Morris Pita’s experience waiting with his son in a hospital emergency department has resulted in an award-winning business that offers a solution for a problem faced by hospital emergency departments across the globe. Christine Young met with Morris to talk to him about how he set about addressing the issue of reducing emergency department waiting queues.
Morris is a born and bred North Shore native, now living in Stanley Bay. He has a background in the energy and corporate sectors where he worked until 2009. He now describes himself as a social entrepreneur, interested in setting up and running a business that has a general benefit for a community or communities. Until the day he waited with his son in an emergency department (ED) – and left feeling there had to be a better way – he had no experience in either software or working in hospitals, both of which are key to a business that eases the pressure on hospital EDs, and greatly reduces waiting times for patients.
The problem was – and is – that many non-urgent patients go to EDs rather than urgent care clinics or their local GP. Morris’s solution is a new company (Tai Pari Mohio, which translates literally as the incoming tide of knowledge) and a complex software program appropriately titled Emergency Q, and the ultimate result is tens of thousands of patients having their long wait time in ED reduced by referral to an urgent care clinic. Emergency Q’s core business, he says, is reducing crowding in hospital emergency departments. Emergency Q “contributes to that by offering patient with non-emergency problems, such as earache, a sprain or a sore throat, the option of being transferred to an urgent care clinic”.
Emergency Q launched six years ago, in May 2017, at North Shore Hospital. Before Emergency Q was developed, a few hospitals, North Shore among them, had used manual systems to transfer patients to local primary care clinics at busy times. They were aware of the concept, says Morris, but there was no integrated digital system. “Using their old manual transfer system, EDs could see it was not making any meaningful dent on ED volumes – maybe a couple of patients a day – compared to 20 to 40 patients a day through Emergency Q ,” says Morris, with the benefit of hindsight.
“It occurred to me that this could be done and I decided to try to help reduce crowding in EDs and give patients choice.”
It’s all very well having a bright idea; taking it through to successful use and execution is quite another, as many entrepreneurs will know. Part of the development process involved – and continues to involve – primary research: asking patients and ED staff about their needs and experiences. Key in that early research was an understanding that one in four patients presenting at EDs are not medical emergencies, and many of them are safe to be seen at a primary care facility.
“We were fortunate that North Shore Hospital was open to trialling a test version,” says Morris. “They found it was very effective in giving choice and reducing non-emergency patients in ED.”
After a year of successful operation at North Shore ED, other hospitals gradually started coming on board including Middlemore, Waikato, Waitakere, Whangārei, Invercargill and Thames hospitals, with the system assisting medical staff and patients at each, and providing data from four large urban and three smaller regional hospitals, which alongside patient research continues to feed regular updates in the systems and processes Emergency Q offers to hospital and urgent care clinics.
From the first hospital sign-ups, “[w]e have been adding hospitals [and urgent care centres], and we’re in seven hospitals now,” Morris says. The business continues to grow, and with the software his team have developed being eminently transferable, he is looking at opportunities overseas, with support from New Zealand Trade and Enterprise.
Morris demonstrates part of a live dashboard that shows vital statistics on the tool’s use, testimony to Emergency Q’s effectiveness and impact on the hospital departments that use it. Since 2017, its use has transferred more than 128,000 (“more than two and a half full Eden Parks”) from emergency departments to primary care clinics. The day before we talk, 74 patients and their families benefitted from the demonstrably shorter waiting times at primary care clinics, and the EDs benefitted from a corresponding reduction in patients presenting to busy doctors. In the short time we talk, several patients opt to be transferred to a local care clinic, where their wait time, on average, will be around an hour and a forty-five minutes, compared with the average four and a half hour wait time in an ED.
With the Emergency Q software able to analyse its impact in real time, and collate statistics on a daily and cumulative basis, Morris demonstrates that, with the average time spent on each non-emergency patient taking nine minutes admin time, 15 minutes nurse time and 45 minutes of a doctor’s time, 147,000 hours of doctor, nurse and administrative time has been saved in EDs using Emergency Q. Add to that the average 270 minutes of each patient’s time, and the impact is even more significant.
More than time or numbers, perhaps, Emergency Q benefits hospital in other ways. Primary research, undertaken regularly by Tai Pari Mohio, has shown a reduction in aggression levels towards frontline nurses, simply because often-stressed patients are offered a viable alternative to the long ED wait time. One ED nurse at Middlemore Hospital says that since Emergency Q started, “it feels like the level of verbal abuse has dropped significantly... even if people choose to stay, they tend not to be angry about the wait as we have offered them an alternative and they can see the wait time on the screen.”
Emergency Q is used at the point of triage. Triage nurses trained in its use, use the state-of-the-art clinical decision support tools within Emergency Q to identify patients that are clinically suitable for transfer to a primary care clinic, which are much better suited than an ED to treating non-urgent or critical conditions. A printed or digital “voucher” accompanies each patient transferred so their time at the urgent care clinic is also streamlined.
“Our focus is on offering patients a choice,” Morris says. To achieve this, a team of 15 works from the company’s Takapuna base. Half are software developers and half are ED doctors and nurses who provide the quality and direction on all clinical aspects of the company’s work. The software team builds and maintains the software, which Morris says is rapidly evolving, “highly innovative and agile, releasing functional services and benefits every two-three weeks”.
While Morris has led this extraordinarily impactful digital initiative, he is relatively low key and matter of fact about the results they have delivered, in part, one suspects, because he has simply done what comes naturally to him – he just “started at the beginning” he says. He backed his intuition about need with well-grounded research, developed his own in-depth understanding of the needs not just of the hospital EDs but also of the drivers that lead to patients arriving in EDs rather than initially opting for a primary care clinic or GP, and has built a team that he says is as focused on the outcome as he is. “We have an amazing team of passionate, creative and caring individuals from a range of cultural backgrounds, a bit like a United Nations – whose sole focus is building leading-edge AI-supported tech to serve the communities they come from and live in.”
For himself, he says Tai Pari Mohio and Emergency Q epitomises the kind of business he’s keen to build: businesses that have “a general benefit for a community or communities. Since we’ve been talking, several families have gone to an emergency department, but given a choice have been transferred to a primary care facility, where they will have been seen in a fraction of the time by people who specialise in urgent primary care.”
Of course there have been challenges along the way but Morris has to think long and hard when asked what these have been. “The biggest challenge in setting up a new organisation, or on going through a growth phase, as we continue to do, is that every phase has its own set of hurdles, from ‘how am I going to get it running and demonstrate that it works’ through to the next phase of sharing the benefits more widely with more people and more hospitals, and growing a team that is unambiguous in its philosophy – which in our case is to benefit patients and hospitals and clinics in ways that are practical, equitable and measurable.”
Morris is especially passionate about the need for equity and access in our health system, with high-need population groups, including Māori and Pasifika, currently over-represented in emergency departments and under-represented in those presenting to urgent care clinics. He’s especially proud that in enabling choice, the data shows that Emergency Q has resulted in these groups disproportionately transferring to urgent care clinics when given the choice. “Inequitable access to urgent primary care is being rectified.”
“Doing that, it’s really easy to get motivated to come to work. It’s been an amazing journey for the entire EQ team.”
