As a traffic engineer in San Diego, Deena Smith’s job was focused on improving processes in order to create safer, faster traffic patterns. She loved what she did, but after 18 years as an engineer she made an abrupt career shift, earning RN and MSN degrees. Today, as a Nurse Manager at Sharp HealthCare, her former life experiences are being put to use improving patient access and helping Sharp with its Centralized Patient Placement Center―where she led a nine-month, phased rollout of patient throughput initiatives at four acute care hospitals with a new team of bed coordinators.
To migrate to a centralized model, leadership across all departments and all hospitals within the system need to be in lockstep. It’s essential to do the hard work to educate, inspire and inform leadership so that they in turn will inspire and encourage the individuals in their departments. This can be accomplished by creating a structure that fosters communication and accountability at all levels of the organization. From the COO to the charge nurse, every stakeholder involved in patient access has easy access to the Command Center staff for support and advice. And everyone in the Command Center―from the vice president to the bed coordinators―can then share outcomes, produce actionable data and answer questions. There is also an open-door policy―so any clinician can drop by unannounced and sit side-by-side with a coordinator so that they can understand patient access operations from the coordinator’s enterprise-wide view of each hospital at Sharp. In addition, leadership routinely attends unit-based staff meetings and retreats―giving them a chance to spread the word about the behind scenes orchestration of the Command Center.
A key to success at Sharp was the level of collaboration established across all departments involved in improving patient access―including environmental services and patient transport―as the team began the journey to centralizing patient placement processes. Being able to see in real-time the status and availability of all beds across the system was as critical to improving patient access and managing capacity as understanding the needs of the next incoming emergency patient.
A robust technology platform that measures each step in the patient access and throughput processes produces actionable data that makes it possible to reliably identify targeted opportunities for improvement. The data generated through Sharp’s Command Center makes it possible to address emerging problems in real-time―while also tracking trends for long-term planning. The transparency that data brings reveals problems without partiality or bias, making it much easier to get buy-in for process changes at the staff level. Sharp is very intentional when it comes to using data to highlight both the successes and the opportunities for improvements in patient access.
Transparency should be the standard when establishing a centralized model, with information easily accessible for everyone involved in patient placement―from transfer and admissions to discharge―across all campuses and locations.
This kind of transparency takes many forms. TeleTracking dashboards are available to all users on the Sharp Intranet―so anyone from the CEO to environmental services can get a real time view of performance at all four hospitals. In addition, leaders receive reports that break down patient access and throughput performance into six distinct intervals. This trend-based data is then used in the development of focused improvement projects. Once underway, these unit-based projects are supported with detailed, actionable data at every step―from baseline to project completion. At the close of the active project, analytics subscriptions are routinely sent to unit staff―making it easy to both spot when metrics are drifting and address the situation before process improvement gains are lost.
Effective patient placement decision making requires individuals with emotional intelligence and the right set of skills. Look for individuals with a strong interest in process as well as direct bedside experience as they will have a fresh understanding of the impact that processes have on patients. Embrace diversity of perspectives by including nurses from different disciplines as part of your command center staff.
A centralized model requires a willingness to change entrenched and comfortable processes on the part of nursing and administrative staff. This is challenging, and under times of stress, both sets of individuals will look to migrate back to old way of doing things. Leadership is critical in promoting best practices and instilling trust, in addition to a two-tiered distribution of data, with trend data going to leadership and detailed daily data going to staff. Combined, this contributes to a successful transition that benefits both patients and the bottom line.