At first glance, a hospital and a factory have little in common — one manufactures items, while one is supposed to be human-centered place of healing for patients and families. But if you take a closer look, they share more than first meets the eye.
"Sometimes the initial reaction is, 'patients aren't widgets, they're people,'" Doug Walker, vice president of client development for Care Logistics, said at the Becker's Hospital Review 7th Annual Meeting. "But it turns out that there are a lot of production model principles that work very robustly and effectively in hospitals."
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One hospital that has realized these synergies firsthand is Springfield, Mass.-based Mercy Medical Center, an acute care hospital that is part of the Springfield-based Sisters of Providence Health System. A few years ago, the hospital was not running efficiently, and officials had to "take a step back and look at operations," said Scott Wolfe, DO, president of Mercy and SPHS. Various issues included:
- Inefficient discharge processes
- Patients held in the emergency department
- High length of stay
- Low patient satisfaction scores
- Low employee engagement scores
"When you look at that, it's really a wakeup call," Dr. Wolfe said, and he and hospital leaders knew it was time to make a change.
"When I think of transformation, I look at it as a complete change in the way we deliver care," he said. "But it's not about doing more with less, it's about doing different with different."
To accomplish this, Mercy leaders turned to a comprehensive care integration model —focused on flow redesign, quality and service improvement — from a production model mindset. The project was called CareConnect, and the hospital partnered with Care Logistics to make it happen.
Preparing for culture change
Not everyone has a positive initial reaction to incorporating a production model into hospital operations.
"I don't know if my first thought [at the time] is appropriate [to share]," said Jessica Calcidise, RN, Mercy's interim CNO. But, after mulling over the data and the opportunity, Ms. Calcidise realized Mercy needed "drastic change."
"Once you realize that, and introspectively look into your organization and where your needs are, it makes complete sense," she said.
Ben Sawyer, Care Logistics' executive vice president, said culture change is an integral part of the transformation. "It's a cultural issue of how you launch and make sure you're clear on what you're trying to accomplish," he said.
Dr. Wolfe also stressed the importance of culture change before any other work can be done. "You have to embed [the need to change] in the culture," he said. "This really has to be embraced by the entire organization in order for it to work."
To get the Mercy staff on board and bought in, the hospital created a system aim — a "rally cry" for culture transformation, as Dr. Wolfe put it — to get everyone on a common ground. They chose, "Together, doing the right thing, the right way, every day for every patient." From there, executives went through several day-long leadership sessions. The changes were then rolled out among the front-line staff.
Huddles and operational rounding
Two of the main components of the CareConnect project are patient progression huddles and operational rounding, both of which are aimed at improving communication throughout the hospital to better coordinate care.
Every unit in the hospital participates in what is called a status-now-action-planning, or SNAP, huddle each morning. These huddles are 15-minute meetings that involve everyone on the unit — discharge planner, physician, primary care nurse, home care, physical therapist, etc. — who coordinates the care that will happen on the unit that day, for each patient, Ms. Calcidise explained.
A second key performance discipline is operational rounding, which takes place every Wednesday. Administrators and coaches round on each unit, and go through a mini process improvement lesson. Rounding allows a front-line nurse and a C-suite executive to have a "meaningful discussion" and establish a "level of comfort," thus breaking down barriers to change, Ms. Calcidise said.
Hub-and-spoke technology
The last part of Mercy's transformation involved technology, with Mercy implementing Care Logsitics' software and creating a physical Hub where all activity in the hospital is overseen by a central care coordinator, who is in charge of the "3-D chess game," as Dr. Wolfe put it.
The Hub shows when all patients come in, their prompt appropriate placement, and their quality care progression toward precise discharge targets. "[Coordinators] oversee the overall outcome of the patient from the minute they step foot [in the hospital] to the minute they leave," Ms. Calcidise said.
The combination of huddling, the involvement of hub and unit coordinators, and software managing patient flow allows Mercy to coordinate care in the most efficient way possible.
Results
Through the full CareConnect program, Mercy has seen its metrics improve across the board. Readmissions have fallen, average patient length of stay has dropped a full day, and the number of patients waiting to be seen has also declined. Additionally, the hospital has seen growth in both patient and physician satisfaction scores.
"This is a fully integrated hub-and-spoke production system, making sure no defect goes unnoticed and is not addressed," Mr. Sawyer said.