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GE Healthcare Camden Group Insights Blog

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

huddle.jpgIn 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 dominic.foscato@ge.com.

 

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 ryan.treml@ge.com.

 

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

Hospitals are Not Hotels: Examining the "Discharge By Noon" Strategy

Posted by Matthew Smith on Aug 25, 2016 10:11:15 AM

By Dominic Foscato, Senior Vice President, and Nehal Koradia, RN, MBA, Manager, GE Healthcare Camden Group

12noon1.jpgMost healthcare organizations have goals of shifting care from acute to ambulatory settings while maintaining or improving quality and satisfaction. That goal has not led to a drop in occupancy rates in every geographic market. Inpatient volumes continue to increase in many markets due to demographic changes, Medicaid expansion, and physician recruitment and consumer engagement projects.

Managing consistently high inpatient occupancy has created many ingenious tools/processes across the country. Healthcare providers have tried many approaches to solve inpatient capacity problems, but many have failed due to poor communication, lack of prioritization, fragmented approaches to change management, misaligned stakeholders, or unclear objectives. Not all of those ideas will solve the main problem (bed shortages) and some may negatively impact cost, quality and other desired outcomes.

Capacity_challenge.pngGE Healthcare Camden Group helps organizations design and implement new approaches to managing capacity/throughput challenges. Clinical leaders often ask our team to conduct three-to six-month studies to model their operations in a virtual environment while posing 3-4 key strategic questions and developing a macro capacity model using the following framework:

  1. Define specific objectives and create leadership committees responsible for the engagement decisions, timeline, and communication
  2. Analyze one-to-two years of available data from various sources to create a simulation model
  3. Create workgroups consisting of staff, department leaders, and clinicians to validate the model and assess potential impact of process or volume changes

One of the key strategic questions that we are asked to model is whether or not ‘Discharge by Noon’ or similar measures may inadvertently create more challenges than it solves. We typically find the following to be true:

  • Optimal patient flow dictates that beds are available when needed
  • Focus must be on the “occupancy overlap” when census spikes for 2-3 hours quickly followed by large numbers of discharges
  • There is a need to reduce ‘empty/unused bed time’--particularly when there is demand
  • Manage to ‘discharge order response’ times
  • Ideal flow would have discharge curve about 90-120 minutes ahead of bed request curve by type of bed needed
  • Achievable goals drive results
    • Generic ‘Discharge by ‘X’ as a house-wide goal often have higher observed/expected LOS ratios and rarely earlier discharges
    • Alternatively, we analyze which nursing units or hospital services need inpatient beds and then focus the care team on prioritizing activities to produce timely discharges

Cumulative_Discharges.png


Discharge_line_graph.png


But remember, it is not just about discharging a certain number of patients before noon when thinking about patient flow/throughput. If your organization already has a goal for discharge time, or is considering setting one, we recommend performing a thorough review by asking these types of questions:

  1. To prevent congestion, how many beds do you need? When do you need these beds?
  2. Which units or services need more beds? Which have too many?
  3. How will you design solutions that align the care team around designation, communication, and execution so that a patient can successfully be discharged in the morning?

Our most successful clients take a very structured approach to answering these questions and defining their capacity strategy. They balance the use of advanced analytic modeling with feasibility studies. The outputs from this process allow them to establish clear goals and expectations that motivate their entire organization. By setting reasonable and achievable unit/service level goals that contribute to solving organizational objectives (i.e., lower LOS, higher quality/satisfaction), the implemented changes have a higher impact and are more sustainable.

Inpatient Occupancy Planning


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 dominic.foscato@ge.com.

 

KoradiaN.jpgMs. Koradia is a manager with GE Healthcare Camden Group. She 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, increase early morning discharges, and reduce ER wait times by utilizing simulation modeling. She may be reached at nehal.koradia@ge.com.

Topics: Dominic Foscato, Nehal Koradia, Hospital Discharge, Occupancy Overlap, Inpatient Occupancy Planning, LOS, Priority Discharge, Hospital Occupancy, Length of Stay

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