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Private Sector ACO Models Rooted in Rugged Individualism

Philip Betbeze, for HealthLeaders Media, September 13, 2011
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Physicians there preferred block scheduling elective surgeries, she said, but that wasn’t working very well at St. Luke’s—even with 42 ORs available. Implementing block scheduling, which allows physicians to do several cases in one block of time, wasn’t perfect.

“In outpatient operating rooms, 87% of the time was blocked. The optimal block should be 42%,” she says. “We had the ability to add 5,000 patients by freeing up these blocks.”

Physicians agreed to help find a solution that worked for all of them and the institution.

 “When you’re talking with physicians about block scheduling, those are really difficult conversations,” she says.

A sophisticated modeling software tool was used to weigh surgical demand against required resources, evaluate potential scheduling scenarios, and allocate block time in a way that meets surgeons’ needs while also accommodating new cases and flex capacity.

A team of physicians looked at many of the possible scenarios that the software presented, and collectively decided upon the most time-efficient schedule for the surgeons and the hospital as an organization. That helped with culture change, says Van Bree.

“They are willing to partner because it gives them greater control and, from a leadership perspective, causes them to ‘own’ pieces of this organization,” she says.

Concurrent work is progressing on moving patients efficiently through the organization, which should be both an employee- and a patient-friendly effort.

As Van Bree notes, the hospital “felt full” but actually wasn’t. By re-engineering the best ways for patients to be moved through the system, the leaders hoped to improve patient care and satisfaction, improve staff satisfaction, standardize employee roles, and improve communication across departments, hopefully yielding better decision-making and financial benefits.

Van Bree says care areas should be better able to prioritize how they take patients. For example, an inpatient might have a final appointment with radiology before being discharged. Yet that patient would still have to wait in line with many others in the queue, which might mean discharge is delayed by hours, or even a whole day. “If that patient goes first, we might be able to free up a bed,” Van Bree says. “There’s no way to tee that up right now, but a big part of this project is to take away that white space where we’re really not advancing patient care.”

Not only that, but this kind of work is likely going to lower the cost of any replacement facility that gets built, because the inefficiencies that exist now won’t be baked in, she adds.

“If you are in an old plant, you can’t avoid the question of rebuilding, but there’s an appropriate hesitancy for anyone considering big building projects right now. We’re trying to make sure that we’re getting improvements we need from operations and that we are not asking our board to fund inefficiencies in our system,” she says. “If cost per bed is $1–$2 million, the difference between a 750- and 650-bed facility … well there’s a lot of difference.”


This article appears in the September 2011 issue of HealthLeaders magazine.


Philip Betbeze is senior leadership editor with HealthLeaders Media.
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