One of the new consulting services offered by Press Ganey has helped a number of hospitals significantly improve patient flow throughout their organizations. As a result of these projects, the involved hospitals have been able to accommodate growth in surgical volumes within their existing operating rooms even while waiting times for urgent/emergent surgical cases decreased. The accuracy of the surgical schedule improved dramatically, and the percentage of patients placed right away in a unit specializing in the care they need increased. The impact of this work was also felt in the emergency department – where waiting times were reduced – and on the inpatient side of the hospital, where correct patient placement led to decreased lengths of stay and morbidity/mortality.
But perhaps even more important for the long-term health of each hospital, particularly during this time of change, these projects triggered a shift in culture. With their eyes focused on solving a complex issue, the surgeons, anesthesiologists, physicians and top hospital managers on the project committee developed a new way of working together that led to a culture of increased trust, openness and collaboration. When asked about how this occurred, two client hospitals cited the same components:
Develop an active and engaged project committee. The project committees were composed of representatives of key surgical specialties, anesthesia, top hospital managers and key line managers. In both cases, an existing committee took on the tasks of the projects, began to meet twice a week rather than once a month or even once a quarter, and membership was appointed rather than voluntary. The committee was given the responsibility and power to make and enforce decisions with their peers. As they successfully brought about real change, their confidence grew and trust began to develop between the medical/surgical staff and hospital administrators.
Use data rather than anecdote. Members of the committees stressed the importance of using good data and analytic tools to build interest and support. Data were used to illuminate historical patterns, identify specific problems, model the impact of change and, later, to monitor adherence to benchmarks. Data also provided a big picture look that allowed all participants to understand the larger context and implications of their actions.
Develop clear guidelines and consequences. In addition to basing decisions on data, the committee also developed clear guidelines to prioritize add-on cases for the OR based on the patient’s clinical needs rather than surgeon seniority or other, “softer” needs. Clear block rules and on-time start requirements all helped to make processes in the OR transparent and consistent for all surgeons.
Provide benefits early. Any project consists of multiple smaller tasks. In the case of the patient flow project, setting aside separate rooms for add-on cases and improving the accuracy of surgical scheduling led to immediate benefits felt by surgeons and patients. Cases started on time, waiting times for emergent/urgent surgery decreased and overtime hours decreased. These early benefits built support for the project and the committee and helped to set the stage for more difficult parts of the project.
Talking and listening. Group decision-making is always a tricky business, particularly when those involved have concerns that are different and conflicting. Surgeons, anesthesiologists and hospital management all want to provide safe and successful surgery, but their immediate needs can be very different. In each project, the committee found that using data and developing clear rules provided a solid and scientific basis for their decision-making. But each group also needed to develop the art of listening and responding to each other’s concerns while keeping the greater good of the hospital in mind. Equally important was keeping the lines of communication open with their peers. A lot of time and effort was spent on keeping everyone up-to-date on the project, listening to concerns, explaining decisions and developing support.
Support from top management. As this was transpiring, top hospital managers played a critical role by maintaining an open door for disgruntled or worried physicians but not allowing end runs around committee decisions. After listening, they encouraged physicians to take their concerns back to the committee for resolution. Top management also provided hospital support for staffing and resources needed to implement project changes and kept up the support during hard times.
Although many of the specific steps of the patient flow improvement projects differed between the two hospitals discussed here, the similarity of their experiences and of what they considered to be the keys to their success are striking. The collaborative culture that blossomed during their projects will have long-reaching effects, including the ability to respond flexibly and quickly to the myriad challenges facing hospitals today and in the future.
Read Susan's
full profile.