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GE Healthcare Camden Group Insights Blog

Demystifying Length of Stay Projects

Posted by Matthew Smith on Aug 16, 2016 11:39:35 AM

By Dominic Foscato, Senior Vice President, and Bree Theobald, Vice President, GE Healthcare Camden Group

Length of StayWhen educating healthcare executives to lead high-occupancy organizations, one of the fundamental outcomes-based measures to monitor is Length of Stay (“LOS”). Usually, the organization has tried many approaches to solving capacity problems but many have failed due to some of the following reasons:

  • Competing priorities
  • Misaligned incentives for key stakeholders (physicians and hospitals)
  • Perception of negative impact to revenue for percentage of charges and per diem payers
  • Poor communication within and between departments
  • Not aligning care models around the consumer experience
  • Lack of data to drive transparency and accountability

When healthcare leaders approach us with a LOS problem, we ask them the following questions before advising on how to proceed:

  • How do you define LOS? Current/in-house, discharged average LOS severity adjusted (comparing observed to expected benchmark)
  • Is it isolated to a specific hospital, department (Emergency Department (ED), Post Anesthesia Care Unit (PACU), etc.), nursing unit, service, disposition, time of year, day of week?
  • How much of a LOS problem is felt by a mid-afternoon census alert? Could it be a throughput/flow issue instead

We then want to understand the internal dynamics, such as:

  • How would other leaders and disciplines respond to the three questions above? Does your organization have a single, consistent point-of-view?
  • How frequently are LOS measurements and key process measures reported? Are department/hospital/system clinical leaders reviewing these metrics and continuously improving?
  • Are incentives aligned for the key stakeholders (especially those that are not in your organization)? How can you influence those groups to help you achieve your goals?

Once we’ve obtained a high-level understanding of the challenge(s), the next step is to understand stakeholder involvement, alignment, and expertise.

Case Study

Here’s a common scenario where health systems engage GE Healthcare Camden Group, coupled with our approach to improving operations:

Background

  • 450 bed, Level I Trauma Center in medium-sized city
  • State Medicaid expansion and physician recruitment have increased demand for IP beds
  • Hospital is working through many solutions: co-locating patients, redesigning hospital beds, planning for IP and ED expansions, managing internal projects on discharge timing, readmissions, and bundled payments

Challenge

The Performance Improvement department has recently assessed LOS and reported to its Senior Leadership Team that the organization has a LOS problem.

Our Solution:

  • Perform a ‘Flash Discovery’ by conducting key stakeholder meetings and data analyses
  • Create/Modify a Steering Committee charged with engagement oversight, communication, resource allocation, and executing decisions
  • Conduct a 3-5 month ‘Capacity Strategy’ engagement to model operations and unique patient pathways around 3-4 key strategic questions
Follow-on initiatives include:
  • Create highly efficient/effective, daily multidisciplinary rounds to discuss each patient’s plan for the stay/day, progress towards transition/discharge with all key members of the care team
  • Re-allocate beds to services based on historic demand, budgeted volume or other initiative to mirror the patient placement matrix
  • Redesigning Case Management to ensure appropriate staffing, staff utilization, resource utilization, workflow and expectations align with efficiently delivering healthcare
  • Target specific patient populations for administrative or clinical LOS opportunity (e.g., pneumonia, heart failure, hips/knee replacement)
  • Reduce elective variation in the Operating Room and create a more predictable outflow with ‘priority discharges’ to better align demand and availability of beds

Value

los.png

  • Each healthcare market is unique, but in this example, the hospital was losing patients to competitors due to capacity issues. By creating organizational alignment, studying LOS and process metrics and selecting a few initiatives to impact LOS, the client reduced severity-adjusted LOS and created capacity to treat new patients.
  • By treating more patients, referring physicians and network facilities were more engaged as the hospital was now more ‘accessible’ and information more widely trusted/understood.

There is great power in taking more of a transformative approach with this as a major initiative well supported by leadership, data driven, and executed in a way that involves a number of change management tools to help drive and sustain change.

  Capacity Management, Length of Stay


Foscato.jpgMr. Foscato serves as a senior vice president with GE HealthcareCamden Group responsible for the overall design andimplementation of solutions, thought leadership and solutiondevelopment. Mr. Foscato has deep domain expertise in improvingclinical operations, implementing enabling technologies, optimizingrevenue cycle and patient access functions for healthcare providersto deliver more effective patient care and financial performance. He also assists clients withactivating strategy leveraging GE’s world renowned management and leadership systems. He may be reached at dominic.foscato@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: Dominic Foscato, Bree Theobald, Capacity Management, Occupancy, Length of Stay

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

Acute care, efficienciesNo 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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