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North Fulton Community Charities Hosts Fork & Cork Event

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North Fulton Community Charities Hosts Fork & Cork Event

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Based in Alpharetta, Georgia, Care Logistics delivers quality solutions enabling hospitals and other medical facilities to improve operational efficiencies. Dedicated to its local community, Care Logistics supports a number of non-profit and charitable organizations, including North Fulton Community Charities (NFCC), which hosts the annual Forks & Corks fundraising event.

NFCC offers assistance to more than 4,200 families in the North Fulton County area through food distributions, clothing vouchers, financial assistance, and a wide array of educational opportunities that have helped 1,200 adults become self-sufficient and financially stable. The first Forks & Corks food and wine tasting event was held in 2016, and will continue to be held annually, with the second event scheduled for September 2017. Forks & Corks invites top chefs from the area to showcase their craft for attendees. Guests enjoy the tasting event accompanied by live music and other entertainment, with 100 percent of the proceeds from ticket sales going to NFCC to assist with its comprehensive community services and programs.

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Hospital administrators are finding that true continuous quality improvement (CQI) requires a radical change in thinking.

For decades, automakers, the packaging industry and the airline industry have created better products, improved processes and greatly increased user satisfaction by adopting the principles of CQI-which, simply put, means constantly looking at our processes and asking ourselves, "Can we do it better"?

CQI principles have been applied to the delivery of healthcare with great success. Hospitals have created and employed myriad mechanisms for all staff members/personnel to continually improve existing processes. But hospital leaders and administrators know that even after decades of dutifully applying the principles of CQI to improving delivery of care, the patient's journey from admission to discharge is still all too often filled with missed opportunities for a speedier journey through the system and better care overall.

Administrators at leading hospitals are finding that, in some cases, CQI means adopting an entirely new model of delivery.They are also finding that the most efficient way to deliver care is also the most patient-friendly. Let me explain.

The Wisdom of Patient-Centered Care

Three decades of experience in the healthcare industry have taught me that providing exceptional, cost effective care benefits both the hospital and patient. But I've also learned that providing superior care starts with the patient. As we shift from fee-for-service to value-based care, we're looking to capture savings in every imaginable nook and cranny. But ironically, the most cost-effective way to deliver care is to attend to the entire system, with a focus on the patient. When you focus on the patient, everything else falls into place; here's why.

Patients want smooth, efficient care. They want a safe, friendly environment. They want to know what's going on, to be treated as individuals, and to be treated with respect. They want staff to know who they are, and they don't want to have to tell their story over and over. They want to be placed in the correct unit, and for that unit to have sufficient staff to attend to their needs. They want to be safe from medical errors and they want to get home as soon as possible. I am, of course, describing the perfect patient experience, but I think that experience is attainable.

How Focusing on the Patient Improves the Bottom line

The secret to creating this Utopian patient experience lies in boosting efficiency. I've watched hospitals adopt changes large and small, all aimed at increasing efficiency, that also dramatically improved the patient's experience. Some of these changes include moving from a linear to a centralized hub-and-spoke system-a bit like an air traffic control center-that is designed to monitor the activity of every patient electronically throughout the hospital. All of this is made possible by cutting-edge navigation and location sensing technology that tracks patients, beds, transport, labs and procedures, so that patients move smoothly from ED and admission to discharge, with maximum speed and efficiency.

This system might include shifting some staff into "care coordinator" roles. These staff follow the patient from ED to discharge, constantly communicating with the patient and assuring quick transition at all stages of care. These changes in process, staff roles and technology all move the patient through the system far more quickly.

Orchestrating successful travel of a patient through the entire spectrum of care requires ongoing accurate communication between departments and units, adequate staffing at all junctures, and transparency on where the patient, caregiver, beds and other resources are at all times. And making all this happen this requires a cultural shift.

Management and staff must embrace "patient first" mindset. For staff, this might mean a change in roles or it might mean embracing new technology and new ways of doing things. No one, me included, loves change. That's human nature. So we need to first embrace change ourselves and then communicate top-down support for patient-centered care. We also need to listen to staff. What barriers are they experiencing that is impeding their ability to deliver patient-centered care? How can we help them deliver better care?

In the end, improving efficiency benefits everyone. Physicians, nurses and technicians have more time to care for patients. Length-of-stay decreases. Patients receive better care and have a better hospital experience. It's a win-win strategy all around. OR, It's not exactly Utopia, but it's getting there.

Kristie Huff is Chief Nursing Executive and Senior Vice President of Transformation with CareLogistics

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Beyond CQI: How Patient-Centered Care and Efficiency Go Hand-in-Hand

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Hospital administrators are finding that true continuous quality improvement (CQI) requires a radical change in thinking. For decades, automakers, the packaging industry and the airline industry have created better products, improved processes and greatly increased user satisfaction by adopting the principles of CQI-which, simply put, means constantly looking at our processes and asking ourselves, "Can we do it better"?

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Written by Ben Sawyer, Executive Vice President, Care Logistics |

Mercy Medical Center wanted to create the best experience for its patients. And its leaders wanted to make Mercy a better place to work for its physicians and staff.

The Springfield, Massachusetts hospital knew that achieving this vision meant removing bottlenecks that were affecting patient and work flow. To accomplish this, Mercy needed to eliminate the inefficiencies and variability throughout its system.

Mercy's leadership discovered that this would require a systemic transformation of their hospital operations - an initiative it called CareConnect.

The transformational shift any hospital must make to optimize operations begins with mindset change at the executive level. Rather than optimize operations around the hospital's capabilities -a common mistake that stems from a traditional hospital mindset - leaders must restructure operations around the patient's needs.

As hospitals like Mercy Medical Center set out to achieve and sustain a culture of operational efficiency, there are three critical ingredients.

1. Establish a culture of efficiency, including a system aim that clarifies the patient-centered focus
The first ingredient for total hospital operational efficiency is being clear about which outcomes the hospital aims to achieve.

A system aim creates a 'north star' for an organization, a clear statement of purpose. In Mercy's case it was to maximize the quality of the patient's experience so they selected, "together, doing the right thing, the right way, every day for every patient," as their system aim. This aim was then linked to the organization's goals, performance measures and operational milestones by asking, "in order to achieve this aim what goals must we accomplish?" They ultimately chose three, which became their key lagging performance measures.

- Improve overall patient experience
- Enhance quality of care and patient safety
- Achieve flawless execution and world class efficiency

Each department then participated with senior leadership in identifying cascading leading performance indicators that would ensure Mercy consistently accomplished their system aim. These were posted in each department and included in weekly operational rounding.

Mercy also established a daily "huddle" to ensure that the care team assessed each patient's clinical status, assigned a "working" DRG and a detailed plan to progress the patient toward an optimal discharge. The care team clarified and resolved obstacles to quality patient progression, or else escalated cases to leadership for prompt resolution.

Mercy also established weekly executive rounding to foster continuous performance improvement. All executive leaders rounded and discussed department level performance toward the key leading indicators. Department leaders and staff used A3 processes to efficiently clarify and resolve operational challenges. A3 rounding was first made famous by Toyota for use within its production system of continuous organizational performance improvement.

This culture of efficiency further encouraged hospital teams to function as a system, rather than as isolated teams and departments. Hospital executives were able to correct performance gaps immediately to ensure patient care and quality progression happen at the right time, in the right ways, with the right results.

Once a system aim and performance optimization infrastructure is in place, a hospital must add in systems engineering and logistics to achieve effective care coordination across all people and departments.

2. Build logistics into the hospital's care coordination model
Every day hospitals must simultaneously manage the input, throughput, and output of patients across a complex organization with many moving parts, prioritizing the use of limited resources, both human and diagnostic.

Hospitals, like Mercy, have applied a logistical "production model" approach to system-wide care coordination. This hub-and-spoke approach centralizes care coordination decision making to ensure reliable, predictable, and effective patient care and throughput.

There are several necessary steps required to effectively incorporate logistics into the hospital's care coordination approach:

1. Establish a clinical care coordinator role, which typically involves combining case management and charge nurse functions into a 24/7 resource deployed within the hub and spokes
2. Establish daily patient progression status updates and length-of-stay event management through team huddles
3. Deploy the hub-and-spoke model to ensure the execution of standard operating procedures and patient throughput milestones across all units and service lines

3. Implement hospital logistics software
Underneath the centralized care coordination model is a logistical control system. Like an air traffic control system coordinates all the planes in the air and on the ground, a hospital's "care traffic control system" coordinates every patient in every area of the hospital.

However, the software installation is the last, not the first, ingredient on the road to hospital operational efficiency. It provides the live analytics and logistical tools that ensure the hospital's system aim, centralized care coordination model, processes and success measures are aligned.

The logistics software, along with operational rounding, provided Mercy the framework to achieve dramatic patient throughput gains:

- Daily multidisciplinary team rounding, facilitated by clinical care coordinators, ensured that all patients were progressing effectively in accordance with the physicians' plan of care
- A real-time length of stay (LOS) management tool integrated with the hospital's ADT system tracked patients' real-time locations and approved days for concurrent LOS management
- The software continuously allowed the care team to see the estimated date and time of discharge from admission across every milestone of care
- Outpatient schedules, EHR orders and results were interfaced in real-time to the order logistics software
- Patient logistics enabled the hub clinical care coordinators to expedite bed assignments from all admission sources (direct, ED, perioperative, and transfers from other facilities)

Mercy's systemic transformation ensured that patients were where they needed to be for the right care at the right time from admission through discharge. The new approach and supporting software also helped Mercy transition from provider-focused priorities to patient-focused priorities and achieve the throughput and operational goals of the organization as a whole.

Patients, families and caregivers at Mercy Medical Center will be able to see a clear, updated patient itinerary at all times. As a result, Mercy's nurses know when to prepare patients for their scheduled services and procedures. Patients and their families know what services and procedures are to be completed on any given day so that they can ask the right questions and adequately prepare themselves. And those real-time itineraries automatically update as any scheduling changes are made.

The Results of Managing Patient Progression in Real Time from Admission to Discharge
Real-time patient throughput data gives hospital leaders and caregivers the information they need to round intentionally and effectively. Teams identify and address challenges, make adjustments quickly and measure improvements.

Within the first year of establishing these three ingredients for total hospital efficiency, Mercy Medical Center has recognized improvements in many key areas of patient care quality and efficiency:

- Reduced average patient length of stay by a full day, from 4.6 to 3.6 days
- Reduced observed length of stay-to-expected length of stay (O/E) ratio for targeted discharges from 1.34 to 1.06 over a nine-month period (The observed length of stay is the actual length of stay for the hospital's patients and the expected length of stay is CMS's geometric mean length of stay calculated for each DRG)
- Cut the number of patients who left the emergency room without being seen by more than half, driving the average down to 1.85 percent
- Reduced patient 30-day readmissions to 9.6 percent, a steady and continuing improvement in one of the key care quality measures that Medicare considers for care reimbursement
- Cut the time from a pending patient admission to assigning the patient a bed from 73 to 21 minutes, a 71 percent improvement
- Made a 50 percent improvement in inpatient satisfaction percentile ratings
- Won the Press Ganey 2013 Commitment to Excellence Award, reflecting the largest annual increase in employee engagement scores
- Reduced the door-to-door time for emergency room patients by an hour
- Reduced hospital-acquired pressure ulcers (HAPU) by more than half since February 2013
- Improved SKIP bundle from 94 percent to 97 percent
- Reduced length of stay of observation patients by 4.8 hours

The road to hospital operational efficiency isn't easy. It requires significant sacrifices and investments at every level of the hospital. However, the patients, physicians, and communities that hospitals serve deserve nothing less than a safe, satisfying, predictable, and reliable care environment.
Ben Sawyer is executive vice president of Care Logistics. The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. © Copyright ASC COMMUNICATIONS 2017. Interested in LINKING to or REPRINTING this content? View our policies by clicking here. To receive the latest hospital and health system business and legal news and analysis from Becker's Hospital Review, sign-up for the free Becker's Hospital Review E-weekly by clicking here.

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Ben Sawyer, Executive Vice President, Care Logistics

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3 ingredients for achieving total hospital efficiency

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Written by Ben Sawyer, Executive Vice President, Care Logistics | Mercy Medical Center wanted to create the best experience for its patients. And its leaders wanted to make Mercy a better place to work for its physicians and staff. The Springfield, Massachusetts hospital knew that achieving this vision meant removing bottlenecks that were affecting patient and work flow.

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Care Logistics helps hospitals deliver exceptional care to happy patients at the lowest costs. The Care Logistics "production system" for care delivery transforms hospital operations, powered by positive culture change, a hub-and-spoke care model, and logistics software.

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"improving patient throughput" "care logistics" "improving patient experience"

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Logistics cures hospitals. It establishes control and eliminates chaos. It's a different way of doing business for hospitals, with new thinking, centralized ...

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Dedicated to improving hospital operating systems and patient throughput, Care Logistics provides logistical and software solutions with a customer-first focus. As part of its philanthropic efforts, Care Logistics supports a number of nonprofit and community organizations, including the Atlanta, Georgia-based
North Fulton Community Charities(NFCC).

NFCC is a leader in North Fulton offering assistance to over 5,000 families. Annually, food is distributed over 23,000 times, over 1,300 families utilize clothing vouchers, and $1.2 million dollars is expended for direct aid to the organizations clients in need of financial assistance. The Education Center offers an array of classes and opportunities to help 1,200 adults move toward financial stability and self-sufficiency. The Family Enrichment Program, which is free and open to the public, offers workshops and life skills classes in the areas of job readiness, GED tutoring, financial and computer literacy and ESOL.

Although the demand for these services has increased significantly since its founding, NFCC continues to help hands-on, one family at a time.

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Dedicated to improving hospital operating systems and patient throughput, Care Logistics provides logistical and software solutions with a customer-first focus. As part of its philanthropic efforts, Care Logistics supports a number of nonprofit and community organizations, including the Atlanta, Georgia-based North Fulton Community Charities(NFCC).

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Orchestrating care for patients in a hospital environment is delicate and complex. There are so many external headwinds in healthcare compounding that complexity. Internally, silos and disparate technology make it even harder. In essence, there's no harmony in the orchestration of care. Harmony experienced by patients and their families makes them more than satisfied.

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Care Logistics, Alpharetta, GA, United States - Hospital Operations Solutions Provider in Atlanta

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Dedicated to improving patient health, safety, and happiness, Care Logistics creates production systems and operation solutions for hospitals and medi

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Four years ago, a visit to the emergency department at Mercy Medical Center for a non-life-threatening condition took more than 3½ hours from the time patients walked through the door until the time they were treated and sent home.

"The patient flow at that time was pretty difficult-lots of gridlock, inpatient beds full and patients held in the emergency room," said Dan Moen, CEO of Sisters of Providence Health System, which owns the 343-bed safety net facility in Springfield, Mass.

The issue of long ED waits came to a head at a challenging time for Mercy. Massachusetts' 2006 healthcare reform law had increased demand for services, and the number of Mercy's ED visits spiked, reaching more than 75,000 visits a year by 2011. The increased patient load led to longer wait times, resulting in 4% of patients leaving the ED before receiving treatment, compared with the national average of 1%.

Moen said some Mercy departments launched initiatives to reduce ED wait times, but it became clear a more comprehensive approach was needed. So in 2011, Moen hired Care Logistics, an Alpharetta, Ga.-based consulting firm that helps hospitals improve clinical operations and patient flow. He chose the firm after visiting Mercy St. Vincent Medical Center in Toledo, Ohio, where he observed the firm's success in improving coordination between hospital departments to shorten ED wait times.

"About an hour and a half after we got there," Moen said, "we looked at each other and said, 'We really need to do this.' "

MH Takeaways More hospitals are hiring consultants to improve efficiency of their clinical services, including emergency and surgery departments and specialty clinics.

Mercy is one of a growing number of hospitals that have turned to healthcare consulting firms for help to streamline and improve their clinical operations. Increased financial pressures associated with declining inpatient volume, rate pressure from insurers, and Medicare performance-based rewards and penalties have forced many health systems to search for ways to improve quality and reduce costs.

Meanwhile, other systems, such as Cook County Health and Hospitals System in Chicago, have chosen to address patient-flow issues on their own.

"We're starting to see hospitals embrace the use of data and efficient processes much the same way other industries have done for years," said Brian Sanderson, managing principal for the healthcare service group at Crowe Horwath, one of the nation's largest healthcare consultants.

Dr. John Flynn, co-director of the Osler Center for Clinical Excellence at Johns Hopkins University in Baltimore, said hospitals have hired consultants to improve the efficiency of their clinical services, including emergency and surgery departments and specialty clinics. "There's a tremendous push for delivering services, delivering them more efficiently and driving waste out of the process," he said.

Costs for such services can range from tens of thousands of dollars for interventions that last a few weeks, to several hundred thousand or millions of dollars for more in-depth processes that can take as long as a couple of years. Tom Brunelle, a regional vice president for Care Logistics, said his firm's consultants may continue to work with a hospital for several years after the initial process changes are implemented. The cost of these consulting services may be a deterrent for some health systems, Flynn said.

The total number of healthcare consulting firms has increased at a rate of about 1.2% annually over the past five years for a current total of more than 40,000 firms with about 80,000 employees, according to a March report conducted by market research firm IBISWorld. It is unclear how many of those 40,000 healthcare consulting firms engage in process and patient flow consulting.

Independent specialty consulting firms are being acquired by larger, general consulting companies to gain entry into a market with profits expected to grow at an average rate of 4.3% in 2015. Total revenue is projected to grow by 5% a year to more than $14 billion by 2020, according to IBISWorld.

Despite the trend toward consolidation, the consulting industry remains fragmented. In 2015, the three largest firms accounted for a quarter of total market share, with more than 90% of companies composed of fewer than 10 workers.

In addition to Crowe Horwath, other big players in healthcare consulting include Deloitte Consulting, which holds the largest share of the market at 10.5%, and IMS Health, which is second with an 8.5% share.

Not surprisingly, hospitals and health systems are key clients for those consultants, accounting for more than 38% of their business, with pharmaceutical companies second at 19%. One of healthcare consultants' major services is "strategic management," which makes up more than 36% of their business.

"About an hour and a half after we got there, we looked at each other and said, 'We really need to do this.' "
Dan Moen
CEO
Sisters of Providence Health System

Healthcare consultants often use quality improvement and change-management strategies drawn from Six Sigma and Lean. These quality and efficiency improvement methods have been adopted by an increasing number of healthcare systems over the past decade to boost productivity and reduce costs.

Mercy began working with Care Logistics on its systemwide transformation in 2012. It added 24 nurses to serve as clinical-care coordinators. They are on duty around the clock to supervise the logistics for each admitted patient throughout their stay. A central hub is set up on each floor, where length of stay and estimated discharge time is monitored and opportunities to reduce wait times for tests and other services are identified.

Ben Sawyer, executive vice president of Care Logistics, said the goal is to reduce "white space"-the time during a patient's stay when no clinical services are being provided because staff are waiting for patient transport, lab tests, or for a bed to become available. Reducing this dead time shortens overall length of stay, which in turn frees up beds for patients being admitted from the ED, Sawyer said.

Moen said Mercy's partnership with Care Logistics has paid off by shaving an hour off the amount of time ED patients spend being seen, treated and discharged. These efforts also have reduced the average length of stay for admitted patients by a day. These changes have increased the number of patients who report being satisfied with their experience in the ED, from 50% to 86%, and have contributed to a rise in staff morale.

Like Mercy, many hospitals have focused their streamlining efforts on the ED, which can generate substantial revenue if it is efficiently operated. But if patient flow is backed up and a significant percentage of patients leave without being seen, revenue drops. Hospitals particularly struggle with how to quickly identify patients who don't truly need emergency services and can be treated through urgent care or some other less-acute level of care.

"The idea of EDs being unpredictable is very false," said Sandra Madden, senior director for consulting and management services at the Advisory Board Co. "If you really look at your ED, you could predict probably 80% of the activity that you're normally going to see. When you know what you're taking care of, you can attack it and make your care more efficient."

Some hospitals and health systems have implemented quality-improvement and cost-reduction strategies on their own.

"We felt an internal process was much more effective in moving things through," said Dr. Jeff Schaider, chairman of the department of emergency medicine at the Cook County Health and Hospitals System, the safety net healthcare network for the Chicago area. Schaider said he and other system leaders implemented a patient-flow strategy out of a belief that they had the data and other capabilities to carry out a plan on their own.

MH Strategies Choosing a healthcare management consultant

Identify hospitals that have worked with a particular firm and find out how well that firm helped with finding solutions.

Look for consulting firms with extensive experience in healthcare.

Hospitals debating whether to implement change strategies should consider whether their staff has the expertise to undertake a full-time project, factoring in loss in patient-care productivity.

Change should focus on improving coordination and communication between hospital departments to shorten patient wait times.

The in-house process encouraged staff to take greater ownership of the process, said Peter Daniel, chief operating officer for the Cook County system. "I think the team working together made a big difference to the commitment to improve on a lot of these activities," he said.

The ED at the system's largest acute-care facility, Stroger Hospital, sees more than 110,000 patients annually. It has one of the longest wait times of any facility in Illinois-an average of more than two hours for patients with non-urgent conditions, according to data from the CMS. In 2013, the share of patients who left the Stroger ED without being seen was about 10%.

Two years ago, Stroger Hospital leaders began a major restructuring that called for a virtual elimination of the ED waiting area. Instead, the hospital began the practice of immediate bedding-sending patients directly to an available bed in the ED where they are triaged by a nurse and seen by a physician. The hospital also assigned a physician to quickly evaluate more-urgent cases as well as to assess, treat and discharge patients whose conditions were not serious. Efforts also were made to reduce the time it took to get lab-test and diagnostic-imaging results, including the installation of additional imaging machines.

Since making the changes, Schaider said the number of patients who leave without being seen by a doctor dropped by 75% from 2013 to March 2015, and the time from an ED patient's arrival to discharge was reduced by 35%. "It's been a great boost from a staff and patient perspective," he said. "Since we're really the front door of the hospital, we really needed to show that the front door was a friendly, efficient and open front door."

Daniel said that he's pleased with the results so far but that his hospital still has work to do to further reduce ED wait times to become more competitive with other hospitals.

Flynn at Johns Hopkins said some hospitals that have hired outside help to solve patient-flow issues have found that consultants tend to use a one-size-fits-all approach, without first getting a solid understanding of the client facility's unique culture. Also, some consultants without extensive healthcare experience may recommend cost-cutting strategies that hurt quality of care, he added.

Moen said that whether a hospital uses an outside consultant or seeks to improve patient flow on its own, "it's not rocket science. It's getting the medical staff and their colleagues all engaged in the right way."

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To reduce wait times, Mercy Medical Center hires outside help, another chooses DIY

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A growing number of hospitals have turned to healthcare consulting firms for help to streamline and improve their clinical operations. Increased financial pressures associated with declining inpatient volume, rate pressure from insurers, and Medicare performance-based rewards and penalties have forced many health systems to search for ways to improve quality and reduce costs.