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Top 10 Opportunities for Improved Acute Care Access and Capacity Management

Posted by Matthew Smith on Apr 22, 2016 11:19:31 AM

The time is now for health systems and hospitals to engage physicians, create actionable data, and plan for operational and financial changes in order to continue to drive better acute care access. Even with population health strategies that are successfully shifting care settings and expectations for target patient populations, there is a continued increase nationally in inpatient demand at large tertiary and quaternary facilities that are designed and required to continue to serve high acuity, time-sensitive conditions.

These facilities report a mid-week operating capacity often exceeding 90 percent occupancy. The hospital is not going away any time soon. To thrive in today’s environment, health systems must align operations with this new reality, and be judicious in expansion plans, as well as managing access to the costly but vital services that are provided.

Top performing health systems do not just look at improving acute care operations as a tactical, cost out effort – operational excellence is being executed as an organizational capability that drives competitive advantage in a market where patients are increasingly becoming consumers, physicians and staff expect a better workplace, and payers aggressively work to bend the cost curve. Here are ten opportunities for improving acute care access and better overall capacity management.

1. Embrace systems thinking. Companies like Amazon, Walmart, Uber, and many others have figured out how systems thinking across their delivery of goods and services can be a competitive advantage; leading healthcare organizations are starting to do the same. The days of finding big opportunity in localized optimization are limited; much of the low-hanging fruit is gone. Healthcare executives must shift their focus to the whole – the whole hospital, the whole health system, and the whole continuum of care – for big wins. This has been a slow process because of the existing fragmented delivery system and incentive structure. Cost pressures and payment reform are forcing “systems thinking” with the acute care setting in a way that we have not seen before, bringing a much wider group to the table in strategic planning and operational reviews to have real discussion around how to improve operations and patient experience.

 
2. Expand as a final resort. Organizations continue to be in a “wait and see” mode in regards to expansion efforts. They have spent a tremendous amount on expansion in the past decade and have heavily invested in healthcare information technology. The last thing most CFOs want to consider is another tower or other construction effort. This is forcing a new level of justification for expansion and deep discussion around how to maximize resources and eliminate duplication of services, including making very tough choices around moving services and appropriate care settings.
 
3. Greater focus on patient experience. After a while it can be easy for those in the operational world to grow numb to – or at least tolerant of – cancelled surgeries, declined transfers, long ED wait times, PACU holds, stretchers in hallways, and a host of other “last resorts” that have recently become permissible mitigations. It is not so easy for the patients. In a recent study commissioned by GE Healthcare Camden Group and Prophet, the gap between the perceptions of patients and health system leaders about the state of patient experience is widening. Despite the rising expectations of healthcare consumers, health systems struggle to move the needle given the myriad of challenges they face. There is not a healthcare professional in the world who does not think there is room for improvement, but it is a task that is too large for a single individual and needs to be approached in a transformative and collaborative way. It also needs to be integrated with efforts to enhance efficiency. The goals are the same:  improve access and streamline the patient care process. We are seeing many organizations take an executive commissioned fresh look at what the world could look like with “Patient Itineraries” and a world class type of experience standard that one would expect in other industries around billing, wait times, transparency to plans of care, and a long list of others. This can be incredibly powerful in creating a shared need and future vision for patient and family centered care.
 
4. Staff smarter. Patients do not get sick Monday through Friday on a defined schedule, yet this is the way many hospitals are run. There is also intense pressure to manage expense budgets by controlling costs in areas such as nursing or support services, but when not done thoughtfully, these efforts can have an impact on patient access in a way that compromises the overall financials in a much greater way. This is a very difficult nut to crack, but one where real progress is being made with approaches such as acuity-based staffing, realignment of staffing models, and smarter use of services based on data models that link demand to the consumption of services.
 
5. Increase flexibility. As beds become more constrained, hospitals are seeking creative ways to increase flexibility which often takes the form of adding flex capacity to absorb fluctuations in demand or increasing the versatility of the existing beds. This includes increasing tele coverage, sharing of beds between departments in times of peak census, rethinking incentives to promote better collaboration around patient care vs. optimizing for an area or department, redesigning processes to say “yes or no” faster, and more. The key for organizations is to promote collaboration and innovation around positive change – this takes data to build a case and strong leadership to overcome a long history of siloed operations.
 
6. Adopt hub and spoke models. Large integrated delivery networks are being much more judicious in aligning their operational strategies around where care is delivered. Increasingly, organizations are seeking to increase the complexity of care at their largest facilities where the most complex and costly services are provided, and use other satellite hospitals in a health system as virtual step downs. This requires a huge degree of coordination to rationalize and relocate services, redefine access patterns, and communicate the change to patients and staff. When done in a thoughtful way, this can be an incredibly effective approach to improving operations, patient experience, and the overall cost structure.
 
7. Target underlying issues. There is no shortage of process improvement effort underway in the acute setting related to access, patient flow, patient experience, and overall capacity management. This is often done in a fragmented way, putting out the fires that burn the hottest instead of taking a comprehensive look to deeply understand the issues and the impact those issues (process/capacity/cultural) are having on our operations. Firefighting can easily result in a “squeezing of the balloon,” where tremendous resources are invested in one area only to shift the issue to another. To truly make a dent in today’s capacity challenges, organizations need to take big swings, building holistic solutions to chronic issues such as long LOS, misalignment of discharges to admissions, inconsistent or misdirected patient placement practices, variation driven by surgical schedules to reduce variation, and more. Though never easy to address, these are the sorts of underlying issues at the root of capacity challenges, and the results of solving them tend to warrant the investment it takes to do so.
 
8. Find partners. A comprehensive look at acute care access and capacity management sheds light on those tough patient populations where we must work smarter and not harder. Organizations are exploring aggressively how they can prevent admissions and shorten stays through the use of retail clinics, partnerships with other hospitals, and improved relationships with post-acute providers that leverage data and establish service level commitments.
 
9. Use smarter operational analytics. Certainly institutions may tout their new EMR or a new bed management system as the solution to all of their problems – but in reality, this is not the case. The sophistication required to understand information in real-time from multiple systems and make critical decisions exists only in small pockets. Innovative organizations are investing in real-time analytics that can help solve their most complex problems in the moment. A problem back approach to analytics is critical. More proactive tools are also being developed that allow organizations to predict operations 24 to 48 hours in advance with amazing precision.
 
10. Consider command centers. In one of the most complex industries in the world, teams are asked to work in silos, often communicating via pagers, fax, and telephone to navigate and resolve complex daily issues. Healthcare may be one of the last industries to actively use pagers in daily work. There is a growing trend to co-locate staff, supported by real-time information from dozens of systems that generate insights and drive action, and well-defined procedures to run hospitals like a busy airport or mission critical space shuttle launch.
 
This is an incredibly exciting time for hospital operators to rethink the Hospital of the Future. It often seems like an overwhelming task because of the complexities of daily operations, the heroics that occur, and the time required to drive change. With a well-informed plan on activities that can truly move the needle, strong leadership, and effective change practices, a better state is just around the corner.

Geoff_Martin.png

Mr. Martin is an Executive Vice President with GE Healthcare Camden and leader of the Care Design and Delivery Practice. Mr. Martin specializes in the areas of hospital operations, process improvement, and the use of advanced analytics to develop innovative solutions. He also has extensive experience in strategy development, care design, population health development, value management, and large scale technology implementations. Mr. Martin has worked with leading academic medical centers and large integrated delivery networks across the country to improve clinical, financial, and operational performance. He may be reached at geoffrey.martin@ge.com.

Topics: Acute Care Hospitals, Acute Care Efficiency, Geoffrey Martin, Command Center, Capacity, Capacity Management

Post-Acute Care: The Original Outside-the-Box Tool for Acute Throughput Challenges

Posted by Matthew Smith on Mar 10, 2016 1:28:27 PM

By Geoffrey Martin, MBA, Executive Vice President, GE Healthcare Camden Group

Let’s face it—hospital throughput represents a daunting challenge for providers throughout the country. As the population ages and more individuals find themselves with health insurance, hospital use—particularly emergency department utilization—has exploded.

For hospital operators, historic approaches to acute throughput are coming up short, and a typical focus on inside-the-walls solutions, while important, are short-sighted. When it comes to literally thinking “outside the box,” hospitals need to look closer at post-acute care (“PAC”), especially skilled nursing facilities and home health agencies.

It’s true that PAC has received considerable attention over the last few months, given PAC’s role in bundled payment, especially for the CJR joint bundle mandate. But post-acute also represents an essential component of any acute throughput improvement plan and broader patient flow strategies across the continuum. As a “pressure relief valve,” PAC can help address acute bed length-of-stay issues, limit unwanted admits passing through the ED, and accelerate hospital thinking around continuum solutions.

Here are some key applications where PAC might be able to foster acute throughput redesign.

PAC Oriented Discharge Planning

While PAC is a destination for many acute discharges, it is often considered too late in the discharge-planning process. As a result, patients often stay longer than necessary in the acute bed while case management “looks for a bed” or tries to “find someone who will take this patient.” New requirements around discharge planning may be exactly the lever needed to start thinking (and talking) about PAC destinations immediately after admission. Patient assessment efforts within the first 24 hours should incorporate appropriate screening efforts that not only identify PAC as an option but also point to a specific PAC setting. This data, in turn, should guide case managers and discharge planners to more effectively apprise PAC about pending transfers and should also inform hospital-wide analytics about pending PAC needs.

Acute Admit Avoidance

Identifying patients who might be served outside the hospital is an often overlooked but essential step in both reducing wait times and avoiding unnecessary admissions. Emergency Department (“ED”) triage efforts must consider PAC as a viable alternative for appropriate patients, either via clinical assessment efforts or expanded case management. In many instances, community-based settings (like a skilled nursing facility) are capable of managing patients who present with non-urgent, non-surgical issues, like pneumonia or UTIs. In-depth evaluation of historical ED use should clarify the potential for acute avoidance opportunities and characterize specific patient types appropriate for PAC.

Real-Time Patient Management  

As more organizations consider adoption of advanced transfer centers, command centers, and similar efforts to better manage hospital performance in real time, PAC must be an omnipresent option for appropriate use. Bed managers, transfer leaders, and others making decision around the flow of patients must understand resources available to them outside the hospital and drive the use of these resources. While many PAC HIT systems have not reached a high degree of interoperability with acute systems, alternative approaches to identifying resources “on-call” or available, reinforcing PAC as an option, and directing patients to these options can be a powerful component in the command center information flow.

Integrating PAC into improved throughput efforts is likely easier said than done. To build strong ties with post-acute entities, many hospitals will first need to engage directly with these providers and identify quality- and capacity-oriented organizations who can serve in a hospital’s narrow network or collaborative. The use of data to clearly articulate how PAC fits into your overall patient flow strategy and to establish expectations with PAC providers is critically important. Once identified, hospitals and PAC providers will need to build strong and reliable infrastructure to support quick and efficient transfer of patients. Linking PAC network strategies related to population health management or bundled payment initiatives to the care redesign effort will reinforce the impact. In some instances, financial incentives (with clearly defined ties to quality) may serve as both carrot and stick on both sides.


Geoff_Martin.pngMr. Martin is an executive vice president with GE Healthcare Camden Group and leader of the Care Design and Delivery Practice. Mr. Martin specializes in the areas of hospital operations, process improvement, and the use of advanced analytics to develop innovative solutions. He also has extensive experience in strategy development, care design, population health development, value management, and large scale technology implementations. Mr. Martin has worked with leading academic medical centers and large integrated delivery networks across the country to improve clinical, financial, and operational performance. He may be reached at geoffrey.martin@ge.com.

Topics: Acute Care Hospitals, Post-Acute Care, Patient Throughput, Acute Care Efficiency, Geoffrey Martin, Throughput

Acute Care Efficiency: Moving the Needle with a Focused Approach

Posted by Matthew Smith on Feb 23, 2016 3:19:37 PM

By Geoffrey Martin, MBA, Executive Vice President, and Bree Theobald, Vice President, GE Healthcare Camden Group

No one doubts that we must become more operationally efficient with our Acute Care settings as we transition to value-based models. This transition presents one of the greatest shifts of our time: as we move from volume to value-based models, our greatest revenue generator becomes our greatest cost center.

We continually hear this statement and commonly see the symptoms of inefficiency around patient flow (Emergency Department (“ED”) boarding, Perianesthesia Care Unit (“PACU”) boarding, declined transfers, late discharges, excess patient days, and many others). Without addressing these basic challenges, organizations hit a ceiling on operational efficiency. The common question remains: Which actions will have a real impact versus those ideas that “squeeze the balloon” and shift issues to other areas?

Given the pressures and urgencies surrounding this issue, leading organizations focus on a more targeted approach while utilizing new tools.

Concept: Combine advanced analytics with organizational domain expertise to create a deep understanding of the dynamics of the hospital as an integrated system and the true drivers of inefficiency. Engage leaders and front line staff to generate the best ideas (we call them scenarios) to solving the problem, and then use a sophisticated simulation model to test and define an implementation roadmap that will achieve the desired results. This type of approach is done in other industries to optimize global supply chains, railroads, and manufacturing plants across the globe.

Objective: Align the organization with the projects and initiatives that will move the needle on Key Performance Indicators (“KPIs”) while understanding the complex interdependencies that are unique to healthcare. Establish a well-defined plan that drives action, collaboration, and results.

Aligning Around Goals and Issues

The ideas for solving challenges exist within every organization. However, to solve these challenges there must be engagement at all levels and prioritization based on the intended impact.

Align Strategies and Growth Plans: To drive Acute Care efficiency, we must first understand how the Acute Care setting fits into the organization’s overall strategy. It’s common to see initiatives such as population health or service line growth that are misaligned with operations. This misalignment puts hospital leaders in a reactive position and dealing with growth only as it arrives—rather than having a solid, comprehensive plan in advance that they may execute. Integrating this type of systems thinking into the budgeting process is a great way to ensure that strategies can be operationalized.

Deeply Understand Challenges: The challenges organizations face around inpatient care are complex and often involve a multitude of factors including political challenges, cultural challenges, process challenges, misalignment of incentives, and a variety of others. For years, individual departments have been using Lean and Six-Sigma methodologies to streamline the clinical area resulting in the identification and elimination of the low hanging fruit opportunities. The opportunity today, however, is to truly understand how changes in one part of the system impact the rest. For example, the solution to ED congestion may require a non-intuitive solution of smoothing the surgical schedule. In our experience, it’s critically important to use a data driven, system-engineering approach to understanding the drivers of inefficiency and use this information to engage leadership and staff on developing potential solutions.

Project Governance: To drive efficiency in the Acute Care setting it’s critically important that leadership is highly engaged and accountable to driving results. We find the only way efficiency can be improved and maintained is by having a highly engaged leadership team that evaluates options (scenarios), prioritizes opportunities, and support change initiatives to improve results. This sounds simple but it is not. There are often misalignments around incentives that drive a desire to optimize individual areas versus a broader view of the Acute Care setting.

Building Solutions: Sophisticated Use of Data and Simulation

It is impossible to design effective solutions with traditional approaches that involve value stream mapping and spreadsheets. This takes a new level of thinking and more sophisticated tools that can understand the interdependencies of surgical schedule variations, physical patient pathways, staffing constraints, seasonality, physical space constraints, and the other real limitations that providers face while testing improvement ideas.

Over the past 10 years, our consulting team (in partnership with The GE Global Research Center) has developed a simulation modeling capability called Hospital of the Future that allows organizations to build a data replica of their organization to test the impact of the best solutions.  

The effective use of tools such as simulation modeling is not a technical exercise. It must include:

  1. Agreeing on growth strategies that are widely accepted
  2. Building a highly accurate simulation model that is validated by staff
  3. Testing changes & reviewing results with leadership
  4. Prioritizing improvement opportunities
  5. Gaining alignment on the path forward

Driving Change

There roadmap for most organizations involves several projects that range from redesign of bed management structures, tackling admission and discharge processes, and refinement of how physical capacity is being used.

Critical to success are the following:

  1. Well defined implementation plans: This includes a plan with project details and charters that clearly link to KPIs that warrant the organizational investment.
  2. Project Governance and Sponsorship: Continuation and sponsorship from the governance teams and strong leadership from individuals such as the Chief Medical Officer, Chief Nursing Officer, and Chief Operating Officer. A high level of commitment is critical. If the commitment level is not considered “high,” then the project in question should be reconsidered.
  3. Project Leadership: Driving change in this environment yields a huge return on investment but requires strong project management that has deep domain expertise, analytics skills, and strong influencing skills to drive change.

Just like making the investment in putting your best people on an EMR effort, you must invest the same way with this type of major change effort.

Acute Care Efficiencies


Geoff_Martin.pngMr. Martin is an Executive Vice President with GE Healthcare Camden and leader of the Care Design and Delivery Practice. Mr. Martin specializes in the areas of hospital operations, process improvement, and the use of advanced analytics to develop innovative solutions. He also has extensive experience in strategy development, care design, population health development, value management, and large scale technology implementations. Mr. Martin has worked with leading academic medical centers and large integrated delivery networks across the country to improve clinical, financial, and operational performance. He may be reached at geoffrey.martin@ge.com.

Bree_Theobald.pngMs. Theobald has been leading healthcare organizations through transformation efforts for 8 years with GE Healthcare Camden Group, focusing on utilizing simulation modeling and advanced analytical tools to optimize capacity, whether that be inpatient, procedural, or clinic capacity. This has allowed organizations to improve access for patients, streamline operations and improve financial performance, while also creating a culture of continuous improvement. Currently, in her role as a vice president, she has spent the last five years navigating and aligning academic medical centers to deliver measurable improvements. She may be reached at bree.theobald@ge.com. 

Topics: Acute Care Hospitals, Operational Efficiency, Acute Care Efficiency, Geoffrey Martin, Bree Theobald

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