Transformational Change Driven by Centralized Patient Placement

Intro: On today's episode of The Patient Flow Podcast, we welcome Betty Sopko, IT Manager of Business Applications at University Hospital Health System in Cleveland. Betty manages 11 IT professionals who support a variety of applications. She recently relocated a transfer center and discusses the IT phase of this undertaking. Lets listen in.

Betty: Our initial transfer center that we had located down at our flagship hospital, Cleveland Medical Center, was in a very confined place, on the 12th floor of one of our towers. And as we move toward centralizing patient placement, we knew that we were going to need a larger area in order to accomplish that.

In order to do that, we needed a location that was neutral. So by neutral I mean, not necessarily associated with the flagship hospitals, and that our community hospital presidents were comfortable. There was a lot of angst at the beginning, thinking that the community hospitals would not get any of the volume and it would all get sent straight to the flagship, if it was there on site.

So as a result, we looked for a neutral ground. An off site premise that was able to accommodate the size that we need for a health system of our size. As well as, we needed to get a great design, and figure all that out.

So, for that neutral location it is several miles away from that flagship hospital. We built it out. Design was of utmost importance. Our VP was very much engaged in the process. We also, as a result of that, were bringing in and doing placement for all of those community hospitals as well as, we were expanding too. In addition to that, we started utilizing additional applications for that.

So, we did their placements at that new centralized placement, which dealt with a lot of training. As well as bringing in the community access portal application for TeleTracking, which would help with bringing in patients from outside the health system.

It was a large change, and there was a lot of training involved. There with us as well, in order to accommodate that larger volume, and to shift away from the nursing supervisors at the community hospitals to do the placements, and having this centralized patient placement do their placement for them. There was a lot of training that was also required.

It was imperative that we kept the peace, that everybody was happy with the decision and the location, and everybody felt that their needs were being met.

Susan: Betty, I know as part of this you set up product action groups. And that there were four categories. How did you determine those categories, and what did they address?

Betty: The premise behind them was all lead by our Valued Improvement Program, as well as a high reliability medicine initiatives that were health system wide. I'd like to say that we came up with them on our own, but we did not. A lot of that was driven by the executive leadership as well as these initiatives.

The first one was accommodate a “just say yes” environment. That dealt with always accept the patient and we'll figure it out. We've got the capacity. We just need to find out exactly where they need to go. So just say yes was also an effort to increase those volumes.

Secondly was the increase the placement of low-acuity patients out at the community hospitals. So, instead of having everybody that came into our flagship, Cleveland Medical Center, the thought was for lower-acuity patients to go and move out to the community hospitals. Therefor increasing their volumes as well as, by allowing the sicker patients to be done at Cleveland Medical Center, which in turn, increased our case mix index as well as, having those sicker patients right there at Cleveland Medical Center.

The third is about the centralization of patient placement. Move that away from those community hospitals. And all the hospitals had their various nursing supervisors doing the bed assignments. Instead, have that be centralized and get more efficiencies out of the process.

And then finally was to implement bed management, and analytics. With the expansion of TeleTracking XT, we also contracted for patient flow dashboards. Each of the hospitals that are part of our health system all have their own dashboards for the various components of TeleTracking. It was very important that the visibility of the performance was there for the executives at a click. Anyone can see it!

Patient flow dashboards within University Hospital's health system is right on our internet homepage. Anybody can click on it. It doesn't matter if you're an environmental service worker, or if you're a transporter, or the CEO. You can see the progress that the various hospitals are making.

Susan: And that has really helped engage everybody across the health system. You all have access to that data.

Betty: Absolutely. Patient first and the visibility is there. And everybody can see how everybody's doing. It's almost like a competitive type thing. You know, you all want to do better and strive to do better, and it's right out there for everybody to see.

Susan: With any type of change, there's certainly a financial aspect to it. How did you determine what your target was?

Betty: The target was developed through our operational effectiveness team here at University Hospitals. As well as the vice president over patient access services. They came up with the number that they'd strive for, calculated out on exactly how many patients they were going to target. Then they used those numbers to meet their goal on, I believe it's for 2017, it's targeting to $7,000,000 savings with the efficiencies brought on by these changes.

Susan: Betty, how was it like to collaborate with TeleTracking? And how did that collaboration help feed into the critical success factors that you were identifying?

Betty: The partnership that we have with TeleTracking has been just phenomenal. We've had TeleTracking at University Hospitals for many, many years. Small footprint, mix mode, legacy, XT. We've grown a lot.

Along those lines of getting everybody on the same platform, as well as expanding it out to all of our hospitals, including our five new expansion hospitals that we've recently purchased, the collaboration with TeleTracking has been pivotal for that.

Besides the great teams that we had from an implementation perspective, and our project management, we were also contracted with TeleTracking for advisory services. They come to our hospitals on a monthly basis. We have visits. We work with the various leadership teams across each of the hospitals. So, whether we're meeting in person on a monthly basis, or virtually, some they do calls, they're very active and involved in their patient flow councils at each of the individual hospitals.

As well as at the onset of our advisory services engagements, we did three separate sessions. One for strategic planning. One for discharge readiness, and the third for precision patient placement. We've had, just great success. I think it brought to the forefront and really enforced. I think everybody from an executive level understands that patient flow is important. I think that the advisory sessions, especially from the strategic one, brought executives in from all the hospitals. They all attended. And I think it just really illustrated and just put it in front of them. That they could see how important it was and how it's just important for the system as a whole to be successful.

Susan: Well I imagine, too, having that constant input, you really were able to just maximize the capabilities of the investments that you were making.

Betty: Absolutely. I think the main thing is the visibility. Having that visibility. That coupled with the dashboards and they can see the improvements that we're making, as well as having the patient flow council meetings that report up through those executive leaders. They see what's happening. They see the engagement, as well as they see that we're not overcrowding in our ED. We don't have as much surge as we used to. And that we're trying to get ahead of that.

Susan: That's great. And I imagine, there's also an impact on patient satisfaction. People are being seen sooner, and getting through the system sooner.

Betty: Absolutely. No one wants to sit in the ED, waiting for a bed.

Susan: Betty, how are you taking the predictive capabilities that are available, and integrating that into your patient flow process?

Betty: Besides the patient flow dashboards that I mentioned before, we recently contracted for predictive insights. So through our value improvement program, as well as our high reliability medicine initiatives, there was a need or a desire for some type of forecasting tool to use for patient flow. So we started looking around, and low and behold, TeleTracking was working on a new venture with Hospital IQ, and so we've contracted now for predictive insights.

So there's three different use cases that we're contracted for. One is for perioperative, kind of smoothing out the schedules from a perioperative perspective. The other is for a census. So staffing from a census perspective. As well as for surge control. All those components together are factors from our patient flow perspectives.

So the whole thought is to get ahead of surge, before it gets you. So, we are still in the building out phases of that. Periop is pretty much squared away, and the other two initiatives, the other two use cases are well on their way. So hopefully up by the end of the year.

We believe that that forecasting tool, that coupled with our patient flow dashboard use, definitely help us from a projective or predictive perspective.

Susan: Betty, could you talk about the results that you're seeing, and how you're sustaining that success?

Betty: I'm proud to say that I have a fantastic team of three TeleTracking support analysts that work for me in the IT department. We do our best to make sure that we're accommodating the health system from a training perspective, a re-training perspective. We've just got great feedback from our hospitals, from our support teams, that just lean on us all the time.

Also, along the lines of maintaining what we've developed. We have monthly patient flow council meetings at each of the hospitals. TeleTracking Advisory Services will attend several of those if they're able. We bring back that constant, that continuous improvement there.

So, issues that they've uncovered in their process. We also have them at each individual hospital, as well as the individual hospitals feed up into the system patient flow council meetings as well. So we're able to vet issues amongst the hospitals. See the commonalities, and then address it based on the experience of the other hospitals.

I think the monthly visits help keep the whole patient flow initiative highly visible. Every month they're participating in calls with the customers as well. And they customers are not necessarily just the folks over in our central, our CPFM, it is across the nursing community. It's with environmental services, it's with transport.

In addition, we have the executive leadership are still very much engaged. They lean on us. They're constantly back and forth with us, and we provide them various reports that they can take action on, the day that within the report. So, I think that that just helps that cycle continue. You know? They're getting viable data. It's good data and it's actionable data. And I think that that just continues to make adaption and the go forward solutions just stick.

Outro: Thank you for listening to the Patient Flow podcast powered by TeleTracking. We take pride in bringing you insightful conversations with the leading experts in patient flow, as well as tips on industry best practices to help ensure patients get the right care in the right place at the right time.