The Exec: How to Address the Patient Capacity Challenge

In addition to adding beds, hospitals with tight capacity must focus on operations reforms and new workflows.

Patient capacity is the biggest challenge at University of California Davis Medical Center, according to the hospital's new CMO.

Joseph Galante, MD, was named CMO of UC Davis Medical Center in July. He previously served as interim CMO of the medical center for a year and trauma medical director of the hospital for many years.

"Like many health systems, our biggest challenge has been capacity," Galante says. "We are full. Unlike other health systems that have beds that are not staffed, we have staffed all of our beds."

A unique element of the medical center's patient capacity crunch has been California's seismic compliance requirements, according to Galante.

"We have had to close 70 beds over the past year," Galante says. "By closing those beds, we had to find 70 new beds to open in different locations throughout the hospital."

UC Davis Medical Center has had to do more than open beds to address the facility's capacity challenge, according to Galante.

"You must apply the operations and work flows to be able to move patients more seamlessly and get them discharged," Galante says.

On the operations front, UC Davis Medical Center has instituted a program on the outpatient side to identify patients who are at high risk for hospital readmission, according to Galante.

"We have a patient navigator and nursing team that can help those patients navigate as an outpatient without returning to the emergency department and becoming readmitted," Galante says. "We call this our Multi-Visit Patients program."

New workflows have been added in the medical center's emergency department to boost patient throughput as well.

In most traditional emergency departments, patients would expect to check in, wait in the waiting room, get a bed, then care begins. However, the medical center has a process to start care as soon as a patient checks in, according to Galante.

"We have physicians at the front of the emergency department and patients can get care while they are waiting in the waiting room—you may leave the waiting room to get imaging studies or labs," Galante says. "Then you come back to the waiting room, but you are getting care without touching a bed, which helps with throughput and eliminates the need to wait for care."

Promoting patient safety and quality

Galante says patient safety and quality have been his top concerns as CMO, interim CMO, and trauma medical director at UC Davis Medical Center.

"We have a variety of different paths that we take for patient safety and quality," Galante says.

The medical center compares itself to Vizient rankings for other academic medical centers as well as metrics through The Joint Commission, according to Galante.

"We continue to monitor the metrics for patient safety and quality," Galante says. "Just as importantly, we do both bedside engagement of the physicians and nursing staff that deliver care as well as systems monitoring of the quality of care that we deliver."

The hospital's Patient Safety Events Committee reviews patient safety events daily. The medical center also engages patients to promote safety and quality, according to Galante.

"We have incorporated patients into our quality spectrum through the Speak Up program, where patients can alert us to issues that arise during their care," Galante says. "We have the Code Help Hotline, which patients can call to let us know that there are issues arising in their care."

With the Code Help Hotline, patients are given a phone number they can contact, and the calls go to the medical center's patient relations team.

"It not only alerts us to potential quality issues that come up, but also helps us remain patient centric," Galante says. "This service is for inpatients with urgent hospital needs."

Joseph Galante, MD, is CMO of UC Davis Medical Center. Photo courtesy of UC Davis Medical Center.

Clinical staff engagement

Engaging the clinical staff of the medical center was one of the key elements of serving as interim CMO, according to Galante.

"Coming out of the coronavirus pandemic, our staff and physicians have been under stress and have been experiencing burnout," Galante says.

To engage staff, a CMO must be present and available for healthcare workers, according to Galante.

"I have been able to do some clinical care each week, so people see me in my scrubs working in the hospital," Galante says. "Additionally, I try to go out each week and meet with different teams to engage them in their workplace, so they see the CMO. I ask questions, engage them, and find out how we can help them overcome barriers they are experiencing while delivering care."

Coping with high costs

The medical center has been experiencing high costs in the labor arena and from inflation's impact on supply costs, according to Galante.

"The pandemic certainly did not help us on either of these fronts," Galante says. "Workforce shortages are driving up labor costs across the entire spectrum of our staff."

To contain labor costs, the medical center has been focusing on recruiting full-time staff rather than employing contract labor such as locum tenens physicians, according to Galante.

"Temporary labor can cost about two times what hiring permanent staff costs," Galante says. "If you can hire someone into your organization and build them into your culture, the amount of time that they stay makes it worth the recruitment costs that are invested up front."

In addition to hiring full-time staff, the medical center needs to ensure that full-time staff are productive, according to Galante.

"That involves eliminating low-value work," Galante says. "It helps to bring in technology to eliminate continuous monitoring of patients and note taking functions. You want to get people to work at the top of their licenses."

To address high supply costs, the medical center is taking advantage of the purchasing power associated with being part of a large health system, according to Galante.

"We can leverage as a joint system to be able to contain costs and negotiate lower prices from supply vendors," Galante says. "We can come up with reasonable contracts through our purchasing power. We also have done some work with inventory management to make sure that we are not overstocking."