About 400 people visit the emergency room every day at the Hospital Pediatrico William Soler in Havana, Cuba.

Here in the South Hills, St. Clair Hospital gets about 175 patients a day to its ER.

So when Cuban doctors Luis Orlando Rodriguez and Carmen Cuba visited St. Clair on Friday, they were eager to learn how the Mt. Lebanon hospital's emergency department went from being nationally ranked in the 61 percentile for patient satisfaction in 2008 to the top 1 percent. The survey was conducted by Press Ganey, an independent, nationwide survey company.

"We haven't slept in five days -- work, work, work. We wanted to come here, to learn even more," Dr. Rodriguez, a urologist and general director of Hospital Pediatrico, said in Spanish. Dr. Cuba, a director in Cuba's Ministry of Health, translated for him.

Global Links, a nonprofit organization that donates hospital supplies to Third World countries, organized and paid for the trip. Dr. Rodriguez and Dr. Cuba were among six doctors visiting Pittsburgh for five days of observation and training.

The physicians said that health care in Cuba often is lauded as exemplary, with life expectancies and infant mortality rates the same or better than the United States. Doctors in Cuba are trained for free, provided they agree to return to their village or community to practice.

They learned that the climb in St. Clair's rankings is a result of implementing the so-called Toyota Process about 18 months ago.

The Toyota Process is a business model named after the Toyota car company, which first implemented it. It is based on continual improvement through streamlining processes and customer satisfaction.

When Tania Lyon, St. Clair's director of organizational performance improvement, was hired, patients coming to St. Clair's ER could be routed to any number of places: to triage, back to the waiting room, to registration, to a treatment room or elsewhere.

A year ago, she gathered a group of St. Clair Hospital emergency department nurses, doctors, managers and registration staff -- from the night and day shifts -- into one room for one day with one purpose: to figure out how to get Patient X from the waiting room to triage to a treatment room in that order every time.

The result was the Toyota Process in action and, administrators claim, much happier patients.

Officials said the average wait for a patient to be taken to a treatment room has dropped from 49 to four minutes. And the average time to see a doctor is 28 minutes, down from 76.

"Because [the staff] designed it, they like it. There's less stress, less confusion and everything goes faster," she said, presenting a Power Point of the process to visiting doctors and other staff.

"This is the only way to improve," Dr. Rodriguez said. "Because they made it, they can't criticize."

After a tour of the emergency department, Dr. Rodriguez was impressed by the hospital's equipment.

"With this infrastructure, we'd be blessed. You must be very proud to have it. Maybe you don't know what you have because you don't realize what other people lack," Dr. Cuba said.

Health care in Cuba is paid for by the government, which is one reason Dr. Rodriguez's hospital gets so many visitors to its emergency department.

Dr. Cuba said Cubans go to the ER "for everything," including getting a second opinion or in hopes of finding a better doctor. She said it takes only about 20 minutes to process patients because hospital staff is not hindered by health insurance forms and paperwork.

Ms. Lyon would like to implement the Toyota Process elsewhere in the hospital.

"A lot of nurses say the [emergency department] is different, that their area won't change. But the Toyota process will work anywhere," she said. "This is just the beginning."

Looking for more from the Post-Gazette? Join PG+, our members-only web site. You'll get exclusive sports content, opinion, financial information, discounts from retailers and restaurants, and more. Our introduction to PG+ gives you all the details.