THE REAL TIME HEALTHCARE PODCAST · Jan 31 · 21:15 min

#49 - Helene Anderson, Regional Director of Capacity and Throughput at Providence St Joseph Health in Oregon

In this Episode:

As the Regional Director of Capacity and Throughput for the Providence Health System in Oregon, Helene Anderson has seen firsthand how COVID patient surges have challenged health systems across the country. The development of the Providence Logistics Center in 2018 gave them a head start on fully leveraging their resources and optimizing capacity during the pandemic.

Built with three key pillars -- process, behavior, technology -- the Providence Logistics Center enables their eight hospitals to operate as a single system. With the right workflows and technology in place, key stakeholders across the system have visibility to bed availability as well as the ability to prioritize where patients should go and streamline transfer logistics. In addition, they can leverage all available resources, such as tele-health, tele-ICU, and tele-hospitalists, to fulfill their mission of serving their community and caring for as many patients as possible, especially the poor and vulnerable.

For Providence Health, managing COVID resource demands goes a step further. Providence Health is part of Oregon’s statewide capacity management system. As COVID takes capacity out of an already strained healthcare system, the Oregon Capacity System enables health systems across the state to work collaboratively to monitor and manage bed availability and other key resources so that patients can be transported to and cared for at the facility that can best meet their needs.

Jeff Terry
Hello and welcome. I'm Jeff Terry, delighted to be joined today by Helene Anderson. Who's the regional director of capacity and throughput for the Providence Health Systems, Oregon region. Hello Helene.

Helene Anderson
Hi, Jeff.

Jeff Terry
So great to have you with us. Thank you.

Helene Anderson
Thank you.

Jeff Terry
So couple questions to unpack that I know the audience will love. So first off, capacity and throughput, Oregon division, it's obviously you more than anyone around to see what's going on with capacity. What is the current state of play in daily operations as you see it?

Helene Anderson
Yeah. Well, it's as people would suspect in watching the news or seeing other hospital and healthcare systems across the universe struggle with capacity in a time of surge. And certainly, we have our constraint capacity city as well. In Oregon, Providence is not unique in this space. The other health systems that we partner with are also in the same stage between capacity constraints, limited resources and staffing, and of course, increasing demand. So we work together to manage that.

Jeff Terry
And is it fair to say that it's now routine to have a certain size COVID inpatient population? And that's relatively routine, but then of course, that takes out a bunch of capacity in an already constrained system. Is that reasonable to say?

Helene Anderson
Yeah. I think I might say that the COVID capacity is certainly something that we monitor for a variety of different reasons. And the capacity and the impact of COVID volumes certainly require a different level of care in the need to donn and doff PPE. So there's a different intensity than kind of the regular flu or the common flu, which is hard to imagine the flu being common anymore. So I think while we monitor those again for trends and impact, also for level of care needs.

So the impact to critical care, because that affects other resources, ventilators, ECMO, those types of things. So we monitor it for a variety of different reasons. But I think our numbers now, while they're very slow to change, we've been hovering fairly steady accounts in Oregon that we haven't had, like others, the relief that some would have hoped for at this stage.

Jeff Terry
Yeah. And I think that's where one way or another, the combination of staffing and some COVID and just pre-COVID normal plus whatever. Add all that up and there's a lot of pressure on the system. That's certainly what we observe from great caregivers like you.

Helene Anderson
Yeah. Yeah. I'd agree.

Jeff Terry
And the team every day.

Helene Anderson
Yeah. Agreed.

Jeff Terry
So in that context, you led the creation of the Providence Logistics Center. Sort of which COVID or not, was important and useful.

Helene Anderson
Yeah.

Jeff Terry
But it's not all you use it for. So could you describe for the audience the Providence Logistics Center, what is it, why do you do it, what has it achieved?

Helene Anderson
Yeah, certainly. Well, when we envisioned the logistics center, it was before COVID. It was in 2018. Looking back then, right? And the driver for us creating a central support team to manage capacity and throughput was because we knew that there was an opportunity for us to use all of our facilities to optimize not only the community level care that we provide, but also to preserve the tertiary level care. Excuse me. So Providence is unique because we have eight hospitals in Oregon.

Jeff Terry
Eight. Yeah. So I was going to-

Helene Anderson
Yep. And we refer to our hospitals as ministries. And we have two tertiary or quaternary level care hospitals in the Portland Metro area. Five of our hospitals are in the Portland Metro area. Three are community. We have two critical access on the north coast of Oregon. And if you've never been, it's beautiful. And we also have a critical access hospital in the Columbia River Gorge in Hood River. And then a community hospital in the very southern part of our state in Medford.

So our goal was to create a vision. And the vision that we're fulfilling today is to act like we're a 1,000 bed hospital.

So instead of ministries referring to my beds, that they're our beds. So we can optimize the care that's provided in the community and keep folks in their community, which is where they want to be. So really patient and family centered care models.

And then when they need the tertiary level care, that they have that access to stroke, STEMIs, transplant. That we're able to fulfill the needs of what our community asks of us. So the vision was to coordinate efforts around this. And then the vision for the logistics center was born.

And while I'm certainly talking about it, I'm not alone in this work. We've had incredible executive leadership support, medical staff support, and the ancillary services teams have been incredible in our ability to kind of bring this vision to life. And it really is kind of a modern day translation of our foundresses, the sisters of Providence who forged their way into the Northwest many, many years ago. We lived that vision with doing this work.

What we've centralized, I think is probably more of the magical piece of what we do, is bed placement. So we do bed placement for all of our ministries in Oregon. We do transfers in and support all the ministries in Oregon again. We have also another service that is what some may know as tele-sitting or remote visual monitoring.

So again, what we're trying to do is say, here's the demand. What services does a patient need? How can we centrally coordinate those services to land them in the right bed in as timely a fashion as possible. And we're soon to be emerging in centralized dispatch at the hospitals or the ministries, so where we can again, match the demand with the needs. So it's not a first in, first out. It'll be an opportunity for us to coordinate more efforts. And we're also into the space of non-emergent medical transport. Again, all in service to getting people where they need to as timely as humanly possible. Even with constrained beds.

Jeff Terry
I love that sort of tagline, which is so clear and is work like a 1,000 bed hospital, right?

Helene Anderson
Mm-hmm (affirmative).

Jeff Terry
And with all the implications, of course, there's a technical piece of having the right information to do that well.

Helene Anderson
Mm-hmm (affirmative).

Jeff Terry
There's also a cultural piece. I mean, you got to get people on board with that idea that it's going to work. How have you approached that?

Helene Anderson
Yeah. Well, we have three pillars that grounded us in this work. And I might have shared that in the last ecosystem call. But the three pillars, the first one is process. It doesn't matter what shining on a wall that has information. It only matters if we have good standard work to support the actions. So process is one of our pillars. The second one is behavior.

Do we get good adoption with what described as a need? And how do we kind of constantly improve that with the clinicians, whether it's the stroke program, the brain and spine program, the women's program. How do we manage with the expert clinicians, and the logistics center, the nurses and the bed control experts in the transfer center to help lift up the visibility of the information that we get from technology, which is our last pillar.

And it's last by design because if we don't get the process or the behavior right, it doesn't matter what the technology solution is.

Jeff Terry
Absolutely. And I know it's sort of a never ending journey, right? But where are you in that? How is it going? What have you achieved?

Helene Anderson
Yeah. Well, it's funny because we're just, what are we, eight months into really the structured and focused work with the GE Tiles. So we've had a series of metrics to be responsible and report to. And one of the things that we track is our external transfers. Again, we did this before COVID. So it's difficult to imagine that external transfers or kind of the new visitors to Providence, the new patients who are seeking our care.

We, again, grounded in our values. Our commitment is to serve the poor and vulnerable. And we can only do that if we have these strong structures and processes to do that. So some health systems, and I understand why they did this, had to kind of throttle down the external transfers, focusing on their own internal needs. And we've certainly done that as well, but not at the extent of meeting the needs of our external customers because the patients call upon us. That is at our core of who we are. So increasing-

Jeff Terry
So your ability to do that, that the PLC has made that possible despite all the crazy ups and downs.

Helene Anderson
Yes. All this has a trickle effect. Every decision we make has a ripple. So it could result in more consultations. It could result in more use of tele-medicine, tele-ICU, tele-hospitalist to manage in place while we're coordinating the needs of the most highly acute. And also the discernment with our medical staff and our medical director, Dr. David Corman, around the prioritization so that we move people, again, who are in the most critical need as timely as possible.

Jeff Terry
And Dr. David Corman is one of the clinical leads-

Helene Anderson
He is.

Jeff Terry
... Who sets up the processes. And then the team does help that allocation of who goes where, what's the best choice. They're involved with that.

Helene Anderson
Yeah. And our core leader for this work, her name is Roxy Barry. Roxy is also instrumental in working with Dave. we have kind of a weird dyad partnership. I have a dyad relationship with Dave and Dave has a dyad relationship with Roxy.

And then Dave interfaces with the medical leaders in the community. Roxy, again, with the other clinical programs or institutes or other people call them a variety of different things. And then through that work, we really lean in the clinicians of that experts in these areas to help us create those standard work or algorithms, the responses, so how we can manage all the incoming.

And then of course, really at the point of care are the nurses and the bed control specialists who are answering the phone and know how to act and react when they're getting a particular call.

Whether it's a maternal hemorrhage, whether it's a stroke, whether it's somebody who needs dialysis. So across the spectrum of care.

Jeff Terry
Which to your point, it's all about those workflows and structures, right?

Helene Anderson
Mm-hmm (affirmative).

Jeff Terry
But you mentioned technology, which is meant to enable those. So maybe if we just double click on that, the GE Command Center software. We think of that as sort of real time patient intelligence. It helps the PLC or I think it does. Could you describe how does it help the PLC?

Helene Anderson
Yeah.

Jeff Terry
Those workers?

Helene Anderson
Well, in our early discovery work in 2018, one of the things we recognized was that we didn't have quick visibility of information. Our electronic health record was certainly something that we had. A little bit complicated by nature by the way the security features are designed. I look at one hospital.

I have to change what we refer to as our context, look at another hospital. And by the time I did that looking for a bed for eight hospitals, the information was outdated. And then that generated a bunch of calls, which was kind of our norm. It's what we did for years.

So the idea of having a product that could give visibility and transparency in real time, and I'm not sure other people know this, but for one of our greatest opportunities in sharing in the information is that on the GE Tile, the information refreshes like every 30 seconds. It would take me longer to log in and log out. And it's not because I'm older. It's because just the technology system is such that it's not as quickly visible. And again, we're looking at eight hospitals.

So if I had one or two hospitals, depending on the size, that might not be an issue. But we're looking at eight different hospitals. And so that visibility allowed us the opportunity to not only have transparency with our bed availability, our bed data, but really be able to start prioritizing where patients would go, where they would stay, the sequence of movement. So, yeah. Absolutely the visibility has been key.

Jeff Terry
That real-time part always resonates me. Sometimes it's hard to describe just how real-time your job is, right?

Helene Anderson
Yeah.

Jeff Terry
Information that's 20 minutes ago, a lot has changed. And it's all critical. Yeah, there's patients.

Helene Anderson
Yeah. And Jeff, if I could add, I think one of the things that we really appreciated with this was the recent Delta search, the demand for critical care beds was it sucked the air out of the room. We just did not have any critical care beds.

And because that's where the patients were needing that level of care. And having the visibility and knowing even further yet where we had care and capability at our larger hospitals and where we had it at our community hospitals. And then added another layer with the physician leadership of where we can manage those patients who required that level of care. So that was a big deal for us. And I think we felt it more then.

Jeff Terry
And one other question on that. The PLC has been a, for the access function, played all the roles you've mentioned. The idea of the command center software and the PLC, the throughput I guess, aspect of your role also extends out into the daily operations out in the hospital.

Can you comment on how you're connected beyond just the PLC?

Helene Anderson
Yeah. So we serve the ministries. We're here to make sure that our patients land in the locations that they need, as I mentioned. But we can't do this in a remote setting, which we are. We don't live in a hospital campus. Even if we did that, we'd only live in one campus and we have eight. So we live in a central location in an office park-like setting. And our anchor at the ministry are generally the house supervisors.

So these are the folks responsible for everything that's happening in real-time. Patient flow, a code, any critical needs, balancing staffing or adjudicating where the staff's going to go to meet the demand. So these folks are our anchors. And one of the workflows and groups that we created from all of our experience in this space was we have a capacity and throughput leader team. And we have a ministry representative.

And one of them is a house supervisor and one of them is either a manager or a nursing director. So that we meet with them monthly, we test our workflows, we get their input.

We've done some really other wonderful things that innovate in the day-to-day. But in the structural process, we've created this linkage so that they know who to escalate to, they have an idea they want to try, if they want to do a PDSA on something we haven't thought of yet.

And we've also done some work training and working with them on using especially the Capacity Optimizer Tile because they can look at discharges. Our discharge feature in the capacity optimizer function around discharges is based on the provider order for discharge.

So that's real-time information as well. And we did that by design, of course. And then we have the, not to mention all of our Tiles, but the one that we have that supports the ed-boarding. We're looking at who's the priority to come out? And then of course, the Transfers Expediter Tile, the ones who are wanting to come in.

Jeff Terry
Brilliant. And of course, and it all sort of makes sense the more you comment. Going back to where you started was working like a 1,000 bed hospital, which is all those pieces, right?

Helene Anderson
Mm-hmm (affirmative).

Jeff Terry
So then one other topic I wanted to get you on, which is shifting gears a bit to the Oregon Capacity System, which you're also critically involved with. So just to frame that for the audience. What we discussed so far is the Providence Logistics Center for the ministries and the region of Providence in Oregon inside the health system in all the ways that we discussed.

Providence is also involved with other health systems in the state of Oregon like Kaiser, and like OHSU, and on down the line in something called the Oregon Capacity System which is meant to help them manage capacity across the health systems for all the beds in the state with a lot less clinical data, no PHI for obvious reasons.

But in a different way, but a similar kind of goal to what you're doing in the health system.

Helene Anderson
Mm-hmm (affirmative).

Jeff Terry
Could you talk about that work? Two things. What is it? How is it working? And also, how did Oregon pull it off? Because it's quite a thing politically to get everybody to do what Oregon has done.

Helene Anderson
Yeah. Well, in the start of the pandemic, we didn't know what we didn't know. Right? And one of the hospital systems in the state, the Oregon Health Sciences University, which is our medical school, had been using the GE software and had worked with the Nike foundation. And Nike provided a grant to the State of Oregon to lift up this emergent capacity tile. And the designer intent originally was to show us where we had capacity, when we were using ventilators, and then to start tracking all this information.

The challenge at the time was that we also have an internal system that was built for our EMS teams around divert, of course, because we want EMS to know when it's safe to land somebody, that also had a lot of other information that we were putting in around COVID numbers, things that were required and still required by HHS.

So we have those two things kind of running in parallel. The new version that you're mentioning, I think it's going to replace kind of this older system that the Oregon Health Authority has been using, which will move us to a much more automated feature requires less manual entry. And the reason that's so important is because we now have agreement on how we define things. So for example, beds. We don't block beds. We talk about staffed beds.

The reality of our situation of how many people can we take care of? And the reason it is so important and certainly in this last Delta surge, when I think of the critical care example I mentioned earlier, what we've done is we're able to look and see who's got critical care space. And I can tell in the Portland metropolitan area where we have the higher level of care than the community resources where we can provide ECMO or dialysis where we have capacity.

And from that, what we've done is something that I think will outlive COVID, which are develop these incredible relationships with folks that we probably would not have had the relationship with had it not been for COVID. Because we all need to care for these patients.

So if there's an ICU level of care need that they can't meet, we literally call each other and have a conversation and ask how we can manage or who's coming off ECMO or who's being downgrade at the transfer out of critical care and who can meet the demands, if any. One time none of us could.

When I was on-call one weekend, I think in a 12 hour period, we solved for about eight patients getting into a bed that they needed. And that was both using the information from the state tile as well as having a real-time conversation. So again, it's that we used the technology but it inspired a conversation and we were able to meet the patient's needs. So that's the greatest blessing for our patients in the state of Oregon.

Jeff Terry
Which is amazing, right? That the state is we're going to act like one state health system across all these great institutions. And I think it connects right back to what you said earlier, which is those conversations still have to happen. You're not going to move a patient without the critical care teams talking. But those very smart people, like yourself, aren't wasting your time tracking down relatively basic information. That's there and then you can get to the next step, I think that's fair to say is very valuable.

Helene Anderson
Yeah. I would agree. I would agree. Yeah.

Jeff Terry
Brilliant. Well, that's what I had hoped to talk about. It's super interesting, Helene. Thank you for sharing it and for joining today.

Helene Anderson
Thank you, Jeff. Thanks for giving us the opportunity to share our story.

Jeff Terry
Yes, ma'am. And with that, I think we'll close the podcast.

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