Accountability and Transparency
The consultants met with YNHH leadership team on a weekly basis. The Steering Committee navigated much of the work. The consultants presented what had been done last week and what was going to be done in the next two weeks. Teams used dashboards, targets, and reviewed variances for identified performance measures. (See Exhibit 1 for excerpts from the YNHH Executive Throughput Scorecard. This scorecard tracks throughput for the week ending 11/06/2010).
Units and departments reported to the Steering Committee followed templates, and set desired outcomes. For example, 11:00 AM was set as the target hour because this was a time when the OR, the PACU, and the ED got congested with patients were waiting for treatment on the floors. The goal was to increase the percentage of patients being discharged earlier rather than to change the hour of discharge for all patients.
The median patient discharge time was moved from 3:00 PM to 1:30 PM.
YNHH has achieved significant results in increasing throughput without adding staff positions. Patients benefit by being in the right bed at the right time.
The Steering Committee was chaired by a respected physician and half of the members were physicians, ensuring buy-in. Data shows that patients were waiting less for needed treatment on the floors as a result of new schedules and targeting. And success in reducing wait times built support for changes in physician schedules. Transparency and accountability was accomplished largely through the formation of a strong Steering Committee with ultimate decision-making authority for the initiative.
Extra resources, both externally from the consultants and internally key staff temporarily reassigned were essential in implementing new methods which spanned many departments and involved major changes in schedules and work flow. Sustainability was assured and implemented before the external and internal consulting services were withdrawn (although they are still available as needed).
To ensure continuity of the SPF initiative, senior leadership has instituted regular meetings with accountability for results going forward as YNHH tackles new areas for improvement. One such area is a transforming patient care initiative. YNHH nurses familiar now with the safe patient flow methodology, trust that the new initiative will not primarily focus on cost cutting.
Richard D'Aquila is Chief Operating Officer, Yale-New Haven Hospital; Peter Follows is President, and Michael Zaccagnino is Managing Director, Carpedia Healthcare; Anthony R. Kovner, Ph.D. is Professor, NYU Wagner. The authors would like to acknowledge the contribution of Sandra Bacon, Director Operations Support, Yale-New Haven Hospital, for her contributions to the authors regarding the content.