the PDCA cycle is used in all quality improvement projects at Mercy. In one specific project project. customer satisfaction with the emergency department at its hospital in Jancesville, Wisconsin , fell below 93%, and a group was created to develop an action plan for improvement. The drop in satisfaction was determined to be caused by an increase patient volume resulting from intermingling urgent care and emergency room patients. The resulted in a misperception that patients who come in later were seeing medical staff sooner than those already waiting, when, in fact, were from two different group: some were urgent care patients and other were emergency room patients.