By Dave Schafer
When St. Joseph’s Hospital Health Center in Syracuse, New York wanted to improve its already exceptional patient care, its leaders focused on efficiency. Among their goals: reduce the average
length of stay to provide the best care for patients in the shortest amount of time; reduce the cost per case; and strengthen their ability to prevent re-admission.
St. Joseph’s soon discovered what many other health care systems have learned – efficiency in care delivery is a great way to control costs and improve quality of patient care.
The hospital adopted a hub-and-spoke production system with a “traffic control center” staffed 24/7 by nurses who can visualize what’s happening with every patient at any time throughout the hospital. They can examine delays and implement ways to mitigate barriers that cause backups. They are in constant communication with care coordinators in every nursing and service area – considered the “spokes” – to anticipate problems and initiate solutions.
The results were significant and easily evident. St. Joseph’s:
- Reduced average acute length of stay by nearly one-half day
- Increased acute patient volumes by 4.3%
- Documented an $11.6 million annual financial benefit from increased revenues and reduced costs.
The care-quality benefits of efficiency – performing or functioning in the best possible manner with the least waste of time and effort –are obvious. If the workflow is optimized to allow nurses to get to the patient quicker, even if just to make sure they’re okay, quality of care will be better, said Dr. Bill Tierney, the chair of the Department of Population Health at The University of Texas at Austin Dell Medical School. A general internist and medical informaticist, Tierney has studied ways to improve health care delivery and its outcomes.
“People are in the hospital because they’re acutely ill, and acutely ill people have bad stuff happen to them acutely,” Tierney said. “If you don’t catch it, then an avoidable thing might happen.
A good hospital will be designed not only to minimize the amount of walking and retreading among staff, but also to maximize the number of touches a patient might have.
“The more touches, the less likely something bad will happen.”
On the other hand, when efficiency is not emphasized, Tierney said, patients can be kept in a hospital room longer than necessary. That can lead to unnecessary procedures – like daily blood draws – and the increasing discovery of “minor deviations” that don’t mean much, but which hospital staff feels compelled to address through expensive procedures. Tierney calls that “incidentaloma.”
“That’s when you find something you weren’t expecting because you were looking for something else,” he said. “But now you’re stuck with it. Now you’ve got to do something about it because it’s there. And then patients end up getting treated for stuff that otherwise they probably don’t need to be treated for.”
That, in turn, drives up the cost and drives down the quality of care, because there is little benefit – but all the side effects – of the treatment, he said.
The Effects of Efficiency on the Nursing Staff
There’s another benefit of efficiency: Improving nurse morale.
Poorly designed workflows cause nurses to physically exert themselves more than should be necessary just to do their job. And when something bad happens to a patient because they didn’t get there in time or were unable to catch a problem because of patient overload, they blame themselves, Tierney said.
“The level of PTSD in nurses is significant,” he said. “The level of emotional distress among in-patient nurses is significant, because bad stuff happens and they see it as their fault. A lot of times, bad stuff is happening not because they’re not any good; they’re excellent. The system is designed in such a way that makes it more likely that something will get overlooked, and it often has to do with clunky workflow that nobody really paid attention to.”
Models for Improvement
Care Logistics helped St. Joseph’s with its transformation. A THA-endorsed partner, Care Logistics approaches efficiency improvement from an engineering perspective. Its “production system” for care delivery transforms hospital operations through positive culture change, a hub-and-spoke care model, and logistics software.
“We’re not talking about cutting staff or increasing workloads,” said Samantha Platzke, senior vice president of system performance and CFO at Care Logistics. “We’re talking about literally doing your work differently with a different model in care coordination.”
The first step in creating efficiencies is to understand and map out current processes, Platzke said. Always look at them – and how long they take – through the eyes of a patient. “Focus on your
customer and figure out the best path with the least amount of wasted time for your customer, and once that is determined, you know the most efficient way to run your operation.”
Many health care systems have implemented Lean Six Sigma, but rather than unitary practice among managers, is a critical piece of the Care Logistics foundation. “A lot of hospitals are using Lean methodology to learn where they have waste,” Platzke said. “Lean thinking is necessary to drive out waste so that all work adds value and serves the patient’s needs.
“Care Logistics helps our customers build on their Lean efforts by implementing a new model of care coordination that drives further efficiency, improves patient care, experience and throughput. They experience dramatic improvements in key metrics and achieve significant financial savings.”