22 April, 2016
The time is now for health systems and hospitals to engage physicians, create actionable data, and plan for operational and financial changes in order to continue to drive better acute care access.
Even with population health strategies that are successfully shifting care settings and expectations for target patient populations, there is a continued increase nationally in inpatient demand at large tertiary and quaternary facilities that are designed and required to continue to serve high acuity, time-sensitive conditions.
These facilities report a mid-week operating capacity often exceeding 90 percent occupancy. The hospital is not going away any time soon. To thrive in today’s environment, health systems must align operations with this new reality, and be judicious in expansion plans, as well as managing access to the costly but vital services that are provided.
Top performing health systems do not just look at improving acute care operations as a tactical, cost out effort – operational excellence is being executed as an organizational capability that drives competitive advantage in a market where patients are increasingly becoming consumers, physicians and staff expect a better workplace, and payers aggressively work to bend the cost curve. Here are ten opportunities for improving acute care access and better overall capacity management.
1. Embrace systems thinking. Companies like Amazon, Walmart, Uber, and many others have figured out how systems thinking across their delivery of goods and services can be a competitive advantage; leading healthcare organizations are starting to do the same. The days of finding big opportunity in localized optimization are limited; much of the low-hanging fruit is gone. Healthcare executives must shift their focus to the whole – the whole hospital, the whole health system, and the whole continuum of care – for big wins. This has been a slow process because of the existing fragmented delivery system and incentive structure. Cost pressures and payment reform are forcing “systems thinking” with the acute care setting in a way that we have not seen before, bringing a much wider group to the table in strategic planning and operational reviews to have real discussion around how to improve operations and patient experience.
2. Expand as a final resort. Organizations continue to be in a “wait and see” mode in regards to expansion efforts. They have spent a tremendous amount on expansion in the past decade and have heavily invested in healthcare information technology. The last thing most CFOs want to consider is another tower or other construction effort. This is forcing a new level of justification for expansion and deep discussion around how to maximize resources and eliminate duplication of services, including making very tough choices around moving services and appropriate care settings.
3. Greater focus on patient experience.
After a while it can be easy for those in the operational world to grow numb to – or at least tolerant of – cancelled surgeries, declined transfers, long ED wait times, PACU holds, stretchers in hallways, and a host of other “last resorts” that have recently become permissible mitigations. It is not so easy for the patients. In a recent study
commissioned by GE Healthcare Camden Group and Prophet
, the gap between the perceptions of patients and health system leaders about the state of patient experience is widening. Despite the rising expectations of healthcare consumers, health systems struggle to move the needle given the myriad of challenges they face. There is not a healthcare professional in the world who does not think there is room for improvement, but it is a task that is too large for a single individual and needs to be approached in a transformative and collaborative way. It also needs to be integrated with efforts to enhance efficiency. The goals are the same: improve access and streamline the patient care process. We are seeing many organizations take an executive commissioned fresh look at what the world could look like with “Patient Itineraries” and a world class type of experience standard that one would expect in other industries around billing, wait times, transparency to plans of care, and a long list of others. This can be incredibly powerful in creating a shared need and future vision for patient and family centered care.
4. Staff smarter. Patients do not get sick Monday through Friday on a defined schedule, yet this is the way many hospitals are run. There is also intense pressure to manage expense budgets by controlling costs in areas such as nursing or support services, but when not done thoughtfully, these efforts can have an impact on patient access in a way that compromises the overall financials in a much greater way. This is a very difficult nut to crack, but one where real progress is being made with approaches such as acuity-based staffing, realignment of staffing models, and smarter use of services based on data models that link demand to the consumption of services.
5. Increase flexibility. As beds become more constrained, hospitals are seeking creative ways to increase flexibility which often takes the form of adding flex capacity to absorb fluctuations in demand or increasing the versatility of the existing beds. This includes increasing tele coverage, sharing of beds between departments in times of peak census, rethinking incentives to promote better collaboration around patient care vs. optimizing for an area or department, redesigning processes to say “yes or no” faster, and more. The key for organizations is to promote collaboration and innovation around positive change – this takes data to build a case and strong leadership to overcome a long history of siloed operations.
6. Adopt hub and spoke models. Large integrated delivery networks are being much more judicious in aligning their operational strategies around where care is delivered. Increasingly, organizations are seeking to increase the complexity of care at their largest facilities where the most complex and costly services are provided, and use other satellite hospitals in a health system as virtual step downs. This requires a huge degree of coordination to rationalize and relocate services, redefine access patterns, and communicate the change to patients and staff. When done in a thoughtful way, this can be an incredibly effective approach to improving operations, patient experience, and the overall cost structure.
7. Target underlying issues. There is no shortage of process improvement effort underway in the acute setting related to access, patient flow, patient experience, and overall capacity management. This is often done in a fragmented way, putting out the fires that burn the hottest instead of taking a comprehensive look to deeply understand the issues and the impact those issues (process/capacity/cultural) are having on our operations. Firefighting can easily result in a “squeezing of the balloon,” where tremendous resources are invested in one area only to shift the issue to another. To truly make a dent in today’s capacity challenges, organizations need to take big swings, building holistic solutions to chronic issues such as long LOS, misalignment of discharges to admissions, inconsistent or misdirected patient placement practices, variation driven by surgical schedules to reduce variation, and more. Though never easy to address, these are the sorts of underlying issues at the root of capacity challenges, and the results of solving them tend to warrant the investment it takes to do so.
8. Find partners. A comprehensive look at acute care access and capacity management sheds light on those tough patient populations where we must work smarter and not harder. Organizations are exploring aggressively how they can prevent admissions and shorten stays through the use of retail clinics, partnerships with other hospitals, and improved relationships with post-acute providers that leverage data and establish service level commitments.
9. Use smarter operational analytics. Certainly institutions may tout their new EMR or a new bed management system as the solution to all of their problems – but in reality, this is not the case. The sophistication required to understand information in Real Time from multiple systems and make critical decisions exists only in small pockets. Innovative organizations are investing in Real Time analytics that can help solve their most complex problems in the moment. A problem back approach to analytics is critical. More proactive tools are also being developed that allow organizations to predict operations 24 to 48 hours in advance with amazing precision.
10. Consider command centers. In one of the most complex industries in the world, teams are asked to work in silos, often communicating via pagers, fax, and telephone to navigate and resolve complex daily issues. Healthcare may be one of the last industries to actively use pagers in daily work. There is a growing trend to co-locate staff, supported by Real Time information from dozens of systems that generate insights and drive action, and well-defined procedures to run hospitals like a busy airport or mission critical space shuttle launch.
This is an incredibly exciting time for hospital operators to rethink the Hospital of the Future. It often seems like an overwhelming task because of the complexities of daily operations, the heroics that occur, and the time required to drive change. With a well-informed plan on activities that can truly move the needle, strong leadership, and effective change practices, a better state is just around the corner.
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 firstname.lastname@example.org.