Cookeville Regional Medical Center


ookeville, TN





Following the COVID-19 pandemic, Cookeville Regional Medical Center (CRMC) was experiencing operational challenges and high staff turnover rates in their 19,000-square-foot, 35-bed emergency department. This was largely due to a shift in workforce demographics, as ED staff were supplemented with nursing floor staff. The hospital engaged Gresham Smith’s Research and Insights and Advisory Services teams to identify opportunities for improvement outside of design changes.

clinicians surveyed
clinicians behavior mapped
hour reduction in length of stay

Taking a mixed-methods approach, the project team utilized design thinking to delve deep into the organization’s culture, soliciting feedback from the department. The following survey revealed a strong need for an improved working environment, including rest spaces. This qualitative approach was complimented by quantitative behavior mapping. By tracking the movements of nine nurses, technicians and providers, the team discovered that the emergency department’s inefficiency was largely due to layout, which forced staff members to walk excessively. For example, spaces initially meant for overflow were being used for high-acuity patients but were not equipped with the necessary medical supplies.

The project team provided recommendations for improvements in four categories: people, place, process and product. Recommendations related to people included improving staff culture and amenities, reducing ambulance volume, and longer shift overlap for nurses and doctors. Actionable items related to place included developing a dedicated psychiatric crisis center and removing hallway beds, while actions related to process included adding a wheelchair storage solution, improving supply storage and standardizing medication dispensers. Recommendations related to product included streamlining the charting process, installing telemetry in provider spaces and improving communication upon room release.