 21
3. Did you leave because you would have had
problems getting transportation home if you had
waited longer?
32
4. Did you leave because waiting longer would have
been a problem with your work schedule? 28
5. Did you leave because you thought that you could
go somewhere else where the wait would be
shorter?
39
6. Did you change your mind and think that you

didn't need to see a doctor? 12
7. Did you leave because you were angry that you
had to wait so long? 57
*The sum of all percentages is greater than 100 since patients
could respond yes to more than one
question.
Source: David W. Baker, Carl D. Stevens, and Robert H. Brook,
“Patients Who Leave a Public
Hospital Emergency Department without Being Seen by a
Physician: Causes and Consequences,”
JAMA 266, no. 8 (1991): 1085–1090.
Hospital | Page 14
CHAN‡

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Endnotes
1 Sreekanth Chagaturu and Snigdha Vallabhaneni, “Aiding and
Abetting—Nursing Crises at Home
and Abroad,” New England Journal of Medicine 353, no. 17
(2005): 1761–1763.
2 Richard A. Cooper, Thomas E. Getzen, Heather J. McKee,
and Prakash Laud, “Economic and

Demographic Trends Signal an Impending Physician Shortage,”
Health Affairs 21, no. 1 (2002): 140–
154.
3 United States Government Accountability Office, Hospital
Emergency Departments: Crowding Continues
to Occur, and Some Patients Wait Longer than Recommended
Time Frames (Washington, DC: USGAO,
April 2009).
4 The Lewin Group, Emergency Department Overload: A
Growing Crisis—The Results of the American
Hospital Association Survey of Emergency Department (ED)
and Hospital Capacity (Falls Church, VA:
American Hospital Association, 2002).
5 Andrew P. Wilper, Steffie Woolhandler, Karen E. Lasser,
Danny McCormick, Sarah L. Cutrona,
David H. Bor, and David U. Himmelstein, “Waits to See an
Emergency Department Physician: U.S.
Trends and Predictors, 1997–2004,” Health Affairs 27, no. 2
(2008): 84–95, doi: 10.1377/hlthaff.27.2.w84.
6 Giuseppe De Luca, Harry Suryapranata, Jan Paul Ottervanger,
and Elliott M. Antman, “Time Delay
to Treatment and Mortality in Primary Angioplasty for Acute
Myocardial Infarction: Every Minute of
Delay Counts,” Circulation 109, no. 10 (2004): 1223–1225.
7 Donald B. Chalfin, Stephen Trzeciak, Antonios Likourezos,
Brigitte M. Baumann, and R. Phillip
Dellinger, “Impact of Delayed Transfer of Critically Ill Patients
from the Emergency Department to the
Intensive Care Unit,” Critical Care Medicine 35, no. 6 (June
2007): 1477–1483.
8 Qing Huang, Amardeep Thind, Jonathan F. Dreyer, and
Gregory S. Zaric, “The Impact of Delays to
Admission from the Emergency Department on Inpatient
Outcomes,” BMC Emergency Medicine 10, no.
16 (2010): 1–6, doi:10.1186/1471-227X-10-16.
9 Robert Derlet, John Richards, and Richard Kravitz, “Frequent

Overcrowding in US Emergency
Departments,” Academic Emergency Medicine 8, no. 2
(February 2001): 151-155.
10 Laura Landro, “ERs Move to Speed Care; Not Everyone
Needs a Bed,” Wall Street Journal, August 2,
2011.
11 Alexander Kolker, “Process Modeling of Emergency
Department Patient Flow: Effect of Patient
Length of Stay on ED Diversion,” Journal of Medical Systems
32 (2208): 389–401.
Hospital | Page 16
CHAN‡
IntroductionChallenges in the Healthcare IndustryCongestion in
the ED and its EffectsSaintemarie University
Hospitalemergency departmentPatients Coming to the EDfigure
1. patient inflow (Daily average plus/minus one standard
deviation)figure 2. Hourly Patient Inflow.degree of
emergencyed rooms (paths)process mappingConcerns about ED
OperationsExhibitsExhibit 1Median Wait Time to See an
Emergency Department (ED) Physician 1997–2000 and 2003–
2004 (United States)Exhibit 2Impact of Waiting Time on
Hospital Length of StayTimeline of hospital treatment divided
into ed and inpatient episodeS of careestimates of the
probability of spending more than a given length of stay (LOS)

for nondelayed and delayed patientsExhibit 3Patient Population
Study: Patients Who Leave ED without Being SeenPatient
CharacteristicsChief ComplaintsExhibit 3 (continued)Acuity
Ratings, Triage Assessment, and Health Status ScoresExhibit
4Patients’ Reasons for Leaving ED without Having Been
SeenExhibit 5Process MapEndnotes
EDSP 360
Project 2: Annual Goals Template
Jackson’s Annual Goals
Annual Reading Goal
Annual Reading Goal
Annual Written Language Goal
EDSP 360
P
ROJECT
2:
A
NNUAL
G
OALS
T
EMPLATE

Annual Reading Goal
Annual Reading Goal
EDSP 360
PROJECT 2: ANNUAL GOALS TEMPLATE
Annual Reading Goal
Annual Reading Goal
EDSP 360
Project 2: Annual Goals Grading Rubric
Criterion
Points Possible
Points Earned

Instructor Comments
First Annual Reading Goal
· The annual goal includes:
· Audience
· Behavior
· Criterion
· Conditions/Degree of performance
· Timeframe
· The goal is measurable and observable
17
Second Annual Reading Goal
· Audience
· Behavior
· Criterion
· Timeframe
17
First Annual Written Language Goal
· Audience
· Behavior
· Criterion
· Timeframe
17
Second Annual Written Language Goal

· Audience
· Behavior
· Criterion
· Timeframe
17
Professional Writing
· Correct spelling
· Correct grammar
· Complete sentences
7
Total Points
75
EDSP 360
P
ROJECT
2:
A
NNUAL
G
OALS
G
RADING
R

UBRIC
Criterion
Points
Possible
Points
Earned
Instructor Comments
·
The annual goal includes:
o
Audience
o
Behavior
o
Criterion
o
Conditions/Degree of performance

o
Timeframe
·
The goal is measurable and
observable
17
·
The annual goal includes:
o
Audience
o
Behavior
o
Criterion
o
o

Timeframe
·
The goal is measurable and observable
17
·
The ann
ual goal includes:
o
Audience
o
Behavior
o
Criterion
o
o

Timeframe
·
The goal is m
easurable and observable
17
·
The ann
ual goal includes:
o
Audience
o
Behavior
o
Criterion
o
o

Timeframe
·
The goal is me
asurable and observable
17
·
Correct s
pelling
·
Correct
g
rammar
·
Complete
sentences
7
Total

Points
75
EDSP 360
PROJECT 2: ANNUAL GOALS GRADING RUBRIC
Criterion
Points
Possible
Points
Earned
Instructor Comments
o Audience
o Behavior
o Criterion
o Conditions/Degree of performance
o Timeframe
17
nnual goal includes:
o Audience
o Behavior
o Criterion
o Timeframe
17

o Audience
o Behavior
o Criterion
o Timeframe
17
o Audience
o Behavior
o Criterion
o Timeframe
l is measurable and observable
17
7
Total Points 75

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