Process improvements in hospitals are a big challenge, and one that requires more than technology to make an impact: it also takes executive commitment and employee participation to make a real difference. Case-in-point: Beaufort Memorial Hospital, a 197-bed community not-for-profit hospital in Beaufort, S.C. The hospital, which is located about midway between Charleston, S.C. and Savannah, Ga., averages 10,000 inpatient discharges, over 50,000 ED visits and 200,000 outpatient visits per year.
The hospital, according to Ed Ricks, CIO and vice president of information services, had an issue with patient flow, and in 2013 embarked on an initiative to improve it. “We are not unique in this, but we had a huge issue with patient throughput,” he says. “We were holding patients in the emergency room because all of the beds were full or not ready for a patient in one of the units.”
The hospital had partnered with a vendor (Medhost, Franklin, Tenn. for a patient flow solution and, later, for consulting services) to help manage the flow of patients. The solution helped, Ricks says, but didn’t go quite far enough. “It was a great tool, but we discovered in the process of implementing it that it became an IT project, about technology—it wasn’t about the process we were trying to fix.” That was the genesis of an initiative to address the problem from a process improvement perspective-a process that centered on the creation of teams, communication and accountability for results.
“Originally the technology solution was giving visibility to what was going on in the organization, so anybody could see if there were delays in the ER or if there were dirty beds that needed to be cleaned but weren’t being turned around quickly enough,” Ricks says. “But until you drill down to what is behind that, you really don’t know what the issue was—and that’s where things pop up.”
With that, Beaufort set about fixing the patient flow process with an initiative that included all of the players. The initiative involved setting up a structure in the hospital, which consisted of a steering committee and “process action teams” that included staff from all of the areas in the hospital that affect patient flow. In addition, ad hoc committees were formed to provide training to the employees in technology and their roles in the initiative.
The committees met frequently, and information about their progress was disseminated throughout the organization. Ricks says that this was the first truly broad-based initiative during his six years at the organization. “We communicated the heck out of it to every employee, so we had visibility. Then we started to add accountability, and we had the data to support that, and that’s when we started to see results,” he says.
Beaufort established key performance indicators (KPIs) for process changes, set realistic targets for change, and measured results continuously. “It’s all process and data driven—look at your process, measure what you can measure, and make the changes you think are right,” Ricks says. “If it makes a difference, great; if it doesn’t, move on to something else.” Three to four KPIs were established for each group, and goals for each group were established.
According to Ricks, the technology solution delivered key metrics governing patient flow. “We had a system to track all of the attributes, like if a room is dirty and is ready to be cleaned; , or how long did it take to transport a patient from one room to another, or out for an imaging study. We could capture all of that information, but then knowing what to do with it, and fixing little pieces of it,” he says. The teams that were created were charged with identifying the opportunities for improvement, and to measure the improvements.
The KPIs that affect patient flow were based on data from the patient flow software. A few examples are: For care management, a goal was established for 50 percent of discharge orders be placed by noon; for environment services, a goal of 40 minutes from the start of room cleaning to the bed marked clean; for nursing, that patients physically leave the hospital within 120 minutes of the discharge order.
Those efforts have been successful. Beaufort has been able to decrease its length of stay for inpatients from 4.5 to 4.1 days; improvements in physician discharge orders written by noon increased from 11 percent to 43 percent; and bed turnover time went from 116 minutes to 62 minutes. Cost reductions from the various improved efficiencies are estimated at $435,000. Those gains have been sustainable, Ricks says.
Ricks says that the initiative incorporated elements of lean methodology. He describes the approach as process driven, which involves a lot of cultural change. That makes people uncomfortable, he concedes—but the cost saving from more efficient processes are significant and there for the long-term.