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doctor talking

by Catherine Shull Fernald
Published on February 6, 2019

Estimated read time: 8 minutes

The diverse and fast-paced environment of health care requires effective management of the many processes and resources needed to keep health systems running smoothly. To offer greater value and a better overall experience for patients, organizations must strive to be more efficient, productive and profitable in every area of care delivery.

In this Q&A, Catherine Shull Fernald, chief nursing officer, acute care at Christiana Care Health System, shares her expertise on the current and future state of health system operations and offers insights into how organizations can be more strategic and innovative in supporting their core functions.

Advancing operational efficiency, patient experience

In your opinion, what is the state of the health system operations landscape today, and more specifically, what are you experiencing at Christiana Care?

Health systems are complex, delicate and constantly changing. Health care providers must make the most of the resources that they currently have and evaluate what else they need to be top performers among their competitors.

At Christiana Care, we are typically running between 96 percent capacity to over 100 percent capacity. We use every resource we have—inc­­luding frontline nurses, providers and all essential services—at maximum speed. That is not sustainable, but we’ve found that applying more people is not necessarily the answer. Instead, we need to address the structures and processes that we have in place. We are working to gain insights into our barriers and what we must change to mitigate the patient throughput.

One example of how we are doing this is the conversations we started having in the six months leading up to flu season. Previously, it was not unusual to have a bottleneck of boarders waiting for beds that would continue through an entire week with no relief.

We worked with our different disciplines around the mantra of “getting the right patient in the right place at the right time.” This mantra helps us know our bed capacity for the surgical patient population versus medical patients. We saw a disparity there, so we closed the gap by reallocating beds to a specific service line. However, right now, it is no holds barred. Every bed is to be used if it is the appropriate patient placement. Now, most of our boarding is one or two days, and we see markedly fewer boarders waiting for beds. We even had a recent weekend where there were zero boarders in our emergency room. Six months ago, that would have never happened. We consider this to be a huge success.

Zero boarders in the emergency department is an amazing accomplishment! What are some of the strategies you've used to achieve this, and what benefits are you seeing so far?

We have patient care coordinators who make decisions on where we are going to place each patient. We are using our capacity management tool to help with bed placement. It’s been a cultural change to stop accepting patient transfers if we are waiting to place patients in beds. In the past, our doors were always open. We looked at how and when we conduct surgical procedures to better manage variation and improve flow. We recognize that patient flow and operations have a big impact on the patient experience. We know we can’t fix all the issues around patient experience, but we are focused on these top areas while still doing the work that we always do.

We are seeing headway in all our service lines, especially in our emergency department, which is the point of entry for most of our patients. With the load of boarders taken off the emergency department, the providers are open to adopting new practices for improving the patient experience.

Constant conversations, coaching and mentoring with our nurse and physician leaders has been crucial. It’s a 24/7 activity that is never off our radar. There is a sense of urgency to move the bar and get ahead of our flow issues.

Guiding health care operations with data and technology

How do you use data analytics to manage throughput at Christiana Care?

Christiana Care is research- and data-driven and that evidence gives us a framework of why we do X, Y and Z. We use data to create touchpoints, and then we analyze those and benchmark them against similar organizations to see where we can do better. We use data to continue to improve. We use it to inform the decisions that we make from capital investments to human resource allocation. It also helps us to forecast what we need to do six months to a year ahead. There is no reason to have the data unless you are going to apply it to correct problems and up your game.

I’ll share an example of how we used data in resource allocation around using patient safety sitters. The program was put into place 10 years ago without much solid data behind it. So, we went in and researched what has been successful and unsuccessful in other organizations. We came up with a business plan to justify doing a pilot program with remote video surveillance of patients as an alternative to human monitoring. We identified five of the highest utilization units across the entire system, and over the course of a three-month pilot, we extended the video surveillance and the diversional activities.

The result was a 50 percent reduction in our use of patient sitters and a $254,000 savings just from employee salaries. Those staff members who were no longer being deployed for safety sitting could be put back on the bedside. We’ve already seen a change in our mindset and culture around the use of patient safety sitters. We are moving in the right direction, and it feels great.

How are you using technology to meet your operational needs?

We are making progress in shifting the culture at Christiana Care to engage people in keeping our capacity management platform current and accurate. Going live with our electronic health record in specialty areas and the primary care platform is helping us communicate our patient needs in real-time and close the loop on the continuum of care.

How do you use your role as an influential leader to drive change within your organization?

Fortunately, I’ve had a lot of different experiences in my professional life. I stay on top of best practices and pull from research to figure out the best things to do, but change is not easy to make happen or maintain. I believe it is important for leadership to acknowledge both the existing culture and the need to move forward in a way that adds value. It’s up to us to take away some of the burdens of health care that we have created.

Of course, there are regulatory requirements that must be met, but there are also things we can take off the plate of providers. The whole point of getting into health care is the patient. The patient always needs to be the center of everything. We can’t allow overhead and administrative tasks to get us away from that. If we tackle these challenges together, everyone can be successful.

The future of hospital operations

From your perspective, is the health care industry equipped to manage operational challenges and prepare for the future?

I don’t think health care can sustain where it is right now, but it takes a team effort to move in the right direction. The paradigm is shifting from reactive care to keeping patients healthy proactively. Transitioning care out of the hospital and into the community is key for organizations to sustain into the future because it a much more cost-effective way to deliver care. We must get to know patient and community needs and use that knowledge to come up with innovative ways to meet patients where they are. We are in a world of consumerism. Patients want care to be convenient, and ultimately, if we can provide that for them it will be more convenient for providers as well.

Where do you see the industry’s approach to health system operations going over the next five years?

I see the industry putting greater focus on using our talents and resources to empower patients to take control of their own health and care. It feels like we are going back to the 1920s and 1930s when health care was more personal, and providers were going into people’s homes. It’s our responsibility to take accountability for providing value-based care to patients.

There is so much brainpower in the industry that is creating innovations to help health care function at a higher level. It’s remarkable how far we have already come, and there is still so much further that we can go. At Christiana Care, we are being intentional about how we approach things, and we are engaging our entire organization in doing what is best for our patients.

Cerner is focused on optimizing each patient’s journey through the health system, including resource utilization, from the time they enter the hospital through the discharge and subsequent placement across the continuum. Learn more here.