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GE Healthcare Camden Group Insights Blog

GE Healthcare Included in Fast Company's "Top 10 Innovative Companies in Health"

Posted by Matthew Smith on Feb 13, 2017 1:42:10 PM

Command Center.jpgGE Healthcare is featured as one of Fast Company's Top 10 Innovative Companies in Health of 2017. As part of the magazine's World's Most Innovative Companies ranking, the Fast Company reporting team reviewed thousands of enterprises searching for those that tap both "heartstrings and purse strings" and use the engine of commerce to make a difference in the world.

From Fast Company:

GE Healthcare works with partners ranging from the University of California San Francisco to Johns Hopkins to develop both hardware and software technologies that solve some of the most pressing problems in health care. Some are drawn from health systems; for example, UCSF needed a partner to develop machine learning algorithms for medical imaging, and Johns Hopkins needed a NASA-style command center to better manage patient flow in and around the hospital. Early results from Johns Hopkins have been promising: The hospital has reported a 60% improvement in the ability to accept patients with complex medical conditions from other hospitals around the region and country; its ambulances are able to get dispatched 63 minutes sooner to patients at outside hospitals; and its emergency department is assigning patients to beds 30% faster.


To learn more about The Johns Hopkins Capacity Command Center, watch this short video and click on the links to Modern Healthcare and Health Facilities Management, below.

 

To speak to the GE Healthcare team about Capacity Command Centers, please click the button below:

Capacity Command Centers

 

Topics: Hospitals, Hospital Operations, Command Center, Capacity Command Center, Capacity Management, Hospital Occupancy

Digital Twins Revolutionize Strategic Planning in Healthcare

Posted by Matthew Smith on Aug 29, 2016 1:04:36 PM

By Jeff Terry, MBA, FACHE, Managing Partner, GE Healthcare Partners

Digital_Twin.pngWhat’s a Digital Twin?

A digital twin virtualizes a hospital (or other) system to create a safe environment in which to test the impact of potential change on system performance. In other words, to play “what if?” with system dynamics. This is important because healthcare delivery is massively complex. Common sense, spreadsheets, and statistics just don’t have the horsepower to inform strategic decisions. 

Are Digital Twins New?

Not exactly. Digital twins use discrete-event-simulation techniques which have been around for 30 years and applied successfully in healthcare to model departments like radiology. But modeling a hospital above about 400 beds has proven too difficult for all but the most experienced modelers using the best tools. 

What is New?

What’s new is using digital twins to design efficient new hospitals and to redesign system dynamics in existing large hospitals. "System dynamics" includes bed mix, staffing, model of care, floorplan, bed algorithm, etc. This is becoming more common with better toolkits and more experienced practitioners at companies like GE and EY. For example: GE analytics consultants using our healthcare-specific simulation platform have modeled >1,000 bed academic medical centers 75% faster than teams of PhDs using traditional methods.  

How are Digital Twins Revolutionizing Strategic Planning?

Digial twins enable massively collaborative, data-driven, and scenario-based decision making. Without a digital twin, leaders rely on tribal knowledge and basic analysis to plan new facilities and next year’s budget for existing facilities. This is normal but it leaves much to be desired. With a digital twin, leaders virtually test changes to bed mix, bed algorithm, task assignment, floorplan, equipment, ALOS, model of care, staffing etc.

The traditional answer is to do our best and see what happens.

  • For example: neuro has recruited two new surgeons, medicine is closing a unit, we’re opening a transitional care unit, the State is buying our rehab unit to convert it to psych beds, and we expect to reduce ALOS for knees by .75 days and for general medicine by 0.2 days. What will that do to ED Boarding? What is our maximum volume with different scenarios of growth by cohort? Can we accommodate the neuro volume? What’s the best day to add these cases to the OR schedule?
  • With the Digital Twin, we learn that we can accommodate the volume but only if the ALOS work succeeds. We add the cases Wednesday and shift two orthopods from Thursday to Tuesday. Alternatively, we could upgrade the transitional care unit to an ICU (but that’s expensive). These answers lead to new questions… which are tested in the digital twin.

Digital Twins Revolutionize Planning in Four Ways:

Digital twins close the gap from “requirements” to system dynamics. Today this is a leap of faith. The simulation model closes that gap when we design new facilities, when we redesign existing patient flow, and when we convert service-line volume plans to annual budgets.

  1. Digital twins target process improvement efforts by putting each process improvement project into larger context. This enables us to charter projects with specific goals tied to both local and system performance. 

  2. Digital twins facilitate massively collaborative strategic planning. Health systems are full of super smart leaders with ideas. Those ideas need to be heard and tested. The digital twin gives us the tool do so. In many cases the result is to demonstrate that some ideas are bad. That’s a great result because it allows that leader to move forward and embrace the eventual strategy the Digital Twin helps to clarify.

  3. Digital twins can also power ongoing short-term forecasts. For example, when we build a digital twin in our Hospital of the Future Analytics Platform to redesign a medical center's system dynamics, we use the same simulation model to power predictive decision support apps outside-the- EMR.

In the end, digital twins help leaders design and execute models of care which are good for patients, families and caregivers. Revolutionary.

 
  Digital Twins, Capacity Management, Hospital Operations
 

Jeff_Terry.jpgMr. Terry is a Managing Principal of Healthcare Partners, the consulting arm of GE Healthcare that works with healthcare systems to define and achieve transformational outcomes related to quality, access, culture and cost. Partners' capabilities include management consulting, mobilizing change, technology integration and advanced analytics. He has a diverse background in consulting, sales, product development, Lean Six Sigma, business strategy, and services. Areas of focus have included clinical asset management, patient safety, patient flow, hospital operations, radiology and advanced analytics. He may be reached at jeffrey.terry@med.ge.com.

 

Topics: Hospital Operations, Command Center, Jeff Terry, Hospital Command Center, Capacity Command Center, Capacity Management, Digital Twins, Hospital Occupancy

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

Top 10 Opportunities for Improved Acute Care Access and Capacity Management

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

Top 10The 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

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