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Kim Whitley, Vice President of Patient Logistics & Care Coordination at Phoebe Putney Health System in Southwest Georgia shares how facing high census, low system-wide transparency and significant throughput challenges Phoebe Putney launched a Health System Command Center. By quickly assembling a core team and engaging senior leadership, Phoebe went from not having any system-wide transparency to seeing a significant decrease in diversion hours [from 622 hours in January 2018 to 98 hours in January 2019], pending patient discharge compliance [up to 48% in the first month], along with a significant decrease in EVS response times [down from 40 minutes to 24 minutes in the first month]—just a few months after going live with TeleTracking.
The key factor for driving success was the high-level of engagement from executives. They made it clear that the Health System Command Center project was Phoebe’s single most important strategic initiative.
A cross-functional team that included IT, care management, process improvement and nursing met two or three times a week, for at least two or three hours to identify the key priorities for launch and the things that could be phased in after the go-live.
Two of the most successful areas to date are Transport and EVS. Transport grew from an eight-person team to a 21-person team—and are achieving best practice turnaround times. The EVS team is also doing well, leading to a reduction in diversions and an increase in access.
Next steps in the Phoebe journey include improving the number of discharges by 11:00 a.m. and identifying pending discharges 24 to 48 hours in advance
Vice President Patient Logistics & Care Coordination
Kim Whitley is a registered and Vice President of Patient Logistics & Care Coordination at Phoebe Putney Health System, a not-for-profit facility in Southwest Georgia. Whitley is responsible for the command center, case management department, palliative care, and care coordination outside the walls of the hospital. Prior to her current role at the Pheobe Putney Health System, Whitley held positions as a staff nurse at Emory University Hospital and Navicent Health, as well as managerial positions within Georgia Medical Care Foundation and Navicent Health.
Speaker 1: What challenges were you facing at your health system that led you to decide to begin [the command center concept]?
Kim Whitley: About a year ago, January of 2018, there was a total gridlock at the hospital. There were probably 20 patients waiting in the emergency room. They'd been waiting for a while to go up to the floor. There was just absolutely no movement anywhere, it was total gridlock. They got a group of senior VPs, and VPs, and directors in a room to try and figure out how and unstop the gridlock and realized that by focusing all those resources from different areas and that focus, that they were able to unstop the gridlock. But it took a lot of work because the first thing they realized is there was no transparency. They didn't have any idea what was going on, what beds were available, who was going home, all that.
Kim Whitley: Obviously a senior VP director model is not sustainable. They decided to launch into a discovery on what's out there in the nation to address this issue because certainly they couldn't be the only people that were dealing with this. [They] started reading about command center concepts and technology and came across TeleTracking. TeleTracking came and gave several demos. They went on site visits. [They] did a lot of research, a lot of investigation and decided to go ahead and move with the TeleTracking concept and the command center concept. It started out as a journey, still is a journey. I came to work there in September. I'd already had 26 years of previous patient flow experience at my other facility. That's what they were looking for, somebody that could help lead the effort. That's how they decided to do it. They were all in from the CEO, to the board, to the hospital authority. Everyone was committed to making this work.
Speaker 3: Can you talk about how you rallied the troops to really focus quickly?
Kim Whitley: When I first came, we still had not solidified the contract, and so we were still waiting for the signatures. Obviously my first month there, so I was trying to figure out what do we have. They had a transfer center at a very remedial level. Our system that we had was not our EMR. Had a bed component, but very, very elementary.
Kim Whitley: I can tell you the number one key factor for driving success was the executive engagement because this was the single most important strategic initiative. The message was sent out that, this is important, and you make time for it, and you make it happen. If you're confused about whether or not you should make it happen, then come to me and I'll help you determine where that confusion is, or is there something on your plate that needs to be moved off. That was the first thing. Then of course my purpose was I was hired to run the project and bring it forward.
Kim Whitley: It was quite a journey. We had a team that met two or three times a week for at least two or three hours. We had a whole list of things that we knew we had to do. We had IT at the table, care management, nursing, of course the transfer center. We had executives there that attended. We have a very, very highly developed and robust process improvement team that does all Lean Six Sigma. They were drivers on the process too, which helped a lot because we could identify those things we needed to do right away and those things that could wait till after we were live. I think that basically was the driving force of how we'd do that.
Kim Whitley: We had very engaged people on the team. We had people that were very committed to making this work and wanting to work. We didn't have as many people that were naysayers, if I could use that term, as what I thought we might have.
Speaker 1: Well, it says a lot about your team that you were able to deal with any of that negativity.
Kim Whitley: Yeah, right. We got it done pretty quickly. It was a very important initiative for us to do. We wanted to bring it up at a time when we were at high capacity, which is always flu season for us in the hospital, although to tell you the truth, flu season is over with and we're still at very high capacity. I think those were the driving forces.
Speaker 1: That's a big cultural shift to do something like this. How did you manage that piece of it?
Kim Whitley: We tried as much as we could to have people work in committees because outside of the three days a week that we worked, we had several committees going on. We tried our best to bring more people in to what was going on so that they understood what we were doing, why we were doing it, and it wasn't just something that we were forcing them to do. From the very first meeting I had at our leadership council, which is where all the directors and managers are, I gave them the best practice document from TeleTracking and the metrics of what we were trying to achieve. From the very beginning, everybody knew this is where we're going, this is what we're doing. I think it was communication and feedback that helped. Now, was it perfect? No, because today we're having our challenges with the change management process. But I think that's why we were able to get things off the ground quickly and then be able to have a lot of process improvement around that.
Speaker 1: That's great. Since you have been live, are there some early results or early successes that you can share with us?
Kim Whitley: I think probably one of our most successful areas is our transport. We went from a 8-person transport team to a 21-person transport team. We got the buy-in and the approval from our administration to hire that many people, and we were able to hire enough people. Their turnaround times are way below best practice. They're just really doing well meeting best practice or better. Our EVS team is doing pretty well. They're turning their beds around in anywhere from an hour and 15 minutes, hour and 7 minutes. They're doing really well. We have reduced aversion at our facility. We've been able to provide more open hours, and of course that provides more access to our facility.
Kim Whitley: We're struggling a little bit with the pending discharge piece and the discharge workflow piece. Getting that discharge time out the door from confirmed discharge to out the door is still higher than what we'd like it to be, but we've had some visits from the advisory group from TeleTracking that's been very, very helpful. Our last engagement was the whole discharge readiness process. We have four teams that are working on the different components of that. We are seeing a little bit of movement in that. Not as fast as I'd like to see it, but it's going well.
Speaker 1: Right. I think you're seeing that movement. It is a big cultural change.
Kim Whitley: It is.
Speaker 1: Incremental progress.
Kim Whitley: It is.
Speaker 1: What are some of your next steps?
Kim Whitley: We signed the contract for Clinical Workflow Suite. That's on the docket to get that going. Our major focus right now is nursing engagement and improving discharge because the rest will seem to fall in place. We've got to improve getting patients out the door, identifying them in advance and moving that discharge time from late in the afternoon to earlier in the morning. We have seen some successes in improving our discharge by, we're looking at 3:00 instead of 2:00. We are seeing those numbers go up; however, our focus now is on discharges before 11:00 because we're not performing well at that at all.
Kim Whitley: Right now, our three major focuses are discharge by 11:00, identifying those pending discharges 24 to 48 hours in advance, and then looking at beds dirtied by transport. We have a nursing leadership group that meets every other week. We started that last week, or the week before last. They know what the three major initiatives are. They have to come in and present their metrics, and their action plan, and their barriers, and then their solutions. We're hoping that's going to drive more nursing understanding and engagement so that we can move those numbers.
Speaker 3: Can you just give us a sentence or two about who you are, your role, and a little bit about Phoebe Putney?
Kim Whitley: Well, I'm Kim Whitley. I've been a registered nurse for a long time. I am the vice president of patient logistics and care coordination. I'm responsible for the command center. I'm responsible for the case management department, which is utilize management, discharge planning, social services, social work. Then I'm also responsible for palliative care, building the palliative care program, and care coordination outside the walls of the hospital. Phoebe Putney is a not-for-profit facility that's in Southwest Georgia. It is the only facility in Albany, Georgia and one of the larger facilities in Southwest Georgia. We take a lot of transfers from other facilities into Phoebe. We have women's services, we have a NICU. We are not a designated trauma center but are working towards that designation and should have it within the next year or so because we treat trauma patients. We're just not designated.
Kim Whitley: We have a North Campus, which is located in the city, and then we have a hospital in Sumter, which is Americus, Georgia. It's called Sumter Regional. Then we have one in Worth County. We have those hospitals, and then we manage another hospital of Southwest Georgia that we manage, that we don't own but we manage. We do have that system. Like I said, we are one of the larger hospitals that's in the Southwest Corner of Georgia.
Kim Whitley: I previously worked at a organization for 26 years that I did patient flow. My story is that I had TeleTracking at this other facility when it was bed tracking, standalone DOS computer. That was it. We'd know when the bed was dirty, when the bed was in progress, and bed was clean. [We} have had a long track record with TeleTracking. It is one of the best technologies. I think what is so amazing about TeleTracking is how relevant the company has made itself from the standalone bed tracking system to what you have now, that you have client engagement sessions like this so you can hear what we need as a client, what we need to make things better for our patients, safer care, and more efficient care, and then you do it. It makes a big difference.
Speaker 1: If you had one piece of advice you could give somebody who's considering starting this, what would that be?
Kim Whitley: Don't go live in three months. That was a huge undertaking. It's never going to be a perfect go live, so don't think that it's ever going to be perfect. You just have to rip the bandaid off and go. I feel like I wish we had more time to have spent on training because that is such a foundation for use of the system. Don't let the perfect get in the way of the good. Just move forward.
Speaker 3: Good. Thank you.
Kim Whitley: You're welcome.