GE Healthcare Camden Group Insights Blog

Complimentary Web Seminar: Modernizing Your Enterprise Imaging to Survive in the World of Value-Based Care

Posted by Matthew Smith on May 10, 2018 1:00:38 PM

Web Seminar: Modernizing Your Enterprise Imaging to Survive in the World of Value-Based Care

Jun. 14, 2018 | 2 PM ET/11 AM PT
Hosted by Health Data Management

The move toward value-based reimbursement (VBR) models is forcing healthcare organizations to leverage investment in their existing systems to more effectively measure and improve the quality and efficiency of their care. The long-term goal is clear - organizations need to integrate their devices, applications, and data to provide clinicians and administrators with the right information at the right time to deliver the best possible outcomes at the lowest possible cost. Join us on this complimentary webinar to explore how enterprise imaging can provide a natural hub for modernizing the flow of healthcare information. Learn how productivity can be boosted at pivotal points in the organization to improve the overall flow of clinical information and provide greater transparency for measuring and documenting quality and efficiency.

To register for this complimentary webinar, please click the button below:

GE Healthcare Partners, Imaging to Survive in the World of Value-Based Care

Speakers

rasushrestha_upmcDr. Rasu Shrestha
Chief Innovation Officer
UPMC 

 

derekdanois_ge_healthcare

Derek Danois
Principal & General Manager
Global Imaging Solutions
GE Healthcare

 

ritapateljackson_ge_healthcare

Rita Patel Jackson
VP of Global Marketing
Analytics Solutions
GE Healthcare

 

Mike Perkowskimike_perkowski
Co-Founder and Partner
New Reality Media, LLC
(Moderator)

Health System Integration: Prescription for Success

Posted by Matthew Smith on May 7, 2018 1:33:11 PM

Achieving health system integration following a merger requires an understanding of the obstacles to effective integration and a structured planning process that includes, among other elements, a clear vision and defined guiding principles.

To read this article in its entirety on the HFMA website, please click the button below:

GE Healthcare Partners Health System Integration

Topics: Mergers and Acquisitions

The Stigma--and Support--of Standard Work in Healthcare

Posted by Matthew Smith on Apr 27, 2018 2:39:21 PM

By Tina Hallberg, RN, Senior Consultant, GE Healthcare Partners

In a world where personalized care and service is so pervasive, such as in healthcare, it’s common to hear hesitancy toward standardization through statements like, “I am not a robot” or “Every patient is unique and different.” Not every heart attack is the same, just as not every medication affects patients in the same manner. “Listen to the patient, provide a therapeutic milieu, treat them for the unique individual they are.” These words have been reiterated over and over by employers, educators, and even patients themselves. As a nurse, I get it. As healthcare providers, we have endured years of training and even pressure to be autonomous toward anyone before us in the exam room or hospital bed. It’s not surprising when I’m met with resistance to implementing standard work in the medical arena.

However, standards aren’t new to healthcare; they’re everywhere. Best practices exist for treating the heart attack, how to take the medication, even trauma care with the ABC approach of checking airway, breathing, and circulation. Patients are safer when we do adhere to best practices, when staff are consistently trained and follow clinical protocols. Medicine is part science and part art. The clinical algorithms, formulas, and research provide us with guidelines and standards to determine the overall health picture of each patient. That is the science. The art is how we mitigate and manage what the data tells us; how we select treatment plans by carefully incorporating the uniqueness of the individual patient into the numbers. Embedding evidence-based standards into the practice of medicine ensures we have consistent, high quality and safe treatment of patients.

So why do so many bristle at the sound of standard work? In its rudimentary definition, standard work is merely a prescribed sequence of repeatable steps. The objective is to minimize and control any inconsistency/variation whether it be in quality, inventory, cost, or outputs. It defines normal conditions and highlights instances when abnormal circumstances arise. The perception that standard work removes the art side of healthcare couldn’t be farther from the truth. It’s meant to make the care of patients simpler and create more time for the art of medicine; the personalized care and service. 

The Significance of Sequence

Consider standard rooming. When bringing a patient to the exam room, I carried a Visit Wizard, a simple checklist of the tasks I needed to perform in order to room the patient. Obtain chief complaint, review medications, take the pulse, temperature, respirations, and blood pressure. Anyone who has roomed a patient in an outpatient clinic may argue this Visit Wizard isn’t necessary, and I’ve heard the reasons. “I know how to take vital signs,” and “I do this already, it’s just extra paper.”

Two reasons why the Visit Wizard was helpful: first, it ensured I captured all components of the rooming process; second, and more importantly, it ensured I did the tasks in the right order. If I obtained the blood pressure first instead of at the end of the process, it would invariably be high due to the patient walking, taking off their coat, getting situated, etc., instead of at rest: the blood pressure we wanted. That higher reading could create a domino effect: the clinician is concerned about hypertension, possibly medicates the patient unnecessarily, and potentially puts the patient through a myriad of needless tests because of poorly timed data collection. In fact, when we instituted the Visit Wizard, they were able to declassify over 40% of the patients off the hypertension registry and off medication because they were falsely categorized.

Staff were trained on the Visit Wizard across all 30 clinics in our health system and, over time, the Visit Wizard became habitual. Any patient could go to any clinic and be roomed by any staff, but would receive the same rooming process, enabling consistent, high quality, and safe care. The Visit Wizard was even adapted by medical subspecialties who put their own twist on it. For example, the podiatry clinic used the same sequence, but added, “remove shoes and socks” at the end of the list.

The Aptitude of Autonomy

Another key takeaway is standard work frees up time for more personalized care and service (more time for the “art” of medicine). In the past, I may have finished rooming one patient and was on to the next when I realized I forgot to do something with the first patient. I would rush back, possibly interrupting the clinician visit, taking time away from the next patient or even missing the first patient altogether. These instances add time into the day, disrupt patient and provider flow, increase stress and chaos, and increase risk of inconsistent and/or missed opportunities of safe and quality care. With the Visit Wizard, my true task work was indeed shorter, and I had more free time to have that individual conversation with each patient without rushing.

Deliberate Design and the Spirit of Improvement

Standard work also means work is intentionally created. We don’t leave things to chance for individual team members to “figure out.”  Just as our healthcare products are carefully designed to keep customers safe, we must design the work to keep our team members safe. By using standard work to establish consistency it becomes the first line of detection for abnormalities. People are now in control of flow, quality, machines, material, and every other aspect of providing care. It certifies we don’t ask people to do the impossible. Training staff becomes easier and the identification of opportunities is clearly visible. Establishing a consistent baseline of how things are, standard work lets us easily see where we need to make improvements, and measure whether we accomplished what we set out to do.

Whenever employees develop new standard work, they become more confident and better skilled — mastering their jobs and growing in their understanding of new aspects of their work every day. After standard work is developed, deployed, and refined, staff are freed up to use creative thinking to investigate other systems and to devise new ways to improve them, because team members ask, “How can I make this work better for our patients?” While clinical studies and evidence of best practices guide our work, we’re still dependent on medical specialists and staff to use their best critical thinking, judgment, and knowledge gained through education and experience to deliver high-quality healthcare.

The challenge is that healthcare is complex and often chaotic, and people make mistakes. What’s more, variability in our processes leads to variation in patient care. In healthcare, we know that no mistake or variation should be acceptable if it leads to an increased risk of harming a patient or staff member. Standard work balances the science that can save a life with the art of personalized care and service we all deserve.

GE Healthcare Partners has helped dozens of organizations improve the quality and safety of their processes. I’m optimistic about the opportunities in front of us to keep moving these efforts forward.


HallbergTina Hallberg, RN, is a highly experienced registered nurse and senior consultant at GE Healthcare Partners. Her leadership and managerial skills are coupled with 20 years of nursing experience in acute hospital settings, including transplant and flight trauma, long-term care, and clinic settings including the roles of Chief Nursing Officer, Director of Nursing, Case Mix Manager, Staff Development Coordinator, and Operations Supervisor. Tina maintains sensei-level expertise in the application of Kaizen methodology to healthcare. She obtained her training under the tutelage of Taichii Ohno’s protégés through multiple missions to Japan. She may be reached at kristina.hallberg@ge.com.

New White Paper Download: Budgeting to the Cyclical Nature of Patient Volumes

Posted by Matthew Smith on Apr 27, 2018 11:50:44 AM

This alternative way of budgeting for nursing units accounts for the cyclical nature of patient volumes. GE Healthcare Partners uses this methodology—along with its proprietary core and flexible staffing analytical model—to assist Nursing and Finance to better understand and plan for staffing needs.

Traditional Budgeting Can Sometimes Pit Nursing and Finance Against One Another

Developing the labor budget for nursing units can be a challenging task and will often pit nurse leaders against their peers in finance when in fact, it presents a great opportunity to collaborate and leverage the strengths of each discipline. In several of our recent consulting engagements, we have seen the evolution of the relationship between nursing and finance move from one of conflict to one of collaboration. This evolution brings with it increased awareness and higher levels of empathy towards the perspective of the other discipline.

The modified budgeting process described in this white paper serves as an ideal opportunity for nursing and finance to learn from each other. It also raises the level of accuracy of the established budget, and increases the buy-in of the nurse leaders being held accountable to achieve budgeted targets.

To download a PDF copy of this white paper, please click the button below:

Budgeting to Cyclical Nature of Patient Volumes

Command Center Executive Brief

Posted by Matthew Smith on Apr 10, 2018 9:30:44 AM

This Executive Brief describes a trend by large tertiary/quaternary multi-location hospital systems to adopt command centers equipped with new predictive analytics to improve quality, efficiency and patient outcomes.

To download the Command Center Executive Brief, click the button below.

GE Healthcare Partners Command Center Executive Brief

Video: How Data Is Getting Patients the Care They Need Faster

Posted by Matthew Smith on Mar 19, 2018 1:43:53 PM

Jeff Terry, CEO of GE Healthcare Command Centers, talks with Fortune Magazine about utilizing cutting edge developments in technology and data collection for the Command Center at Johns Hopkins Hospital to positively impact patient care.

To download our Command Center Executive Brief or to contact GE Healthcare Partners to learn more about Command Centers, please click the buttons below:

here.
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Aligning for Outcomes, Transforming for Patients

Posted by Matthew Smith on Mar 16, 2018 6:30:27 PM

By Helen Stewart, Managing Principal of GE Healthcare Partners

Healthcare organizations face incredibly complex problems as they try to navigate the transformation in healthcare. Providers face these changes boxed in by the pressures from regulatory groups, dropping prices from public and private payers, and increasing demands from consumers around convenience, transparency, and connectivity of care. Traditional vendor-supplier relationship models provide one more point of pressure across the provider system, but they don’t have to. In these disruptive times, providers and vendors will need to work together to transform both the care model and the business models that support it. Vendors who offer technologies and services to health systems must consider how to ensure those tools are used appropriately to deliver the intended results, and providers will need to choose their ‘partnerships’ carefully, to ensure they select an organization that can help them integrate the technologies, people, and process to transform their care model and financial situations.

Is Your Health System Ready for a Different Approach?

A variety of new partnership models are emerging. As Frost & Sullivan points out: “Hospitals are becoming more aware of the financial risks they face and of ways in which they can be mitigated, such as vendor contracts that include risk sharing components.” i

A critical consideration for health leaders when seeking a partnership to share risk is their own willingness to work in a win-win scenario and to change their organizational approach to buying and implementing products and services. Many organizations have executive-level interest in transcending the buyer-supplier model to alleviate the increasing pressures; however, they struggle to find an approach that enables meaningful engagement with a vendor to achieve success jointly.

The traditional “tell me what you need” (vendors) and “tell me what you can do for me” (health systems) way of doing business is not up to the challenges in healthcare today. True partnerships will require leaders to discuss the capabilities of both organizations; align around intent, governance, and the business model they will work under; and replace the traditional supply chain process with a roll-up-your-sleeves-together approach.

Of the more than two dozen health system executive teams I’ve worked with in the past three months, only a handful have taken an approach conducive to the dialogue and joint investment of time needed to structure true partnerships. In those cases, the conversations began with discussions around the priorities of the health system and the journey and investments already in place, and were distinguished by three factors:

1. The CEO and at least one or two other senior leaders shared a clear understanding of the need to work differently with a vendor if they were to truly form a partnership. All had the willingness to discuss, shape, and shepherd a non-standard process within their own organization to achieve their goals.

2. The executive sponsors allowed for working sessions and meaningful discussions to jointly shape the potential business model, governance approach, and operational integration of resources that would be needed to be successful. 

3. The executives recognized that the process to develop an outcomes-based relationship takes time and investment from both organizations and careful consideration around what makes an organization a strong potential partner.

What Should Healthcare Leaders Look For In a Transformational Partner?

Given the complexity and investment required to craft a true outcomes partnership, healthcare leaders need to quickly narrow the field and carefully select the organizations they will work with. There are three things I believe every executive should evaluate before considering a partnership to help them achieve their goals.

1. It is critical to pick an organization that aligns across values and culture. This may seem obvious but it is often overlooked in the traditional buying process. When purchases were focused solely on the acquisition of a technology, software, or service, it was less important to evaluate the way a vendor works culturally and the values they have instilled in their people. In outcomes relationships this will become a critical enabler to success or a crippling challenge if the two organizations are misaligned.

2. It’s no longer about buying a product or a service for a particular point of care; it’s about finding a partner who shares your vision for the enterprise and offers broad-ranging technology, expertise and resources to help you determine the right solution to your healthcare challenges.

Here’s just one example. In imaging, the emphasis on nuanced incremental capabilities, such as the difference between a 64-slice and a 132-slice CT, is being replaced by discussions that harness analytics to help clients determine the most effective use of a CT in the system of care – the right CT, at the right time, and all will be transcended by how imaging should be used in the future, the most appropriate use of technology in the care plan for the best and lowest cost outcome. It will take partners with expertise and broad capabilities in CT technology, asset management, and data and analytics and with the vision to define the future to help providers align the right resources to provide the best clinical outcomes in the most efficient manner possible.

That mindset means vendors need to be open to working with additional partners when necessary. That’s core to an outcomes-based relationship: the willingness to bring in the right resources to solve the problem in a meaningful way, and the wherewithal to do so over time as a partner to ongoing transformation. That’s one reason leaders should be looking at organizations that have the technology and software capabilities to provide the products and services required to deliver care, and the focus on innovation and broad capability building to allow them to meaningfully support unconventional approaches and execution of outcomes in the environment of care. They will be best prepared to help you find new answers to stubborn problems as well as challenge you to consider the healthcare organization you want not only today but five and ten years down the road.

3. Leaders need vendors who are willing to commit to new business models that share the risks providers today have to face alone. True partnership-minded vendors assist not only in delivering outcomes but in activating the outcomes. They accept risk and work in concert to achieve specific outcomes, and will commit to specific financial guarantees. The environment is changing so rapidly that what you buy today may be irrelevant in 18 months unless the vendor is helping you prepare for market trends, coming legislation, and other vectors of change in healthcare. Aligning to outcomes means that a vendor commits support even as legislation and the environment are shifting under your feet.

For example, vendors can’t install software and walk away; they have to be willing to connect their software into the work being done to provide care, connect to existing technologies and software as an integrator, and to helping health systems adapt to changing conditions along with the client in order to achieve the goals jointly defined. As a result, the role of the supply chain in changing and the traditional contracted product/vendor relationship is transforming. 

Outcomes alignment is about delivering value to clients in specific ways that will be unique to their environment, their market, their payer mix, their current situation, and their strategy. In the new world of risk-sharing, “I buy these features and benefits and you sell them to me for X price” has to become “We have a relational agreement in which governance defines how we’ll work together to navigate a changing environment and the implications it has on the agreement we’ve put in place.” The vendor organization has to be committed to aligning their resources and the resources of other organizations to help you navigate the changing environment rather than simply billing you based on delivering a product.

Sharing Risk, Creating Success Together

The shift to outcomes-based relationships with true risk sharing is going to take time - a multi-year transformation. Organizations that get on the pathway now are going to be well ahead of the game as the complexities continue to grow. Although the alarm bells have been sounding for years about the shift to value-based payment, the majority of healthcare organizations are still operating as though it will always be a fee-for-service world. As that shift starts to accelerate, organizations that are not forming partnership relationships with vendors who can help them across the care continuum will feel pressure from all sides and find themselves squeezed financially with limited avenues to achieve transformation.

i Evolution of Transactional Vendor-customer Relationships into Shared-risk Partnerships (2016), Frost & Sullivan.


shutterstock_image (11).jpgHelen Stewart, Managing Principal of GE Healthcare Partners, leads client relationships, practice strategy, business development, and day-to-day operations. She brings 20+ years of experience within the healthcare industry, focused on strategy activation and execution, management and leadership strategy, quality, compliance, business development and operations. She has an extensive track record building successful strategic relationships and helping healthcare leaders solve the industry’s most difficult challenges.

Topics: Performance Partnerships

Applying Simulation Modeling to the Hospital Environment

Posted by Matthew Smith on Mar 15, 2018 2:53:33 PM

Harnessing the Power of Raw Data with Simulations

Most hospitals in the U.S. and Canada face capacity planning challenges. Every situation is nuanced. Needs vary with geography, patient demographics, workforce, and financial strength, but one thing is certain: the complexity of providing the right patient care is an obstacle to effective capacity planning.

The fundamental complexity of patient care is challenging to understand and difficult to plan strategically. Why? Because unlike industries such as aviation or energy, in a hospital setting there is less control over inputs; hospitals inherently operate with greater variability than many other industries. Each patient requires (and deserves) individualized care, people respond to treatment in different ways, and the demand for services can be erratic. Anticipating needs and planning accordingly is not a simple question of supply and demand. Nonetheless, leadership is charged with optimizing available resources for the best outcome for each patient. Yet, the information needed to make the right choices is challenging to gather and difficult to interpret. In some cases, data is unavailable. In others, the sheer volume of raw data overwhelms decision-makers, leading to more questions than answers.

Johns Hopkins Medicine (JHM) and General Electric (GE) are two healthcare organizations on the frontlines of capacity planning. Together, they’re exploring new approaches and technologies to apply simulation and analytics to enhance decision making – and investment planning – in an industry full of variability. GE has developed a proprietary simulation modeling program that makes sense of disparate data from different source systems to create a “digital twin” of the hospital that is used to test alternatives, make decisions and develop a capacity plan. This simulation program enables leaders to ask hundreds of hypothetical questions, explore possible scenarios, and study capacity planning options in a low-risk environment.

A $7.7 billion integrated global health enterprise and one of the leading healthcare systems in the U.S., JHM is an early adopter of this approach. During a year-long program, JHM and GE worked together to test many alternatives to create an action plan to achieve JHM’s specific capacity goals. The program explored new opportunities, growth and financial strength to inform the capacity plan.

“Defining the work that needs to happen now for an organization to reach a future goal is critical,” explains Dr. David Efron, Chief, Division of Acute Care Surgery (Trauma, Critical Care, Emergency and General Surgery), Johns Hopkins Medicine and the Medical Director of the JHH Capacity Command Center. “Yet, within the healthcare system there are many grey areas: products, caregivers and providers are all dynamic and multi-dimensional. These nuances matter.”

From a planning perspective, running simulations can help answer the questions “How will the organization perform if we make a particular change?” and “How will a decision impact the organization as a whole?”

Running simulations can also inform the work that needs to be done today to enable an organization to pursue the goals stated in three, five and ten year plans. It is a vehicle to test ideas and align those ideas to a strategy.

“Leadership and academics want ‘proof’ during any decision making process,” adds Dr. Efron. “Simulation offers that proof, as well as the steps needed to achieve a goal. And while running pilot programs is not new to Johns Hopkins, the ability to run simulations is a different experience. We’re motivated because simulation is helping us to visualize what we want to achieve as an organization.”

Solutions for Complex Challenges

“Informed decision making is the goal of running simulations,” explains Bree Theobald, Principal, GE Healthcare Partners. “Previously, most organizations operated in silos, leaving departments and units without the information they needed to consider the impact their decisions had on other departments of the hospital, from both an operational and financial perspective. Hospitals did not have the tools to think as a whole… as a system.”

Another key factor: care delivery networks are ever-more integrated. Leaders who “grew up” handling single facilities now manage a portfolio of clinics, outpatient centers and hospitals, as well as employed physician groups, community hospital affiliates, and adjunct research facilities – all within an intricate bureaucratic structure. In addition, the standard of care changes constantly and those changes ripple through care teams, creating impacts that are awkward to gauge and assess. Compounding the issue are reduced healthcare reimbursements and the consolidation of hospitals that create even larger campuses and more intricate systems. Many organizations reflect a structure of six or seven hospitals within one enterprise, each with its own history, budget, priorities, directives, needs and data.

“Today, we’re managing in a very different environment than ten or even five years ago,” explains Jim Scheulen, Chief Administrative Officer, Emergency Medicine and Capacity Management, Johns Hopkins Medicine. “It would be irresponsible not to take advantage of all the tools available. Healthcare is different and we need to think about it in different terms than we have in the past. Historically, we might think about bed occupancy, but we didn’t think about it in terms of utilization of a limited resource. Today, more than ever, we have to optimize use of those resources rather than just bemoan circumstances. Running simulations showed us there is no magic bullet, no single solution to improving utilization. It revealed that we need to implement a number of process improvement actions in order to have a meaningful impact.”

According to Geoff Martin, Managing Principal and COO, GE Healthcare Partners, “Simulation applies aspects of system engineering, mathematical modeling and statistical analysis to gain a thorough, 360-degree view on questions and issues. The result is data availability and data transparency.”

The complexity and constant change of the healthcare environment makes it essential to design capacity strategies that are flexible and efficient. Understanding the many capacity scenarios a health system will face, and the optimal responses within each scenario, can help leadership determine the right investments to make – whether that’s the number of beds, elevators or surgeons. Running simulations can help organizations avoid the pitfall of spending more money while simply moving staff and patients around, resulting in no improvement in efficiency or cost savings.

Answers to Key Questions

“As part of long-range planning, many hospitals bet on growth,” explains Martin. “Simulation lends insights to expansion and construction plans, and these insights can potentially stop an organization from investing in facilities and capacity that aren’t needed. With the findings simulations provide, leadership can identify bottlenecks and under-used facilities, and evaluate solutions. In some cases, clients use their ‘digital twin’ to plan for optimal resource allocation during periods of change, such as economic downturns.”

Despite the fact that hospitals now possess a wealth of data, it is nearly impossible for leadership to make sense of all available information. Simulation can take data and transform it into meaningful information that is actionable. The findings that result from a robust simulation approach can help organizations explore issues prior to investing resources. And, by cutting through anecdotal information, greater objectivity is introduced into discussions about growth.

“Analytics cannot happen with raw information,” adds Theobald. “Running simulations confirms possibilities and viabilities, as well areas of concern. It can also clarify what is not a concern, freeing up resources to focus on pressing issues.”

Hospitals in particular require a systems-thinking approach that helps decision makers understand the nuances of major and minor changes. Quantifying costs – such as the funding required to staff a hospital bed each year – is simply the beginning. Simulation findings also support decisions that can reduce waste. 

“One of the beneficial aspects of simulation modeling is that it allows you to ask specific questions, as well as hypothetical ones, in a non-confrontational, non-threatening manner,” explains Scheulen. “Say, for example, your organization wants to build a new emergency department or grow a department. Simulation allows you to run a variety of scenarios while asking certain questions, such as how big the emergency department would have to be to hit specific metrics. This is where simulation is particularly valuable.”

One of the more common pitfalls of growth is adding capacity when recruiting new surgeons. For example, how does an organization weigh the checks and balances in determining if it has capacity for another neurosurgeon? Prior to recruiting new surgeons, providers can use simulation to determine if the facility has enough capacity for each surgeon to be productive. They can explore how adding patients into a model will increase volume – and identify potential bottlenecks.

In the case of transplant surgeons, even minor, unforeseen factors can play a tremendous role across a hospital. When considering adding a new transplant surgeon to a team, hospitals can use simulation to determine the impacts on medicine, with long and unforeseen pre-transplant hospital stays, as well as significant post-operative care and readmissions. These patients receive care through an entire spectrum, and determining available capacity beforehand can prevent delays and crises down the line.

“In the past, modelling was expensive and time-intensive,” concludes Theobald. “GE’s simulation modeling puts efficiency into the enterprise. It supports capacity planning, informing decisions on where to invest time, resources and funding.”

Bringing Leadership Together

According to Max Garifullin, Analytics Manager, General Electric, “In the past, strategic planning questions – especially those concerning new programs – were usually evaluated from a financial or operational perspective, with few insights available about long-term viability.”

Running simulations brings leaders together. By testing many opinions, it allows more leaders to “feel heard.” Testing ideas may diffuse the tension that builds during capacity planning to support more productive conversations, especially when trade-offs are required. The ability to ask questions within a simulation is a different way of managing an organization, shifting how leadership traditionally weighs options.

“When we ran the emergency department and hospital-wide simulations, there were a number of choices that could affect our ability to meet demand,” explains Scheulen. “Specific actions were recommended to reach long-term goals. We were able to prioritize based on such factors as cost, ease of implementation and likelihood of success – and gauge how some actions are easier to accomplish in some circumstances than others. We developed a matrix of potential solutions that we have used in our efforts to create capacity.”

Increased Efficiencies

Today, hospitals must operate more efficiently. Often, when an organization “fixes” one area, it creates bottlenecks or problems in another. Running simulations allows hospitals to spot this phenomenon in advance.

According to Dr. Efron, “The reason why simulation is so powerful is that everybody gains clarity about how their work impacts the organization as a whole. Previously, we had a myopic view in which we only dealt with the crisis in front of us. Without simulation, it’s impossible to know all the variables, stresses and needs across the entire organization. When decisions are made in a large organization in one area, there is usually an impact elsewhere – but we don’t see it or feel it. Simulation shows us all the possible impacts. Yes, there is still uncertainty in the system, but simulation findings reduce ambiguity. It takes debate out of the process.”

For JHM, running simulations is not only a matter of testing strategic ideas, but also of weighing hundreds of combinations of options to develop an action plan.

“Healthcare is too complex to make decisions based on intuition or what worked in the past,” concludes Scheulen. “These are decisions that will ultimately affect people’s lives, and hospitals should use every tool possible to achieve the best outcomes. What’s at stake if we don’t get it right? The risk is not succeeding in process improvements and making the wrong decisions. Simulation opens the door to thinking about how we use the resources of our entire system. Without simulation our ability to plan and consider new ideas is limited.”

Topics: Digital Twins

Command Centers in Healthcare

Posted by Matthew Smith on Mar 9, 2018 3:02:53 PM

This overview describes a trend by large tertiary/quaternary multi-location hospital systems to adopt command centers equipped with new predictive analytics to improve quality, efficiency, and patient outcomes. (Click here for an instant PDF download of this overview).

Context

Health systems are unique but have similar challenges. Most face a new normal of more than 90 percent occupancy, resulting from changing demographics, the relative infancy of population health efforts, and little investment in new acute capacity. As a result, major providers worldwide are operating at record-high levels of occupancy and utilization.

The Problem

In this environment, it is increasingly difficult to provide reliably affordable, accessible, efficient, and safe patient care. This manifests in problems such as staff fatigue, declined transfers, ED and PACU boarding, excess days, sub-optimal implementation of pathways, inefficient utilization of staff, and imbalanced resource utilization across the system.

Providers have invested in a range of tools to address these challenges: Lean, EMR, electronic bed boards, workflow software, and real-time location systems (RTLS). These tools are important but not sufficient to manage the “new normal” of 90 percent+routine inpatient occupancy. Moreover, a wealth of data being created in IT systems and machines is not being put to work for real-time action.

What’s missing is a central node with the information, authority, and wherewithal to anticipate, identify, and resolve bottlenecks, delays, and risk. This node is the healthcare analog to the air traffic control tower or NASA mission control.

A New Tool: Hospital Command Centers

Having the capability to anticipate, detect, and mitigate risk in real time, command centers complement other performance improvement tools. Command centers are multi-purpose and scalable; they evolve over time like smartphones building on the cultural and technology infrastructure.

They create value by:

  • Supporting front-line care teams
  • Focusing decision makers, empowering them to take action, and equipping them with predictive information to act in real-time
  • Providing a center of gravity for culture, learning, and continuous improvement
  • Offering wide-ranging scope that can span complex care management, delays in care, continuum patient flow, scheduling, clinical deterioration, patient safety, eICU, virtual care, and more.

Leading providers with legacy transfer centers, bed management centers and resource centers are replacing them with command centers because of several key advantages. The new centers:

  • Offer multi-purpose flexibility and scalability
  • Manage patients into, through and out of the hospital
  • Manage patient safety and experience, not just bed management or transfers.
  • Include care management and strategy, not just housekeeping and transport.
  • Incorporate predictive and prescriptive decision support tools, not just dashboards from IT systems.

Proof of Concept

The Johns Hopkins Hospital opened the Judy Reitz Command Center (JRCC), the first of its kind globally, in February 2016. GE designed, implemented, and activated the JRCCC as part of an overall transformation program that has delivered step-function improvements in ED boarding, OR holds, and declined transfers despite the hospital routinely operating above 95 percent occupancy.

Humber River Hospital opened a Command Centre (HRCC) in November 2017. GE designed, implemented, and activated the HRCC as part of an overall transformation program focused on improving quality of care, throughput, access, and cost.

Evidence from this proof of concept suggests that healthcare command centers can have significant impact as the centerpiece of an overall efficiency agenda. In addition to real-time action, the JRCC has become a highly visible center of gravity enabling overall efficiency.

GE Healthcare’s Approach

Typically, command centers are the centerpiece of an overall transformation. Transformation starts with discovery and then proceeds in two work-streams: first, reengineer the system using a digital twin to target process improvements and second, design the command center for real-time, all-the-time optimization.

GE “tiles” trigger command center staff to act with finely-tuned decision support based on a cross-system data model outside the EMR. A typical command center has 10-20 tiles that stream information within the command center and to staff across the hospital via smartphones, PCs, tablets, and other devices.

Command center design begins by crystallizing problems during the discovery phase. The GE team then leads clients through a problem-back design process to develop functional requirements, which may include functions, staff, location and floor plan, source systems, actions, analytics, and a multi-generational plan.

Once the design is approved, GE works with the client-selected architect to fully specify and build the space. In parallel, GE builds the Wall of Analytics™ which delivers tiles to users and integrates with the video wall in the command center. GE also works extensively with staff to socialize the concept, plan actions, rehearse, and ultimately activate the command center to deliver impact. GE Healthcare drives the overall program from inception to sustainable outcomes.

Command Fig1.png

Impact

The program at Johns Hopkins delivered a step-function improvement in key indicators that has been sustained, including:

  • Patient transfers from other hospitals – Johns Hopkins has seen a 60 percent improvement in the ability to accept patients with complex medical conditions from other hospitals.
  • Ambulance pickup – Johns Hopkins’ critical care team is now dispatched 63 minutes sooner to pick up patients from outside hospitals.
  • Emergency Department – Once a decision is made to admit a patient from the Emergency Department, the bed is assigned 30 percent faster. Patients are transferred 26 percent faster after they are assigned a bed.
  • Operating room – Transfer delays from the operating room after a procedure have been reduced by 70 percent.
  • Patient discharges – 21 percent more patients are now discharged before noon, compared to the previous year.

What’s Next?

Like every command center, the JRCC is expanding to tackle new problems for patients, families and caregivers. The scope has already expanded to throughput and the team is planning to address clinical outcomes and cost.

What’s Different?

The command centers described here are different from the many existing transfer centers, bed management centers and resource centers. Leading providers with these legacy smaller centers are already replacing them with command centers. These new centers are multi-purpose and scalable. They manage patients into, through and out of the hospital. They manage patient safety and experience, not just bed management or transfers. They include care management and strategy not just housekeeping and transport. They also incorporate predictive and prescriptive decision support tools, not just dashboards from IT systems.

Command Fig2.png

Topics: Command Center

Are You “Operationalized” to Drive Patient-Centric Growth Strategies?

Posted by Matthew Smith on Mar 9, 2018 12:18:53 PM

By Vesna Gernot, Director, and Semhal Araya, Principal, GE Healthcare Partners

As an industry, we agree that patients are becoming increasingly attentive healthcare consumers. They shoulder more and more financial responsibility for rising healthcare costs, and will continue to drive wide-ranging demands on the healthcare ecosystem around value, access, personalization and efficiency.

Addressing the patient consumerism movement as a growth opportunity has become a key healthcare strategy. For example, providers are working aggressively to create more access channels, and integrate new technologies and methods of communication to personalize the end-to-end patient experience.

But are providers paying sufficient attention to the operational implications of patient consumerism? There is commonly a significant gap in how we understand that relationship, resulting in poor execution. When smart consumer strategies generate new demand, often the health system does not have sufficient capacity and efficient clinical operations and processes to accommodate that hard-earned volume nor deliver on the consumer-centric promise with standardization and reliability.

Operational excellence becomes more challenging with increased industry consolidation. Health systems are growing in size, level of variation, and complexity, leading to operational fragmentation that works against the consumerism agenda of standardization and personalization. Providing a reliable and consistent experience is critical to gaining consumer loyalty. Patients want to be “known“ at every access point and expect every caregiver to have access to the same up-to-date information on their medical journey.

This level of standardization requires a holistic, balanced approach to operations driven from the top down and across the organization. To do so, health system leaders will need to leverage one of the most powerful strategic assets at their disposal: data.

Healthcare organizations are rich with data, especially from electronic health records, but also from ADT, ED, and OR systems; claims databases; market demand forecasts; HCAHPS surveys; and other sources. It’s imperative that leaders get their arms around all their data to inform operational decisionmaking and support such critical patient-centric strategies as:

  • Forecasting capacity
  • Developing and prioritizing service lines
  • Monitoring and decreasing wait times
  • Redesigning clinical care and pathways
  • Creating convenient and accessible points of care
  • Understanding how to remove redundancies and unnecessary costs

Here are a few ways in which new methods of analyzing and harnessing data can help health systems deliver operationally on their promise of patient-centric service.

Millennial or Not, Today’s “Now” Culture

In today’s “now” culture, we can receive goods the same day we order them, and track them minute-byminute from order placement to delivery. Some call it the Amazon effect, and it’s impacting healthcare. Consumers now expect the same high level of service and personalization from healthcare organizations as they get from leading non-healthcare companies. Instead, they are often frustrated by a lack of convenience, transparency, flexibility, and respect for their time. Common complaints include lack of online appointment-scheduling; lengthy waits for an appointment slot; having to provide the same information at registration that they did during scheduling; delayed appointment starts; uncertain results availability; and lack of clarity about the cost of their care.

Organizations recognize that they need to assess these current barriers to consumer satisfaction. Applying advanced and predictive analytics to existing data can help them understand what to solve for and identify the actionable next steps, such as:

  • Deploying smart technology that can seamlessly share clinical and operational data to the cloud while signaling opportunities to reduce idle time or warn for unplanned outages and notify service partners.
  • Enabling disparate data aggregation and interoperability inside, across the care continuum and outside the organization via cloud technologies to improve transparency across access, service, pricing and care delivery.
  • Using patient-centric technology to improve the convenience, speed, and transparency of care. Solutions include standardized pre-registration protocols, real-time insurance verification, online patient registration, self-check-in kiosks, a test-results tracker for patients, financial counseling applications, and online cost calculators and price listings.
  • Providing data-driven decision capabilities to physicians to make real-time changes and clinical care decisions.

Same Diagnosis, Different Needs

Consumerism is also about personalizing patient access and engagement. Two patients with the same diagnosis do not necessarily have the same needs and preferences. Analyzing data on specific patient segments can help organizations structure operations to align clinical care services and operational processes to provide timely and on-demand patient access to the appropriate services. The goal is to enhance convenience, choice and personalization while still ensuring that core care delivery is standardized, efficient and cost effective.

An illustration:

  • Two patients present with knee pain. One is an active student while the other is a retiree with co-morbid disease states.
  • Both will have similar clinical work-ups to ultimately diagnose a torn ACL. While it is critical to align resources with the unique way in which each patient seeks information, makes decisions, and requests communication, these preferences will increasingly require providers to drive standardization of many resources and services that these patients share in common.
  • In this example, the two patients may diverge in certain aspects, such as how they select a surgeon (based on online information or a neighbor’s recommendation) or when they prefer rehabilitation clinic (evening appointments or mid-day appointments with option for 3 transportation assistance). However, the lion’s share of the resources and processes they utilize across the episode of care will be the same, particularly in outpatient radiology, the operating room or ambulatory surgery center, and rehabilitation. The key is to standardize and operationalize care delivery wherever possible to offset the investments required to meet unique consumer requirements—and to do so in a way that is beneficial to patients and physicians and not cost-prohibitive to the system or the patient.

Consumer Strategy Activated Across the Network

Patient-centric organizations are focused on building care pathways that provide a seamless experience for all patients at every access point. As providers design their networks, data will key to be informing locations for care, strategies to meet supply-demand fluctuations, and opportunities to differentiate the patient experience.

For example, consider patient-centric diabetic care and the opportunities and challenges posed by new care delivery models such as wellness clinics, co-located services (labs, nutrition, wound care), innovative remote monitoring solutions, and other new market entrants. Interrogating and analyzing EHR data can help inform such strategic decisions as:

  • Establishing locations that meet access and convenience needs.
  • Assessing capacity to meet anticipated demand along each node in the continuum, and driving efficiencies to ensure affordability and sustainability.
  • Identifying the critical pathways that create increased demand and related capacity requirements from the acute care sites.
  • Integrating new care pathways with the overall system service line.

Mergers that Create New Value for Patients

As health systems consolidate and expand, it is vital to understand how to activate merger-acquisition goals to support consumerism goals. For example, many mergers have the objective of improving local community access to specialty care while increasing market reach. Meeting this goal requires a deep understanding of how patient pathways will evolve and how satellite sites will integrate with tertiary/quaternary hubs.

Data-driven service and asset rationalization is critical to achieving system integration efficiencies while ensuring appropriate, timely care to patients across the new portfolio of care sites. For example, understanding referral and transfer flows for specialty care will help organizations define the hub-andspoke model in a way that creates access and avoids transfer denials to the tertiary hub and potential patient leakage due to delays.

Key considerations include:

  • Service line rationalization – Prioritize the services that the system should provide based on strong existing capabilities, patient needs, revenue generation, competitive edge and cost to patient.
  • Access channels – Segment the population to determine which hospitals or ancillary care areas will best align to patient service needs, such as locating urgent care or rehab services in a retail outlets.
  • Operating model – Create a standardized and efficient operating model to ensure that these services meet the organization’s cost and revenue targets, aligned with value-based care goals.

Investment in a Distinctive, Lasting Brand

Healthcare consumers are just like consumers across other industries: they expect great customer service, timely information, ease of use, and cost-to-value ROI. While most providers began incorporating foundational process re-engineering methodologies years ago, now is the time to go beyond incremental improvement efforts by leveraging data as a strategic asset to identify, prioritize and execute operational plans that support a patient-centric vision.

Providers who combine next-generation digital applications and market-based strategies with health system redesign and care coordination will create a high-performing operation—one with the potential to become a distinctive brand that not only attracts consumers but earns their loyalty through operational excellence.

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