GE Healthcare Camden Group Insights Blog

3 Key Priorities in the Perioperative World

Posted by Matthew Smith on May 18, 2017 10:48:47 AM

By Nehal Koradia, RN, MBA, and Ryan Treml, GE Healthcare Camden Group

As has been the case for many years, hospital organizations continue to look to perioperative services to be one of the most important financial engines for the institution – consistently looking for ways to maximize the utilization and efficiency of the department.

As reimbursement declines, new payment models are being explored, and hospitals continue to consolidate, organizations are expanding on and moving beyond past methods to drive improvement. Here are key priorities in the perioperative world that healthcare leaders should keep in mind:

1. Be more deliberate and detailed in linking the strategic plan to perioperative services.

Evaluate volume against capacity. Volume has historically solved most problems. However, with reimbursement changing towards value-based payment, volume has to be analyzed much more thoroughly. The days of adding volume without first understanding the total capacity available and the corresponding costs – labor, equipment, supplies, etc. – are gone. Organizations are tackling this challenge by becoming more specialized in their elective volumes – creating centers of excellence to combine specialty services and procedures in a common location to drive extremely efficient day-to-day processes. In addition, they are increasing their focus in shifting outpatient volume to ambulatory surgery centers, embracing the ability to utilize technology and new techniques to transition traditionally inpatient cases to an outpatient environment. Advanced institutions are also making the tough decision to truly rationalize their capabilities – thoroughly evaluating their market and understanding what the community truly needs and can support long-term. All of these options attempt to maximize the organizations utilization of their highly specialized resources.

Match recruitment to the strategic plan. As noted above, forward thinking organizations are pursuing surgical volume that matches their strategy. Similarly, as these organizations evaluate or recruit potential new surgeons, they are taking much more time than they have historically to consider capacity variables. Equipment and staffing capabilities are usually considered when making offers to surgeons, however rarely does an institution evaluate the inpatient capacity needs for the new surgeon joining and determine the optimal day to allocate block time to both maximize OR and IP Capacity. In order for the entire organization to run efficiently, there has to be a good match between the new providers' needs and the access the organization can provide.

2. A refined focus on operational processes and cost.

Embrace systems-thinking and advanced analytics to inform process improvements. It is well known that the elective surgical schedule typically accounts for more variation in inpatient census than ED admissions. Managing that variation is extremely difficult – very few institutions have been able to create a surgical schedule that maximizes OR utilization while also efficiently smoothing the downstream IP volumes. However, it's becoming more common to utilize simulation and forecasting tools to appropriately match inpatient resources to the demand created by surgical inpatient volume. Nursing, support personnel, ancillary services, etc. are being staffed with much more flexibility to allow for the daily, weekly, and monthly variation in inpatient surgical volume. In addition to these dynamic staffing concepts, organizations are focusing on inpatient operational processes to ensure that downstream capacity is not a limiting factor in growing surgical volume. Units are being re-purposed, the benefits and risks of specialization vs. generalization are being analyzed in detail to ensure that beds are available and utilized in the most efficient manner.

Make difficult decisions regarding supply cost. Organizations have always reviewed surgical supply cost and understood that there were opportunities to streamline/standardize, but the most advanced have taken the difficult step in convincing their surgeons to work with them to manage cost. This requires a very detailed dissection of case cost information while balancing it with quality and utilization measures. Often, the supply opportunity is only viewed from the cost perspective, and decisions are made that can impede utilization, extend case lengths, and impact outcomes. High performing organizations understand these situations and include the information into a surgeon's balanced scorecard – often driving change through awareness rather than forced decisions.

3. Establish governance, don't just talk about it.

Use the governance structure to execute strategy. Governance of perioperative services has typically been a term associated with policy development and enforcement. The problem is that it quickly becomes detached from the consistently changing healthcare environment. Surgeons that sit on committees such as Surgery Executive or Block Management are asked to manage with a set of policies that are infrequently reviewed or refreshed. They are asked to align with strategic imperatives and plans, but are not included in the development discussions. Organizations have realized this is not an effective structure to drive true governance and are incorporating these key strategic decisions into their surgical committees. This drives better alignment with the surgeon community, shortens the adoption of key changes, and actually makes policy enforcement much easier.

Hire a Chief Surgical Officer (CSO). To build on the concept of incorporating strategy into governance, hospitals are hiring a surgeon to drive the surgical portion of the strategic plan. This role is different than the chief of surgery – the CSO is part of the executive team and is involved in the development of the strategic plan, drives the recruitment of new surgeons, and balances the wants of the surgeon community with the needs of the hospital system. This role helps buffer the often contentious relationship between surgeons and the administrative suite – complementing the Chief Medical Officer.

Even though many organizations recognize that these changes need to occur to ensure future success, many have difficulty implementing these strategies due to the complex environment in perioperative services. But overcoming the difficulties and implementing even one to two of these strategies can increase revenue and/or decrease cost significantly for an organization, making it well worth the effort.

KoradiaN.jpgMs. Koradia has been leading healthcare organizations through transformation initiatives for over nine years. Ms. Koradia has worked with many large academic centers and community hospitals to transform their operating rooms, decrease readmission rates, and increasing early morning discharges and reducing ER wait times by utilizing simulation modeling, Lean, Work-Out®, and CAP® methodologies. These initiatives have allowed organizations to improve access for patients, streamline operations and improve financial performance, while creating a culture of continuous improvement. She may be reached at


treml.jpgMr. Treml is a manager with GE Healthcare Camden Group, with 12 years of management consulting experience. He has led a broad range of engagements including: improving perioperative service departments through scheduling optimization and specific process improvements, developing comprehensive capacity strategy plans for high occupancy institutions, implementing electronic event reporting tools, streamlining discharge planning processes, and increasing throughput in diagnostic imaging departments. He may be reached at


Topics: OR Optimization, Hospital Operations, Nehal Koradia, Ryan Treml, Perioperative Services

Navigate the March Madness of Hospital Operations

Posted by Matthew Smith on Mar 22, 2017 11:07:51 AM

By Stephen Verdi, MS, Manager, GE Healthcare Camden Group

As a lifelong sports fan, a former athlete, and a Duke alum, there’s no month on the calendar that commands my attention quite like March. With March comes brackets, Cinderellas, buzzer-beaters, nail-biters, and the best 67 basketball games of the year. It’s time for the NCAA men’s Division I basketball tournament – affectionately and appropriately known as “March Madness.”

More than 350 teams have played through their 30-game regular season schedule for the opportunity to compete in the tournament. Now, for the 68 teams who made the cut, the real season starts. The National Championship is in sight, but now the stakes are higher, the room for error is gone, and the pressure is on.

In the world of hospital operations, it feels like we have entered our own version of March Madness. Years of process improvement and creative solutions to complex access challenges have served us well, allowing us to provide care to our patients as bed capacity has dwindled. We’ve competed well in a tough environment over the course of time. Despite our sweat and tears, the capacity challenges haven’t let up, and an evolution of policy, demographics, and models of care have put pressure on costs, created volatility, and continued to fill our beds. This has created a new environment that demands a different operating point to be successful. We’ve made it through our own sort of "regular season," but the tournament has started, and the games have gotten tougher.

At GE Healthcare, we work with health systems to develop Hospital Command Centers that shift us to a new operating point. We stay true to our belief that a strong foundation of mindful strategy and efficient process still punches your ticket into the tournament, while also recognizing that the decision support, situational awareness, and visibility offered by a Hospital Command Center are now necessary to excel in healthcare’s March Madness.

Fundamentals – Your Ticket to Play

To get the chance to compete for the NCAA National Championship, a team must first be one of the 68 teams selected to play in the annual tournament. The teams selected are those that assemble the best bodies of work over the course of the regular season (or those who get an automatic bid by winning their conference championship, but let’s keep it simple). Success in the regular season comes to those who generally get the fundamentals right-–take smart shots, limit turnovers, box out, hit free-throws, play hard-nosed defense, and so on. Strong execution of the basics helps a team win games, and teams who win games get the chance to play for the Championship. During the regular season, individual games matter less than the sum of a team’s performance. No single turnover will wreck the season. No single loss will exclude a team from contention for the NCAA tournament.

Like a team fighting to make the tournament, when we think about a hospital striving for world class operational performance, we first imagine a hospital that is nailing the basics – staffing nurses and ancillaries to match demand, aligning discharges to bed requests, reducing waste from the bed assignment process, designing efficient OR block schedules, right-sizing their bed mix, and so on. This is the work that many of us have been doing for a long time now, fending off the high costs of inefficiency. Process improvement has allowed us to operate at inpatient utilization rates near 80 or 85 percent. We still may not always feel comfortable at these occupancy levels, but we can care for our patients and deliver good outcomes. We may have declined the occasional outside transfer or left the occasional bed open while patients lined up in the Emergency Department, but we have performed well overall. By building smart capacity strategies and activating them through process improvement, we have made it through the regular season portion of our journey to top performance.

Stepping Up Your Game

After Selection Sunday, when the 68 tournament teams are announced, the whole game changes. There is a new level of pressure on teams who are now just one loss away from falling short of their goal. Whereas individual mistakes may not matter in the regular season, they can spell the end for a team during March Madness. Without a doubt the fundamentals these teams relied on all year will be critical during the tournament, but they now need to reach a new level of performance. They need to play flawless basketball through six (or seven) games while under intense pressure.

Today, under the many stresses of healthcare, our hospitals and health systems need to find ways to reach that next level of performance. We need to continue to pull the levers of capacity strategy and performance improvement, while also finding new ways to perform under more and more pressure. We are getting used to managing at 80 or 85 percent occupancy, but the time has come where we need to be capable and comfortable operating at 90 percent or 95 percent without sacrificing outcomes. Now is the time we look to Hospital Command Centers to raise our operating point. By bringing people, data, and information together, we make decisions faster and act faster. A Wall of Analytics with custom-built analytic tiles provides us with the situational awareness we need to see around corners. The ability of those tiles to make accurate predictions about the future allow us to prevent problems before they arise. With more information, more insights, more speed, and more operational horsepower, we hit a new level of performance. We no longer have to decline that transfer, or board that patient in the Emergency Department, or cancel that surgical case.

The Lasting Impact of Success

Winning the NCAA National Championship delivers much more than a banner in the rafters. The team that takes the trophy achieves a new stature on the national stage, forever to be recognized as a national champion. This recognition helps them recruit talented players who want to be part of a winning team. Better recruits lead to better teams, and better teams get prime-time games on television that attract viewers and sponsorships--further filling the recruiting funnel. On April 3rd, one of the 68 teams will win that last game of the tournament and be crowned National Champion. And while the celebration that night will be a good one, the real impact of the win will be felt for years to come.

A large East Coast academic medical center partnered with GE Healthcare to set out on their Hospital Command Center journey, seeking to bring their people and information together to help them better manage the operations of the hospital. In the summer of 2016, they opened a 2,550 square-foot Hospital Command Center in the center of their main hospital. While the opening ceremony was a great day for the staff and patients, the Command Center has continued to produce results well beyond the ribbon cutting:

  • Patient transfers from other hospitals: There has been a 60 percent improvement in the ability to accept patients with complex medical conditions from other hospitals around the region and country.
  • Ambulance pickup: A critical care team is now dispatched 63 minutes sooner to pick up patients from outside hospitals.
  • Emergency Department: A patient is assigned a bed 30 percent faster after a decision is made to admit him or her from the Emergency Department. Patients are also 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: Twenty-one percent more patients are now discharged before noon, compared to last year.

For the next few weeks I’ll be tuned in to see how each of the 68 teams perform under the bright lights of the NCAA tournament. Each of them has done their job to deliver a strong regular season performance, now they will be shifting into a different gear to succeed in the tournament. By relying on their basics and playing mistake-free basketball, they’ll give themselves a good chance. At the same time, our hospitals will be striving for a path to their own version of success under the bright lights of high occupancy. By supplementing a culture of process improvement with the horsepower of a Hospital Command Center, they’ll get there.

Verdi.jpgMr. Verdi is a manager with GE Healthcare Camden Group specializing in the areas of patient throughput, capacity management, hospital simulation, data analysis, and change management. He also has experience in operating room scheduling, governance, care management, and length-of-stay reduction. Mr. Verdi brings over 10 years of GE experience in engineering, project management and healthcare consulting. He may be reached at 

Topics: Hospital Operations, Hospital Command Center, Capacity Management, Stephen Verdi

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

GE 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

Is Your Care Management Program Delivering Exceptional Results?

Posted by Matthew Smith on Oct 11, 2016 4:19:34 PM

“If I had an hour to solve a problem I’d spend 55 minutes thinking about the problem and 5 minutes thinking about solutions.” – Albert Einstein

Healthcare organizations operate under an ever-changing and complicated set of rules, regulations, laws, and standards. Paul Starr (Harvard University, 1982) is credited with labeling the hospital as “the most complex organizational structure created by man.” It can be a daunting task for healthcare leaders to set priorities and to plan for the future sustainability of their organization. Which of the myriad of regulations will the Congress or the Centers for Medicare and Medicaid Services change in the coming years? What are the two presidential candidates expected to do if elected? Will the Affordable Care Act (ACA) be radically changed, or will it remain largely intact? How can we best position ourselves to negotiate favorable contracts with our payers? What is our population health strategy? And the list of questions continue…

A high-performing care management program is one of the few programs that can help a healthcare organization succeed, regardless of what the answers to these questions turn out to be. Your organization’s strategy on volume versus value and a robust and effective care management program will help you drive towards desired results. Without comprehensive care management throughout the continuum of care, your organization will likely struggle to achieve its strategic goals. Here are 10 questions to ask to help you evaluate your care management program.

1.  Does your care management strategy extend beyond the four walls of the hospital?

“Strategy without tactics is the slowest route to victory; tactics without strategy is the noise before defeat.” – Sun Tsu 

In the past, case management (as it was often called) was a service to be consulted by the inpatient care team, often long after hospital admission, if the team felt the patient might require complex discharge planning, such as placement in a skilled nursing facility, or need durable medical equipment (DME) at home. That is the model of the past.

In today’s demanding healthcare market, your organization must expand the role and responsibility of your care management department to include a strong focus on, and alignment with, your population health strategy. This includes comprehensive discharge planning (both from the inpatient arena as well as the Emergency Department ["ED"), including the scheduling and monitoring of aftercare appointments, ongoing monitoring of patients with a high risk of readmission (such as congestive heart failure), and appropriate short and long-term placement in skilled nursing facilities. These activities are also dependent-upon a strong healthcare information exchange infrastructure that is not limited when communicating clinical information beyond your four walls.

A successful population health strategy must have clearly defined care model principles, aimed at providing clinical effective care in the safest and most cost effective way, thus improving the care of the patient while simultaneously improving the bottom line of your organization. A comprehensive care management program is the vital foundation to this critical strategy. It requires an integrated care management process and communication to assure that patients have one care plan that follows them, rather than reinventing the plan between care venues. Be sure that your ambulatory care managers, who may be embedded in primary care practices or specialty service line venues, and the inpatient care management staff are organized as a seamless care management team for the health system.

2.  Do you have a clearly defined care management model that is the best fit for your unique organization?

“Unless structure follows strategy, inefficiency results.” – Alfred D. Chandler

There are a variety of widely accepted care management models in use across the country. These include the traditional model, dyad model, partially integrated dyad model, integrated dyad model, triad model, hybrid model, etc. Confused yet?

While many have strong opinions about which model is “best,” they all have pros and cons, and it is important to examine each in order to determine the best fit for your particular organization. But far more important than which model your organization employs are two key questions: a) Is the model clearly understood and applied consistently and efficiently and b) Does the model have the full support of both the hospital and physician leadership? If the answer to either of those questions is anything other than an unqualified “yes,” you are unlikely to have a highly successful care management program.

3.  Are you using an established tool and most current practices to perform Utilization Review ("UR")?

“If I had nine hours to chop down a tree, I’d spend the first sharpening my ax.” – Abraham Lincoln

CMS requires that all participating hospitals employ a structure and process to determine if a patient qualifies for inpatient or observation status. Hospitals use a variety of tools to accomplish this UR process. These include commercially available screening products, such as InterQual or Milliman, as well as home-grown solutions. As with the care management model, which UR tool an organization chooses is less important than utilizing that tool correctly and having a clear structure and process in place for the Care Manager (CM) and physician to communicate the output of the initial UR. Often the difference in appropriately classifying a patient as an inpatient, rather than observation, is a small amount of additional documentation by the physician.

4.  Do you have a comprehensive care management dashboard used to drive results?

“Without data you’re just another person with an opinion.” – W. Edwards Deming

In the world of the electronic medical record (EMR), most organizations have access to myriad data points. They can pull reports on almost anything they wish; however, this “data” is often aggregated and unverified for accuracy. Many healthcare leaders complain of “data overload,” where they struggle with what data to focus on in order to drive results.

A comprehensive care management dashboard contains the following elements:

  • 10-15 evidence-based, operational data points
  • All data points have been validated and benchmarked
  • Aggressive but appropriate goals have been set for each metric that is under-performing
  • The dashboard is “pushed” to the end-user, rather than “pulled” by them
  • A clear escalation of accountability, from the individual CM all the way to the C-suite
  • An operational group/committee that is tasked with monitoring the dashboard results and driving improvement
  • Transparency of the data, the goals, and the accountability

5.  Are you staffing appropriately to demand?

“Coming together is a beginning. Keeping together is progress. Working together is success.” – Henry Ford

Many organizations struggle with how to determine if they are staffing appropriately to meet the demands of their patients, while remaining mindful of the bottom line. Whether it is nursing ratios on the inpatient unit or the number of environmental services staff on the evening shift, it is critical to balance operational and financial goals.

Care management programs are staffed in a variety of ways, primary driven by the CM model discussed previously. Depending on the CM model, the makeup of the staff (i.e., nurse, social worker, support staff), the complexity of the patients, and other factors, there is an appropriate staffing plan for your organization. Designing these plans can be complex, because the best plans incorporate a wide variety of variables, but when an organization can harmonize the financial and operational goals simultaneously, they achieve optimal staffing in their care management program.

 6.  How do you measure length-of-stay ("LOS")?

“Measurement is the first step that leads to control and eventually to improvement. If you can’t measure something, you can’t understand it. If you can’t understand it, you can’t control it. If you can’t control it, you can’t improve it.” ― H. James Harrington

As with any data point, evaluating whether your organization is accurately capturing and reporting LOS can be a byzantine task. Here is the first problem – the most accurate and actionable LOS calculation is not the average LOS ("ALOS") that many organizations have been using for decades. Why? It tells you almost nothing that is actionable about your operations. If your ALOS went from 4.1 to 4.6 last fiscal quarter, what does that tell you? Other than your “average” patient spent more time in the hospital, it tells you little else. Also, what does an “average” patient look like? Were they admitted for myocardial infarction, a planned orthopedic surgery, or did they present to the emergency department in septic shock? Were they a readmission?

In order to have the maximum impact on meeting the organization’s LOS goals, the data must be examined far beyond averages. A comprehensive examination of the organization’s LOS data should involve the following elements:

  • ALOS (this is still useful for internal benchmarking)
  • Observed versus expected LOS
  • Case mix index
  • Severity adjust LOS
  • LOS by:
    • Service line
    • Provider
    • Group
    • DRG
    • Unit
  • Benchmarking against peers, using one or more benchmarks, including, but not limited to:
    • UHC and other commercially available databases
    • CMS Geometric Mean LOS

7.  Are service lines/specialties incentivized and or aligned with organizational goals?

“If everyone is moving forward together, then success takes care of itself.” – Henry Ford

If your organization has adequately addressed all of the other questions herein, it’s time to take a hard look at whether there is internal alignment. How does your organization align goals and accountability with your providers, both employed and otherwise?

To maximize goals around care management efforts, not only LOS, but also prevention of readmissions and adequate clinical documentation, the organization must align those goals with the providers. Though incentivizing the providers to drive towards those same goals can be time-consuming and complicated, the benefit of doing so is incalculable.

8.  Is care management supporting the ED to prevent unnecessary admissions/readmissions through shared decision-making at the time of admission?

“Teamwork is the ability to work together toward a common vision. The ability to direct individual accomplishments toward organizational objectives. It is the fuel that allows common people to attain uncommon results.” – Andrew Carnegie 

The ED is, with few exceptions, the portal through which the majority of hospital admissions originate. Although the largest quantity of admissions may come through the ED, they are often admissions with far lower contribution margin than those who enter the organization through a portal such as the OR. They are also sometimes the admissions with little to no value to the patient or the organization.

In a strong care management program, the case managers in the ED should be the front-line of defense in preventing readmissions, “social” admissions, and other inappropriate types of admissions. This may be accomplished by processes such as:

  • Automatic, real-time notification of the ED CM by the EMR upon the arrival in the ED of a potential readmission.
  • Establishing an ED care management committee, led by an ED Case Manager, in order to identify and evaluate ED “Super Users,” and develop an individualized care plan for each of those clients in order to reduce both ED visits and admissions to the hospital.
  • Developing a robust network of up-to-date contacts that the ED Case Manager can call upon to assist them in the development of an appropriate discharge plan and follow-up care following an ED visit.

As noted above, a robust care management program in the ED is invaluable to prevent readmissions and unnecessary admissions, but the program should also be the “tip of the spear” when it comes to the care management process and services for an admitted patient. Ideally, the majority, if not all, admissions from the ED should be screened by a case manager using an appropriate utilization tool, as noted earlier. This requires buy-in from the Emergency Medicine providers, who may see this additional step as something that can have a detrimental effect on ED flow, or simply something that has to do with the inpatient arena. This is a prime opportunity to align service lines with hospital goals, as discussed earlier. The ED must be part of the solution when it comes to patient classification and management across the continuum.

 9.  Do you have a clear escalation and resolution policy to support CM?

“None of us is as smart as all of us.” – Ken Blanchard

What happens when your talented and educated group of case managers runs into a barrier? Whether that barrier be one of your own providers who does not support the case manager’s status evaluation (e.g., inpatient versus observation, etc.), a payer that issues a concurrent denial of care, or perhaps a family member who does not agree with the decision to discharge their loved one, a high performing care management program must have a robust and effective escalation and resolution policy in place. Such an escalation pathway often looks like the following:

Each link in this pathway gives yet another opportunity to achieve a successful outcome for the organization, the patient, and the family. Not only does it continuously bring a fresh perspective and set of skills to bear, when dealing with a payer, oftentimes, repetition, escalation, and documentation can be the key to a favorable outcome.

 10.  Do you have a comprehensive in-house Physician Advisor (PA) program?

“A coach is someone who can give correction without causing resentment.” – John Wooden

In a highly effective care management program, the PA provides counsel to the case management department, clinical documentation improvement (CDI) team, and the hospital leadership on matters regarding physician practice patterns, resource consumption, medical necessity, and compliance with government regulation. The PA also provides coaching and formal education to the medical staff and maintains collaborative relationships with payers. The PA is a member of the organization’s leadership team charged with meeting goals of quality and cost reduction.

Many organizations have one or more PAs in place who deal with and resolve clinical cases, on a case-by-case basis, in a highly effective manner, and consider this be a successful implementation of a PA program. Without the other elements of a PA program, noted above, there is work to be done. One of the most powerful uses of a PA is leveraging them to prevent escalations in the first place. This is accomplished through a robust education program and coaching aimed at their physician peers, so that they may better understand regulations, charting requirements, etc. Ironically, a motivated PA should be working to put themselves out of a job. 

Topics: Care Management, Care Design, Hospital Operations, Care Design and Delivery

Are You Operating Your Hospital With a ‘Hurry-Up’ Offense?

Posted by Matthew Smith on Sep 15, 2016 2:40:26 PM

By Dominic Foscato, Senior Vice President, and Ryan Treml, Senior Manager, GE Healthcare Camden Group

In American football, many teams have turned to a "no huddle, hurry-up" offense in order to disrupt their opponent’s ability to make defensive adjustments in scheme or personnel. While effective for sports, operating a hospital or department without formal communication standards or too many well-intended huddles/rounds can be a recipe for inefficient, ineffective care delivery.

Nationwide, hospital systems continue targeting ways to improve care coordination in an effort to reduce cost, improve quality, and increase patient/provider experience. Most end up identifying communication as a major component in limiting unnecessary delays, turning to a variety of meeting formats as a way to implement change.

Examples include:

  • Daily Bed Huddles – house-wide discussions led by Patient Placement and involving department leaders to identify expected discharges, admissions, and transfers
  • Long Length of Stay ("LOS") meetings – led by Case Management to review long-stay patients, assist in removing barriers; ultimately integrating with UM committees
  • Unit Huddles – shift meetings or safety huddles to communicate key priorities
  • Multidisciplinary Rounds – daily meetings led by case management/social work in conjunction with nursing, physical therapy, pharmacy, providers, etc to discuss the daily patient list, the plan of care, potential barriers to discharge, disposition needs, and escalation needs.
  • Discharge Huddles – case manager(s) meet with nurses and providers to identify current or next-day discharges
  • Teaching Rounds – educational rounds in Critical Care or teaching facilities with focus on detailed clinical history and differential diagnosis
  • Patient or Family Centered Rounds - discussions involve the care team and the patient/family to resolve care questions/concerns and education

All of these forums can be effective in improving communication across disciplines and addressing LOS challenges. There are readily available templates and guides that outline best practices--key questions to ask, the appropriate frequency, and suggested attendees. But the list of options is long and coordinating information across multiple meetings becomes increasingly difficult.

Does your organization use some/many of these forums? Are they all well connected and efficient? Are there gaps in communication, attendance, focus, walking/talking points and accountability for action items? 

  1. Do we have all the right members of the team or designees?
  2. Is it an efficient discussion of every patient, every day?
  3. Are we discussing plan for the day as it relates to the stay, progress towards medical milestones, and adherence to evidence-based medicine?
  4. Are we using these forums for other internal initiatives (e.g., new patient scripting, quality initiatives)?
  5. Is it led by a consistent member of the team that has been coached in facilitation?

If you’re like most organizations, you answered “no” or “sometimes” to some of the questions above. Regardless of the number of meetings, the members involved, the format, or the technology utilized, the success of any program is ultimately dictated by the quality, consistency, and timeliness of the information shared. When these initiatives fail, we typically see the following:

  • Programs are routinely initiated with clear objectives, comprehensive designs, and well thought-out tools. But after with an initial wave of positive progress, commitment wanes and results diminish. Staff get frustrated as old problems reappear. Teams begin a daily routine of “going through the motions."
  • There is an organizational mandate to have the huddles, but no accountability to the quality of the discussions. Meetings intended to improve communication and reduce ALOS will actually consume more staff time with no results. Which means the organization will have wasted a lot of time, effort, and money to further frustrate staff and maintain sub-standard performance metrics.

These pitfalls can only be prevented if leadership is fully engaged and supportive of the change. In high-performing hospitals, executives reinforce the importance of these programs by actively participating, gathering data, and reviewing dashboards to understand issues. They reward their staff for identifying opportunities and sustaining improvements. Until it is demonstrated that prompt elimination of barriers is the normal outcome, they know the culture will not change.

Foscato.jpgMr. Foscato serves as a senior vice president with GE HealthcareCamden Group responsible for the overall design andimplementation of solutions, thought leadership and solution development. Mr. Foscato has deep domain expertise in improving clinical operations, implementing enabling technologies, optimizing revenue cycle and patient access functions for healthcare providers to deliver more effective patient care and financial performance. He also assists clients with activating strategy leveraging GE’s world-renowned management and leadership systems. He may be reached at


treml.jpgMr. Treml is a senior manager with GE Healthcare Camden Group, with 12 years of management consulting experience. He has led a broad range of engagements including: improving perioperative serviced epartments through scheduling optimization and specific process improvements, developing comprehensive capacity strategy plansfor high occupancy institutions, implementing electronic event reporting tools, streamlining discharge planning processes, and increasing throughput in diagnostic imaging departments. He may be reached at


Topics: Hospital Operations, Dominic Foscato, Hospital Discharge, Inpatient Occupancy Planning, Hospital Occupancy, Huddles, Length of Stay

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

What’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


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

Planning a New Hospital or Clinic? First, Design How it Cares

Posted by Matthew Smith on Mar 3, 2016 4:56:51 PM

What will the hospital of the future look like? How will it simplify care processes? How will it fit within the broader system of care? How will it further population health? How will you plan for changing care models and uncertain demand? What if the hospital of the future is designed for both patients and caregivers?

Design4Care leverages GE’s HoF Analytics Platform™ which has been used to optimize facility design from Brussels to Marshalltown to Toronto. Our HoF Analytics Platform™ solutions provides the expertise and proprietary simulation technology that enables you to realize a fundamentally more efficient system — physical capacities, workflows, staffing model, and patient experience — by design.

We help you visualize the interdependencies of your operations, staffing, and workflows to guide your team through its transformation. 

To better understand how physical design and operational model of care will impact patients and staff in your proposed facility, please watch the demo video, below or download our case studies. 

Design4Care, GE Healthcare, Hospital Operations

Topics: Healthcare Delivery, Design4Care, Facility Design, Hospital of the Future, Care Design, Hospital Operations

In Command: The Rise of Command Centers in Healthcare

Posted by Matthew Smith on Feb 10, 2016 10:54:13 AM

By Geoffrey Martin, MBA, Managing Principal, Chief Operating Officer, and Jeff Terry, MBA, FACHE, Managing Principal, GE Healthcare Partners

Command Centers are commonplace in many industries such as military, space and aviation, government, oil and gas, and broadcast entertainment. But until now, they’ve been a rarity within the healthcare industry. This, however, is quickly changing. Many GE Healthcare clients in the U.S., U.K., Brazil, Canada, and Australia are considering the idea, and some are investing. GE Healthcare Partners is helping several hospitals shape and realize their Command Center visions.

While project names vary (Command Center/Centre, Operations Room, Situation Room, Control Center) the concept and objectives are similar.

  • Concept: Concentrate operational decision-makers and equip them with real-time decision support tools to enable better and faster decisions.
  • Objective: Enable a new level of efficiency, visibility and integration measured in outcomes, utilization, patient waiting, staff satisfaction, length-of-stay, and cost.

Concentrate Decision Makers

Coordinating the care of hundreds of patients through dozens of steps in thousands of pathways is immensely complex; perhaps the most operationally complex human endeavor. Functions must constantly coordinate physicians, nurses, bed managers, transport, housekeeping, case management, outbound patient placement, social work, inbound patient placement, admitting, roaming services, periop, and cardiology. GE Healthcare’s work has shown that co-locating key functions can improve coordination. But which functions and with whom? How should the functions evolve in a new setting? How do these functions interact with each other, with other units and departments, and with other, external facilities?

Consider a command center as a visible investment in your hospital’s next-level integration. The rendering below illustrates a fully-equipped command center, complete with a centralized Wall of Analytics and stations constructed for:Command Center

  • Bed managers
  • EVS coordinators
  • Transfer leaders
  • Operating Room schedulers
  • Transport coordinators
  • Staffing coordinators
  • Command Room supervisor

Real-Time Decision Support

There is no shortage of information technology in hospitals. But we all know the flood of dashboards and email alerts are too often retrospective, too complicated, or miss the point entirely. The challenge is that “doing better” is extraordinarily hard. It forces us to ask the question: What information, in what format, would be useful to whom at what moment to make a difference to what problem? Not easy to answer systemically--and what about the benefits of predictive information? 

How to Make it Happen?

GE Healthcare approaches command center design from a “problem-back” perspective:

  1. Start with problems
  2. Fixate on them
  3. Get stakeholders aligned with them

This is hard to do. Once the staff is aligned, start designing. GE Healthcare leads clients through an energetic collaborative process to design the space (lighting, acoustics, ergonomics, location), staff (which functions/what roles?), Wall of Analytics™ (predictive simple information in real-time to create awareness and impact the problems) and IPOM (the interactions, procedures and operating mechanisms of the center). Then we help clients build it, launch it and make a difference. Start to finish, the process takes between 12-18 months, including construction. This a major investment with a major return for patients and the institution.

GE’s Command Center Experience

GE operates approximately 25 command centers worldwide to manage its energy, rail, healthcare and aviation operations. For example, GE’s energy command center outside Atlanta, Georgia monitors the performance of more than 3,700 gas turbines around the world 24x7, and GE Healthcare’s InSite™ command center outside Milwaukee monitors >10,000 GE CT and MR scanners around the clock. Moreover, GE Healthcare Camden Group along with GE Healthcare Productivity Solutions has experience imagining, designing and building hospital command centers.

Related Content

5 Things to Get Right in Your Hospital Command Center


Mr. Martin is Managing Principal and Chief Executive Officer with GE Healthcare Partners. 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

Jeff_Terry.jpgMr. Terry is a Managing Principal of GE Healthcare Partners. GE Healthcare 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 or 212-613-2137.



Topics: Geoffrey Martin, Hospital Operations, Command Center, Jeff Terry

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