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Conversations about Optimizing Hospital Operations

3 Things Needed to Kick-Start Your Patient Flow Improvements

“You never change things by fighting the existing reality.  To change something, build a new model that makes the existing model obsolete.” – Buckminster Fuller, American architect, systems theorist, author, designer, and inventor

I’m sitting on a train on my way to visit a client. It’s a twisting, turning ride that reminds me of all the twists and turns a journey to an optimal patient flow strategy can take.  I’m also reminded of the faces of clients that feel incredibly challenged as they work to make a positive difference for patients and families, and I think of the ones that found the fortitude to keep going with this work of improving patient flow.  They all know the importance of building the necessary foundation, and at the heart of it, an age-old saying that still rings true comes to mind, “It starts at the top.”

Even the combination of dedicated team members, tremendous technology and the best of intentions, isn’t always enough to take the first step towards improvement.  That’s because the day-to-day challenges that everyone faces in healthcare get in the way, and the less hour-by-hour attention we pay to patient flow, the worse it gets. Even in the face of routine and significant ED boarding, patient safety concerns, waits for post-op beds, disgruntled patients and burned out team members [I could go on…] consistent focus on flow remains elusive.

Sadly, at some point this current state becomes ‘the new normal’ for the hospital.  That’s when I hear, “Kathy, it’s always going to be like this here – it’s just what we do…we’ll figure it out.”  It becomes a loop of leadership putting out the call for discharges, emergency bed huddles, texts going out to every physician within 85 miles of the hospital, and then miraculously by the 4pm bed huddle, the hospital has discharged 80 patients when only 50 were actually needed (causing one to ponder ‘why now and not earlier, or even yesterday..’).

“See Kathy, we did it again!  I told you, it’s what we do.”  My heart just breaks for these caregivers and the people they care for.  I shudder to think about the patient safety and satisfaction implications of this furious activity―not to mention the possibility of readmissions.  When every day is like this, dedication to patient flow improvement strategies diminish and team members become relegated to dealing with the lack of adequate open beds as a way of life―no matter how risky that may be.  This is literally the perfect storm.

If you see early symptoms of this in your organization now―STOP!  Don’t let this happen.  Be proactive.  If you’ve started your journey to improve patient flow, take the time to pause and self-assess.  If you haven’t started―GREAT!  Put processes in place now.  These three critical components will help your organization build a solid foundation for ongoing patient flow improvement strategies―and your ultimate success.

How can you start improving patient flow?

1. Senior Leadership Champion

Select an engaged, enthusiastic senior leadership champion for patient flow and capacity management (PFCM)―one who will not let you ‘give up’ and is a great cheerleader.  Choose wisely and carefully.  This leader must understand and be an advocate for patient flow, establish accountability for using standard processes, best practices and  of course TeleTracking.  This leader should also oversee the work of your Patient Flow Council.   Breaking down silos, rounding throughout the organization and understanding that flow must be managed 24 hours a day/7 day a week should come naturally to this leader.   Remember, it starts at the top!

2. Patient Flow Council

Develop an active, dedicated patient flow council―this is the group that will govern all your work around patient flow strategies.  Again, choose carefully.  The Patient Flow Council should be interdisciplinary, engaged, action-oriented and led by the senior leadership champion.  The Council should meet on a regular basis (no less than monthly) with a standard agenda.  Membership typically consists of representatives from the following areas: leadership, nursing, medical staff, case management, environmental services, patient placement/transfer center, ancillary services and transportation.  Other ad hoc members may represent information technology, quality or safety, or education.

Attributes of a Patient Flow Council

3. Patient Flow Measurement Plan

Design a comprehensive patient flow measurement plan so that you can effectively track opportunities and successes.  Determine the overall, key outcome (lag) measures for the organization, measures such as length of stay, readmission rates, patient satisfaction or ED boarding hours.  You’ll then want to add key process (lead) measures, including metrics focused on the patient’s point of entry or discharge and key patient flow processes such as transportation, patient movement and bed turns.  Targets and goals are established for each of these measures, with monthly reviews by the Patient Flow Council, and daily reviews by leaders.

There are additional building blocks that are needed to create a foundation for patient flow and capacity management, however these three are the most critical to support ongoing attention to patient flow strategies―and ultimately improvement.  The earlier these decisions can be made―and structures put into place―the higher your chance of success will be.  It’s never too late to start and it’s never too late to start over―but please don’t let me hear you say “it’s always going to be like this here. It’s just what we do…..”

While technology is important, redesigning processes and engaging people is hard work, TeleTracking’s Advisory Services team—with a combined 200 years of experience—stands  ready to help!  Reach out to us at

About Kathy Menefe, DNP, RN, NEA-BC, CPHQ, Consultant, Advisory Services

Dr. Kathy Menefee brings extensive clinical and executive management experience to her role as a Consultant with TeleTracking.  With hospital and health system experience in operational and support roles as a nurse for more than 30 years, she has been a member of executive teams in hospitals, post-acute, and community settings.  In addition to serving as a member of senior leadership, her responsibilities have included orchestrating the acquisition and implementation of patient care technology, leading health system departments such as quality, service and safety, learning and organizational development, and process improvement.

Dr. Menefee’s experience includes leadership positions with small rural hospitals, large tertiary medical centers and health systems.  She provided leadership for operational and support roles for more than two decades for Riverside Health System, based in Newport News, Virginia.  A national presenter on topics such as information technology, healthcare quality and process improvement, Dr. Menefee’s doctoral work and professional passion is focused on the development and improvement of interdisciplinary approaches to care across healthcare settings.  Her research has shown that approach to result in positive outcomes for the patient, care team and organization.

Dr. Menefee holds a bachelor’s degree in nursing from Shenandoah and James Madison Universities, a master’s degree in Nursing Administration and a Doctor of Nursing Practice from George Mason University.  Dr. Menefee is also certified as a Nurse Executive at the Advanced Level by the American Nurses Credentialing Center and a Professional in Healthcare Quality (CPHQ).

Categories: Author: Kathy S. Menefree, Operational Efficiency, Patient Flow

Are you a patient flow Renegade Samaritan?

Over the past half-century, the United States has experienced exponential growth in population, and life expectancy has risen.  Many diseases that were once fatal, are now chronic conditions.  Breakthroughs in science have led to vaccines and antibiotics reducing the communicable disease burden.  Engineering has improved transportation and workplace safety, eliminating many preventable deaths.  These improvements are all good news.  Along with our success, however, comes the challenge of caring for an aging population.  The challenge is acutely known to those who lead patient access, capacity management and patient flow across our healthcare systems.  Addressing these challenges depends on essential knowledge.  Our recent research is summarized into Seven Patient Flow Insights:

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Categories: Author: Scott Newton, Patient Flow

TeleTracking at HIMSS18

TeleTracking Booth #7301 @HIMSS18
TeleTracking Booth #7301 @HIMSS18

HIMSS18  KLAS Honors, Donations for Demos and Community Impact

TeleTracking will take its relentless commitment to ensure that no one will ever wait for the care they need to the HIMSS18 Conference & Exhibition in Las Vegas, March 6-9, 2018 at booth #7301. That commitment is further recognized by the fact that we’ve been named the Patient Flow Category Leader for the 7th consecutive year by U.S. healthcare market research leader KLAS. In fact, we’ve received this prestigious recognition of excellence for eleven out of the past twelve years.

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Categories: Uncategorized

It Takes Three – People, Process and Technology

My journey with TeleTracking actually started a few years ago when I was a client. I was at  my first TeleTracking client conference, and I vividly remember sitting in amazement as I listened to a series of  success stories from hospitals across the country talking about the ways they were empowered to improve access to medical care, to the people who needed it most, with the guidance of TeleTracking.  As a clinician, I was intrigued to learn about the solutions available to become more efficient and give precious time back to caregivers. » Continue reading

Categories: Client Success Management, Patient Access

Tips from the Experts: Process over Chaos with Flu Season in Full Swing

Flu Season 2018 - Process over Chaos

The holiday season is over and flu season is in full swing.  Experts from the Centers for Disease Control and Prevention say things may get worse before they get better due to an imperfect vaccine and exceptionally cold weather.  And this means that hospitals from California to Maine are dealing with surging EDs—leading to challenges with everything from long wait times to overnight holds to inpatient admission delays.

In fact, some health systems are seeing a 16% increase in ED visits and almost a 40% increase in acuity [according to Brittany Lindsey, Director of Patient Flow, UAB Hospital, Birmingham, AL].  “We have setup our PACUs as additional ICUs, we are looking at staffing our EP cardiology unit as a flu unit, we are using our Post Recovery for our Heart and Vascular Center as a 23 hour bedded outpatient location, and certain floors of our women’s hospital have been converted to regular acute care for all genders,” according to Lindsey.

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Categories: Author: Joy Avery, Author: Scott Newton, Command Center, Disaster Preparedness

Hospitals Aren’t Hotels ― Finding Balance with Staggered Discharge Times

Discharge Times and Capacity

How many times have we seen patient flow projects that center around “out by 11am” or “home by noon”?  It’s often suggested, “Can’t we put a sign in the room that says discharge is 11am?”  It’s true, we need to create capacity early in the day to reduce wait times for early ED (emergency department) arrivals and early PACU (post-anesthesia care unit) patients, but at what cost?  Is there really a need to get as many patients as possible out as early as possible, or is finding balance and staggering discharge times just as effective?  There’s a key factor to consider before putting pressure on precious hospital resources to discharge early –  Queuing Theory and the Utilization Curve.

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Categories: Author: Deb Kaczynski, Discharge Efficiency

Patient Flow Weekly Top Three | Issue 20

Patient Flow Weekly | Industry Insights from TeleTracking
Each week, we highlight the top three stories from our current Patient Flow Weekly Issue.  Subscribe today!

New Technology Improving Patient Flow at Countess of Chester Hospital

Hospital is the first in the country to issue patients with electronic wristbands that track their movements through ‘big brother’ style technology

In an NHS trial, the Countess of Chester Hospital, in Cheshire, has more than 4,000 infrared sensors above beds and doorways that read data chips on patients’ and staff’s wristbands to record where they are.
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Categories: Healthcare Technology Management Week, Patient Flow, Patient Flow Weekly, Weekly Top Three

Patient Flow Weekly Top Three | Issue 19

Patient Flow Weekly | Industry Insights from TeleTracking
Each week, we highlight the top three stories from our current Patient Flow Weekly Issue.  Subscribe today!

Client Success Webinar Series: Redefining the Discharge Process

December 12th, 2017
1:00pm – 2:00pm EST

McLeod Health is a seven hospital system with 931 acute licensed beds serving more than one million people in Florence County, SC. The focus of this session will be on culture change and what it takes to initiate, transform and sustain change. » Continue reading

Categories: Operational Efficiency, Patient Access, Patient Flow Weekly, Real-Time Capacity Management, Webinar, Weekly Top Three

The Emergence of the Nurse Navigator Role in Patient Flow

Susan Kilgore
L to R: Tena Barnes-Carraher, Nancy Niski-Martin, Susan Kilgore, Nanne Finis

Today’s reality―an aging population with increasing healthcare needs, highly complex inpatient cases, and sharply rising costs combined with shrinking reimbursement, are challenging hospitals to optimize internal operations and improve the efficiency and effectiveness of care.  Additionally, emergency department (ED) overcrowding that results from delays in getting patients placed in a bed can also result in ambulance diversions―all of which negatively impact the quality and safety of patient care.  Not to mention the fact that hospitals risk losing revenue from inefficient processes.

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Categories: Author: Nanne Finis

Patient Flow Weekly Top Three | Issue 18

Patient Flow Weekly | Industry Insights from TeleTracking
Each week, we highlight the top three stories from our current Patient Flow Weekly Issue.  Subscribe today!

Client Success Webinar Series: Interdisciplinary Centered Care Rounding/Optimization Through TeleTracking Advisory Services

December 5th, 2017
1:00pm – 2:00pm EST

Palmetto Health is a non-profit health care system in South Carolina made up of 5 inpatient facilities totaling 1,479 licensed beds. This session is ideal for those interested in learning more about how TeleTracking can enhance the quality of interdisciplinary rounds on inpatient units.

Who should attend? Patient Flow Managers; Case Managers; Performance Improvement Managers » Continue reading

Categories: Patient Flow Weekly, Webinar, Weekly Top Three