There are Big Bucks in Better Patient Flow

Admitting there's a problem is the first step toward finding a solution. When was the last time your facility looked at your patient flow in each department? If it's been a while you are likely missing a serious opportunity not only to improve patient satisfaction but also to save serious bucks that can go directly to your bottom line.

Looking at your patient flow could potentially save you hundreds of thousands of dollars. In the case of St. Joseph, Missouri-based Heartland Health improving the surgery department patient flow garnered them over $300,000 in savings the first year ($283,000 in FY09, and $217,000 in the first six months of FY10), plus an 80-90% patient satisfaction ratings a 60% improvement in on-time a.m. start times (from the 71% range to over 81% each month), and greater employee satisfaction.

What did they do to achieve such lofty results? Well, according to Carolyn Paden, the service leader for surgical services and patient care at Heartland Health, it took the empowerment of the oversight committee to make and enforce decisions and a little help from another hospital. For years the oversight committee met and discussed utilization of the surgery department, but when it came to taking action, the group felt powerless to make changes. Consequently the surgeons were doing their own scheduling, and booking rooms for non-urgent operations well into the wee hours of the night.

"Having an operation at midnight or two a.m. is a big dissatisfier for patients, physicians and the rest of the staff. All the staff together agreed that we had to change," says Paden. "So when we starting focusing on patient experience at Heartland Health we knew that we wanted to move our scores up and improve our on-time starts."

Paden and her team reached out to St. John's Regional Hospital in Springfield, MO, for help. Its Level I trauma center handled about 25,000 patients annually when Christina Dempsey, BSN, registered nurse, and vice president of perioperative services was working there and making great strides in smoothing and improving their patient flow. Heartland Health invited Dempsey to come and speak with its lead physicians and surgeons.

"The only piece we have any control over is the elective schedule in the operating room, so we start in the operating room and finish in the ER. What we often find is that by spending the time, energy, and money focusing on the ER as the cause for all bottlenecks, you can fix [patient flow] the rest of the hospital," says Dempsey.

As Heartland Health began this process, Dempsey joined the Press Ganey Consulting Group as senior vice president for clinical operations, and she continued to work with the hospital in that capacity to help address their patient flow problem. Dempsey explains that when analyzing patient flow they look at three areas:

1. Queuing theory (the science of waiting) and simulations with operations, experience, and expertise.
2. Scheduled and unscheduled volume and ways to smooth the flow of electives patients through the hospitals.
3. Right-size simulations to ensure you have the right staff at the right time.

Dempsey and Paden determined that their first action was to separate scheduled and unscheduled demand. To do this they needed to review queuing theory data, which looks at random arrivals, known service rates, number of services (i.e., operating rooms) and capacity to accommodate urgent need.

Their queuing analysis showed that they needed to have one room for urgent cases, and allowed all the others to be scheduled for elective surgeries so there would be no gaps, bumping or delays. "So it reduced the overtime Heartland Health had, so they achieved more than their goal and they exceeded their targeted saving," Dempsey adds.

Next, the oversight committee created a set of scheduling rules and designed a block-room schedule. And, Paden says, to ensure the committee could effectively enforce the rules and the schedules they worked with the hospital administration so that any staff complaints or requests for exceptions with the new program were re-directed to the committee.

"Once we started blocking the rooms, we could see more cases, but it caused many of our surgeons to have to rearrange their office schedules," Paden explains. In doing so, however, the facility could schedule more surgeries during the day increasing revenue (note, revenue increase figures were not available), driving up patient satisfaction and reducing staff overtime costs by over half.

"We learned to staff to the blocks, which we didn't do at first. When we started doing this there was a huge change," she adds. "But by far, the biggest win has been getting the engagement of the physicians in the process."

Dempsey notes Heartland was able to save the equivalent of six FTEs and "make life much more predictable for the staff and physicians."

Equally important, the act of correcting the patient flow helped the facility save money and with more available time to schedule operations they will likely increase revenue along with patient and employee satisfaction. So, before you let your patient flow problems fester, it's time to step back and begin to analyze the flow—doing so may just be the best cost cutting effort you'll pursue all year.