Ascension is the nation’s largest national Catholic health organization with several systems in each state. St. Vincent Health in Indiana is comprised of 17 hospitals and recently launched the One Ascension project to centralize patient placement across those hospitals. Chris Wagoner, RN, BM, BSN, CPHQ
Regional Director, Clinical Service Line for Ascension Connect shares how their team worked to combine support folks, clinicians and the IT department in order to streamline processes to work for the benefit of their patients.
Ascension had a Transfer Center in place, along with their physicians' answering service, physician practice office scheduling, a consumer care line, a regional resource team and remote patient monitoring. These entities were spread across Indiana so the first step in the Health System Command Center journey involved figuring out the synergies between these different groups.
The implementation started with their largest, most complex facility, ensuring that every aspect of the technology, including Capacity Management Suite, was being fully utilized.
Unit performance is shared at a monthly throughput meeting and metrics are also shared with the executive team on a daily basis.
Executives were highly supportive of the initiative since it was helping “shorten the distance” between hospitals, bringing them under one roof and making them feel like one health system rather than a bunch of hospitals. The over-arching goal was to get the right patient in the right bed, at the right time, at the right facility.
An initial challenge—and eventual success—involved the silos between the different departments. Now everyone from the CNO to the transporters knows how the system works and the role they play in order to make everything work successfully.
Chris Wagoner, RN, BM, BSN, CPHQ, is the Regional Director|Clinical Service Line for Ascension Connect, Ascension’s centrally managed, patient placement center. In this role, he is responsible for directing operational efficiency and improvement to meet financial targets and performance measures; collaborating, planning and organizing staffing to support operational objectives; and developing positive relationships in order to implement quality improvement initiatives and enhance physician, patient and associate satisfaction. Ascension is a faith-based healthcare organization dedicated to transformation through innovation across the continuum of care. As the largest non-profit health system in the U. S. and the world’s largest Catholic health system, Ascension is committed to delivering compassionate, personalized care to all, with special attention to persons living in poverty and those most vulnerable.
Susan: Chris, just to start off, could you give us a little bit about your background and a brief summary of Ascension?
Chris: Absolutely. My background, I started in health care about 15 years ago, as a nurse. I started in a critical care ICU as a student nurse, and sort of got my feet wet. Went on to a post-surgical ortho unit for my first job.
From there, I went on to the ER, which then moved me into a health supervisor role, at about a 400 bed hospital on the night shift. I was a night shift person, really loved that. We are a different breed of people, I will say.
From there, I moved on to management at a critical access hospital. What I learned there was ... I got to wear many hats. At that place, I got to do ... run a med-surg unit, which also was a swing bed. I also did utilization review. I opened up an infusion clinic. I was also the Director of Quality there. I got to do a clinical informaticist there as well, again, wearing many hats.
As you move through your journey, you wonder, "How do I get into these things? This is not where I started."
From there, I moved on to ... came to St. Vincent, or Ascension, to be quality and risk. I was Quality and Risk Coordinator for about a couple of years. A job opened up in trauma, so we were going for our Level 1 Certification. I was actually the Performance Improvement Coordinator for that, as we moved into that. I helped shepard in ... us being a Level 1 trauma center, which was great experience. It got me still in the quality safety role, but then also sort of back at the bedside because I could part of the codes. I could be back in the ER, back at bedside helping to drive that change. That was very exciting for me.
After that, it was sort of, "Well, now what do I do?" My former boss said, "Hey, there's this opening in the Transfer Center," which had been opened at that point for about ten years and said, "Hey, do you want to run the Transfer Center?" I'm, "Okay, sure I don't know anything about it, but I'll be glad to do that."
Did that for about a year and then we moved into our Command Center. The Transfer Center then became part of the entire Command Center. Then I was moved into a Regional Director role for that. I have, not only the Transfer Center, but I'm also responsible for doing our centralized telemetry. I'm standing that up.
We are also doing e-sitters, so our remote patients sitters, there's that. I also have our communications, so we're actually moving to the Volt phones for our platform for all hospitals at St. Vincent. We'll have one standard communication platform, so I'm helping with that project as well. It's been quite a journey.
Susan: You're very busy.
Chris: Very busy, very busy, so all that to say.
About Ascension, it's the largest national Catholic health organization. Several systems in each state. St. Vincent Health in Indiana being one of them. We're comprised of 17 hospitals and that's part of the TeleTracking work. I'm helping to bring all of those hospitals online, into the Transfer Center utilizing the application.Susan: Terry Rich had shared a little bit-
Chris: Oh, yes.
Susan: ... about the One Ascension plan. Chris, obviously 17 hospitals is a lot.
Chris: It is.
Susan: What challenges were you facing that lead you to decide to embark on a Command Center journey?
Chris: That was actually the vision of our CNO at the time, and literally it was on the back of the napkin deciding to be part of that journey. Having that idea of centralizing ... because the whole idea of what you mentioned before on One Ascension, that's looking inward at, "How do we combine our support folks, our clinicians, our IT department? How do we bring all of those people together to work as one for the benefit of the customer and the patient?" As we embarked on that it was just a natural progression that we would, of course, bring in the idea of a Command Center. The challenge, of course, being what services? What does that look like?
The Transfer Center was already kind of in place. We were part of what was known as the Contact Center at the time. We had our physicians' answering service. Some of our physician practice office scheduling was there, as well. We also had our care line, which was our consumer line, but they get calls about anything. Bringing them into the Command Center was, of course, a no-brainer. Then we also had the regional resource team. We had our remote patient monitoring, our patient navigators. There were all of these sort of disparate people who were just sort of spread across Indiana. Sort of bringing them in under one roof and figuring out, "What are the synergies between these different groups?"
Of course, we moved in, in about September of the past year, so we've only be housed together for a short time. Already trying to figure out, "What is it that I can do with this group over here, so that we can make that transition and access to care for the patient as seamless as possible?" From everything from, "I'm sitting at home and I want a virtual provider appointment. I need to make an appointment with my primary care physician" all the way through, "I'm now in the hospital. How do I get to the hospital? How does that become easy? How do I help with the discharge process?"
Then getting people back home and how are we monitoring them, so that we can reduce re-admissions. Trying to look at the Command Center as touching the patients' experience at every point on the continuum of care.
Susan: Neat, thank you. Obviously, to go live, it's not every facility-
Susan: ... simultaneously. How did you determine which facilities to start with?
Chris: We decided to start with our largest facility. Moving on from there because it's the most complex. Trying to make sure that we utilize every piece of the application, so for EVS and transport and all of that, so that we could appreciate what it could do from a total big bang sort of perspective, if you will, for the large hospital. Then, obviously, we're doing it in a different way. We're going from the biggest hospital down to the smallest, down to our critical access hospitals. Utilizing CMS for those that need it, and then BMS for those critical access hospitals.
It was an interesting journey, I will say. Because, obviously, with a large center like that, it is a Level 1 trauma, we do have women's and children's services. Then trying to figure out, how do you take this great tool and make it work for not only the Transfer Center, but for also your largest hospital who's used to doing everything internally? We run our own house. We know how our patients are coming in and out. Then to sort of superimpose the Transfer Center on top of that with this application, now how does that narrate? That's been quite a challenge. We're still working through a lot of challenges because it's all in your approach.
I think it was good that we started with our largest hospital because I think we get a lot of appreciation for, "Okay, what it is we need to do moving forward with each of the other hospitals." Hopefully, the idea getting a little easier each time you go through, so yeah.
Susan: Now, with that decision, how did you get your executives on board and how did you engage the employees at the hospital?
Chris: The engagement of the executives was actually pretty easy because we already had the vision of the Command Center for us in Indiana at St. Vincent Health. We wanted to start bringing all of the hospitals together and utilizing the Transfer Center as a way to get them sort of under one roof, if you will. It was really a no-brainer the idea of TeleTracking coming along. Yes, there is cost savings, but it's also being able to really shorten, I guess, the virtual geographic map. Because from our hospitals, I think we're about four and one-half hours away from our most geographically located hospital. We're kind of spread across the state and so TeleTracking coming on just kind of seemed to shorten the distance and brought you under one roof and made you feel more like one health system rather than a bunch of hospitals underneath the health system.
The buy-in was great from the executives. They're, "Absolutely, this is what we need. This is the best thing for the patient as we're moving forward with One Ascension. Looking at, again, access to care. How we need to make it easy for the patient getting them as with TeleTracking, the right patient in the right bed at the right time at the right facility. That was our commitment, even before. Again, it was a no-brainer for us.
For the hospital, there are always challenges with different areas. I think its, again, all how you approach it. If this is a tool that helps you care for the patient in a better way and avoid those delays, avoid getting the discharges out late. I think it's all how you sell it. Because, I think, as nurses we kind of like when we're told, "Well, this is what you're going to do." "Oh, really? This is ... okay well, we'll see about that."
You sell it as, "This is a partnership, so as have been onboarding hospitals, one of the things that I have been talking with the leadership about or even the front-line staff as they've gone through TeleTracking training. I go behind and talk about how TeleTracking works in context. The training they get ... the nurses get their training, EBS gets their training, so on and so forth. Then having sessions that say, "Okay, this is what for Ascension this means for us. This is how you fit into the big picture." I think giving them the context of, "You are part of a whole team that is driving change and is also driving the access of care and the efficiency of care to the patient." I think that makes them appreciate it more, and so they're getting a buy-in. To the ... This is a positive experience and we're all in this together. I like to tell them, "Yeah, you're a new hospital. You're coming up on TeleTracking, however, we're new to this application tool. This is a tool that we are both using." Help us help you get the patient what they need.
Susan: Great. We had touched on it, about the goal of becoming One Ascension. Can you explain a little bit about what that is and how you plan on achieving that goal?
Chris: Absolutely. The real goal, again, is getting every point across the continuum of patients having access to care. It's also driving ... keeping the patient in a community-based health access. Looking at using our systems as a patient has access. They can go into the community. They can go into the urgent care. They can see their provider close to home. Then if they need to go to another facility for surgery or what have you, get them to that facility that offers that service. Then think about, now get them back to the community for rehab or an extended care kind of an aspect.
The journey for One Ascension is, again, the patient having ease of access to care at any point. Then keeping them as close to home as possible while you're trying to give them ease of access. Bringing in our IT department and our ancillary departments, supporting the clinicians. For us in One Ascension we are looking at, from the IT perspective, not having 15 platforms in every different hospital for every ... There's this free-for-all for buying as far as software, "Well I use this EMR. Well no, I use this EMR. I use this financial system." What's been really nice for us is that we are already one system in Indiana that we have one financial system. We have one EHR, so when TeleTracking comes on, it's a whole ... it's easy. I don't have to keep reinventing the wheel from a software perspective or an IT challenge because those barriers are being removed because of the One Ascension journey.
Susan: Great. Now that you are live and you have some experience under your belt. I understand seven hospitals are live right now. What lessons have you learned from the process and what are some things, now looking back, you're, "You know what? If I could start from scratch, I would do this differently this time."
Chris: I think one of the big key pieces we missed in the very beginning was physicians. Getting onboard with the physicians. They are a player. I know in talking with physician folks here during the last couple of days, people are, "Well, the physicians just came along onboard." For us, there really needed to be buy-in, especially at our specialty hospital for cardiac. They really needed to be part of the journey because they're so integral to the workings of that hospital. I think that engaging the physicians ... Also one lesson we learned was, again, giving context to the clinicians and the people who were going to be utilizing the tool.
We did not do that with the first campus with our main campus at 86th Street. Then we learned, of course, that nursing and different departments are working in silos. We really appreciated that when we got to our specialty hospital because it's the universal bed model. At that facility, everybody from the CNO clear down to EVS or transporter, knows how the system works and what the nurse's job is, what the physician's job is. I feel we kind of missed the boat because we didn't give that facility the context. Nurses had their training, EVS had their training. It was a big struggle because it's, "Well, but I'm just doing that." Well, by doing that, you don't understand the down stream effect of what's happening. They kind of got lost in their own processes. They had sort of this go live paralysis because they couldn't even manage with their old process because they're, "Oh, this is new and it's different and I just don't know how to function."
After that, we learned we have to give you, "This is what this means." Since then, I think, it has been very successful. We brought our second largest hospital on as well as two other large facilities. Again, we're kind of decreasing in size as we go. The concept is the same, and I think it's led to more easy go lives. We're not having the pushback. We're not having the type of calls. We're not having that go live paralysis that we did have in the beginning.
Susan: Do you have any plans to do some ... I guess I would call it outbound marketing, to physicians about the benefits of the Command Center?
Chris: Yes. We're actually going to be doing that when we roll out CAP. For our St. Vincent Medical Group, which is in Indiana, we are going to be rolling that out to the physician offices. Letting them know instead of making a phone call, you can use this application. Then sort of bringing in the idea of TeleTracking and the Transfer Center because right now they're so used to calling our transfer line, which they've known for 11 years. In their mind, I'm still calling the same number. I'm still getting the same kind of service that I had.
Then having the understanding of, "Well, there's this whole other system that's behind that you don't even know about." So far our SPMG provider scheduling, they sit right in the next room. Their patients are calling in to get an appointment for the practice in a room right next door to the Transfer Center. They probably don't even know that. The physician's answering service when they get paged at night, those folks are sitting right next door to us as well.
Our challenge is to find what are the synergies between all of those groups so that, again, we can make it easier on the patient to get whatever they need. Also, to help the provider get what they need as well. Trying to centralize an on-call schedule because, again, we have different on-call schedules. Again, these are the providers. Selling that as the Command Center is going to try to make your life easier because we're going to one platform. Again, One Ascension, one sort of platform to use, one vision.
Susan: Wonderful. Are there some early metrics that you're really proud of?
Chris: We're struggling with data right now, of course, with things being new. I think our ready to move at our main campus has gone very well. I think we're not seeing the impact of discharges like we would like to have seen. Everybody here struggles with that. That's ... Our efficiencies of intake, as far as from the Transfer Center perspective, we have ... we were on paper before we went to TeleTracking.
It was a very easy transition, but we actually did a test of ... a test call and we had one nurse who was on the paper and we had one nurse in front of the computer. As soon as they picked up the phone and were doing the intake, one was writing, one was typing. The one that was typing was done in a fraction of the time than the one who was writing. It proved to the nurses in that instance, this is going to be more efficient for you. Our initial call to acceptance time of the provider has been reduced greatly. We are very proud of that as well.
Susan: Fantastic. Do you have any questions?
Chris: With the product and what it could ... can bring. Talking to my peers here the last couple of days, thinking outside the box because ... I think that's a great thing for these engagement summits because yes, there's networking. There's also this out-of-the-box thinking because you guys provide a product that says, "Okay, this is what this product was intended for." Then in order to make it work or to think outside the box for an operational perspective, I might come up with a way to use that tool in a different way that you guys didn't even think about. It's, "Oh yeah, I guess you could use it for that." I mean, great takeaways from this kind of thing. I very much appreciate the opportunity.
Susan: Wonderful. Thank you very much.