The State of Texas remains to recover from the winter storm blackout back in February. While the state still has much rebuilding and catching back up to do by covering damages and other economic losses, new operations among the state's and nation’s healthcare providers are coming out of it.
The State of Texas remains to recover from the winter storm blackout back in February. While the state still has much rebuilding and catching back up to do with covering damages and other economic losses, new operations among the state and nation’s healthcare providers are coming out of it.
Although hospitals and healthcare providers have already been overwhelmed with the effects of COVID-19 for over a year now and are working under new conditions, there is still room for further operations in the workplace.
Peter Keogh, managing director at Carl Marks Advisors, said the events in Texas and COVID-19 showed us that hospitals and healthcare providers need to be operationally prepared for national disaster that most don’t expect to occur.
“Whether it’s a global health crisis, hurricane, deep freeze or wildfire, health systems across the country have faced increased stress from “disaster-level” incidents over the past few years,” Keogh said. “One of the best ways to prepare ahead of time (and) not to be overwhelmed in the face of crisis is to improve methods and procedures around patient flow.”
When faced with these situations, hospitals need to have a dedicated patient flow management team to maintain capacity, address overflow and communicate with other departments and facilities, he said. When infrastructure is in place to balance the system, it ensures decisions are integrated with a deliberate purpose, rather than each floor, department or hospital trying to optimize in a silo.
“(Infrastructure) provides an ‘air traffic control’ or ‘ringmaster’ to coordinate all the various activities including ER flow, surgery, EVS, bed management, house supervisor, transport and external placement,” he said. “The result is enhanced communication and integration, increased departmental efficiencies and throughput.”
Keogh noted a centralized patient flow office balances the daily operational needs of a hospital (patient care outcomes, bed capacity, admits, transfers, ER, LOS, discharge, surgeries) with its long-term strategic goals.
A centralized patient flow puts in place processes that manage interactions to optimize the entire enterprise rather than at the department/floor level - which leads to sub-optimization, he said.
For example, centralized patient flow is like Tetris, Keogh added. It’s relatively easy to progress at first-term when you only need to make short-term decisions to clear the blocks. However, as time goes on, and unforeseen pieces fall, short-term decisions increasingly impact overall progress. Eventually, you have to be more strategic or its game over.
UC San Diego Hospitals were first to practice these operations under Keogh.
Some of the biggest takeaways that come out of these operations are leadership and stakeholder buy-in, frequent communication and utilizing available data, Keogh said.
“To elaborate: centralizing the patient flow process comes from the top down,” he said. “Healthcare leadership can shepherd the process along by identifying — and involving — the right stakeholders from a very early point in time, but it’s critical to make sure the backyard is in order before implementing any changes that impact your clinicians. Any pressing internal issues need to be addressed before diving in to reorganizing patient flow. It goes back to the impact of short-term and long-term decisions impact each other.”
He added data is also incredibly useful in developing and refining the inflow process. Tangible data points allow leaders to communicate the progress and improvements being made, and where there is still room for improvement.
“In my experience, most clinicians operate in a bubble — more so as specialization has significantly increased — and have a propensity to make decisions based on the immediate situation,” Keogh said. “There is an increasing awareness of the impact of decisions on their world and the positive impacts if a different decision was made, or process adhered to. Clinicians need to know ‘what’s in it for me?’ and backing up change with empirical data makes it easier to acknowledge the positive change.
Lastly, setting realistic goals in the healthcare industry is key. Leadership must acknowledge the journey will have challenges and commit to resolving them effectively and immediately, Keogh recommended.