"You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.” – Buckminster Fuller, American architect, systems theorist, author, designer, and inventor
I’m sitting on a train on my way to visit a client. It’s a twisting, turning ride that reminds me of all the twists and turns a journey to an optimal patient flow strategy can take. I’m also reminded of the faces of clients that feel incredibly challenged as they work to make a positive difference for patients and families, and I think of the ones that found the fortitude to keep going with this work of improving patient flow. They all know the importance of building the necessary foundation, and at the heart of it, an age-old saying that still rings true comes to mind, "It starts at the top."
Even the combination of dedicated team members, tremendous technology and the best of intentions, isn't always enough to take the first step towards improvement. That's because the day-to-day challenges that everyone faces in healthcare get in the way, and the less hour-by-hour attention we pay to patient flow, the worse it gets. Even in the face of routine and significant ED boarding, patient safety concerns, waits for post-op beds, disgruntled patients and burned out team members [I could go on...] consistent focus on flow remains elusive.
Sadly, at some point this current state becomes 'the new normal' for the hospital. That's when I hear, "Kathy, it's always going to be like this here - it's just what we do...we'll figure it out." It becomes a loop of leadership putting out the call for discharges, emergency bed huddles, texts going out to every physician within 85 miles of the hospital, and then miraculously by the 4pm bed huddle, the hospital has discharged 80 patients when only 50 were actually needed (causing one to ponder 'why now and not earlier, or even yesterday..').
“See Kathy, we did it again! I told you, it’s what we do.” My heart just breaks for these caregivers and the people they care for. I shudder to think about the patient safety and satisfaction implications of this furious activity―not to mention the possibility of readmissions. When every day is like this, dedication to patient flow improvement strategies diminish and team members become relegated to dealing with the lack of adequate open beds as a way of life―no matter how risky that may be. This is literally the perfect storm.
If you see early symptoms of this in your organization now―STOP! Don’t let this happen. Be proactive. If you’ve started your journey to improve patient flow, take the time to pause and self-assess. If you haven’t started―GREAT! Put processes in place now. These three critical components will help your organization build a solid foundation for ongoing patient flow improvement strategies―and your ultimate success.
Select an engaged, enthusiastic senior leadership champion for patient flow and capacity management (PFCM)―one who will not let you ‘give up’ and is a great cheerleader. Choose wisely and carefully. This leader must understand and be an advocate for patient flow, establish accountability for using standard processes, best practices and of course TeleTracking. This leader should also oversee the work of your Patient Flow Council. Breaking down silos, rounding throughout the organization and understanding that flow must be managed 24 hours a day/7 day a week should come naturally to this leader. Remember, it starts at the top!
Develop an active, dedicated patient flow council―this is the group that will govern all your work around patient flow strategies. Again, choose carefully. The Patient Flow Council should be interdisciplinary, engaged, action-oriented and led by the senior leadership champion. The Council should meet on a regular basis (no less than monthly) with a standard agenda. Membership typically consists of representatives from the following areas: leadership, nursing, medical staff, case management, environmental services, patient placement/transfer center, ancillary services and transportation. Other ad hoc members may represent information technology, quality or safety, or education.
Design a comprehensive patient flow measurement plan so that you can effectively track opportunities and successes. Determine the overall, key outcome (lag) measures for the organization, measures such as length of stay, readmission rates, patient satisfaction or ED boarding hours. You’ll then want to add key process (lead) measures, including metrics focused on the patient’s point of entry or discharge and key patient flow processes such as transportation, patient movement and bed turns. Targets and goals are established for each of these measures, with monthly reviews by the Patient Flow Council, and daily reviews by leaders.
There are additional building blocks that are needed to create a foundation for patient flow and capacity management, however these three are the most critical to support ongoing attention to patient flow strategies―and ultimately improvement. The earlier these decisions can be made―and structures put into place―the higher your chance of success will be. It’s never too late to start and it’s never too late to start over―but please don’t let me hear you say “it’s always going to be like this here. It’s just what we do…..”
While technology is important, redesigning processes and engaging people is hard work, TeleTracking's Advisory Services team—with a combined 200 years of experience—stands ready to help!
Kathy Menefee, DNP, RN, NEA-BC, CPHQ, Consultant, Advisory Services
Dr. Kathy Menefee brings extensive clinical and executive management experience to her role as a Consultant with TeleTracking. With hospital and health system experience in operational and support roles as a nurse for more than 30 years, she has been a member of executive teams in hospitals, post-acute, and community settings. In addition to serving as a member of senior leadership, her responsibilities have included orchestrating the acquisition and implementation of patient care technology, leading health system departments such as quality, service and safety, learning and organizational development, and process improvement.
Dr. Menefee’s experience includes leadership positions with small rural hospitals, large tertiary medical centers and health systems. She provided leadership for operational and support roles for more than two decades for Riverside Health System, based in Newport News, Virginia. A national presenter on topics such as information technology, healthcare quality and process improvement, Dr. Menefee’s doctoral work and professional passion is focused on the development and improvement of interdisciplinary approaches to care across healthcare settings. Her research has shown that approach to result in positive outcomes for the patient, care team and organization.
Dr. Menefee holds a bachelor’s degree in nursing from Shenandoah and James Madison Universities, a master’s degree in Nursing Administration and a Doctor of Nursing Practice from George Mason University. Dr. Menefee is also certified as a Nurse Executive at the Advanced Level by the American Nurses Credentialing Center and a Professional in Healthcare Quality (CPHQ).