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Conversations about Optimizing Hospital Operations

Value Based Care: High Reliability, Complexity & Patient-flow

Scott Newton, DNP, RN, MHA, EMT-P,  Vice President of Care Model Solutions at TeleTracking—and a patient flow expert with more than 25 years of clinical experience—shared his thoughts on this topic during a webinar on March 21.  The following is a recap, along with questions that were submitted from audience members.

Here’s the challenge that every healthcare provider faces.  How do you maximize resources in order to generate the best possible patient outcomes?  One answer to that question is through value-based care—a strategy that provides improved outcomes at the same or reduced costs.  And in order to achieve those positive outcomes, a high level of process reliability is essential —which is done through a combination of people, technology, equipment, supplies and process.

Value-based care [VBC] has gained particular significance recently in light of the fact Centers for Medicare & Medicaid Services [CMS] will be increasing VBC payments in 2018 and private payers typically follow CMS policy.  This makes coordination and collaboration across the care continuum even more important—and which is tied to ensuring that people get the care they need, when they need it.  Because when patients don’t—when they have to wait—the costs are profound:

  • 20 million unnecessary patient days
  • 3-5 million additional patients could be served
  • 37,000 deaths correlated with ED boarding/year
  • $100 billion per year in hospital operational inefficiency
  • 9 million patients leave without being seen while 39% of hospital beds remain unoccupied

With value based care—and high reliability further enhanced with patient flow—this waiting can be mitigated.  The result is better individual care, better population health and lower costs.  Specifically, this is done through a:

  • Preoccupation with failed access, throughput and discharges
  • Reluctance to simplify clinical care
  • Sensitivity to operational readiness
  • Deference to clinical and operational expertise
  • Commitment to organizational resilience

Patient flow also adds calm to the complexity of a health system—instead of diverse points of control, multiple stakeholders and a tendency to self-organize.    The result is:

  • Small inputs that produce large system wide effects
  • Connected units with consistent relationships
  • Predictable automated communications
  • Interconnected units perform integrated functions

Taking all of this information together, it comes down to five key characteristics that make high reliability organizations with a patient flow strategy successful:

  • Let the experts be experts
  • Drive clinicians and staff to do the highest value work
  • Create a culture of proactivity
  • Build a centralized healthcare command center
  • Use data to drive performance

Thank you to everyone who submitted questions after the webinar. We’re happy to answer them here.

How does patient flow impact the value based care agenda?

Patient flow can impact the value based agenda directly by adding efficiency to the communication process among care teams as patients move through their care progression journey. The care environment becomes enabled with reliable patient movements and processes, reducing variation and lost time. When communications are efficient and variation is reduced, then patient needs can be coordinated with precision—giving rise to reliable clinical services delivery in support of quality outcomes.

What effect does highly reliable patient flow have on quality outcomes?

When patient flow performance is highly reliable and sustained across an organization, it has a smoothing effect to the peaks and valleys of work. When the workloads are more predictable, resources can be better deployed to provide the best patient care. When patient needs and resources are aligned, patients are able to access care when they need it, in the right location and at the right level. Timely access to care, improved outcomes and lower costs are net results.

We have a very complex care system. How can we get patient flow to be a part of our daily operations?

Complex health systems without a patient flow focus often find that nearly all stakeholders can relate to the resulting challenges.  However, those challenges can serve as a catalyst to bring cross-functional collaboration, and a sequential approach to care teams. As collaborative relationships develop, stability among separate units matures. As stability matures the care transitions for patients are more reliable and care coordination is enhanced.

Of all the insights shared which one is the most important?

While all five of the insights are important to building and sustaining a highly reliable patient flow program, the single most impactful is the use of data to drive change. Collecting, sharing and discussing the performance data with the staff performing the work is what drives change. This method provides essential closed loop accountability.

Click here to watch the first of this Value-Based webinar series.

Categories: Webinar