- How would my hospital benefit from Press Ganey’s PatientFlow Optimization solution?
- Isn’t adding capacity (physical and staff) in areas of unmet demand the right way to address overcrowding in the ED and other units, long wait times and patient boarding?
- What are some of the available approaches to improve patient flow? How is Press Ganey’s PatientFlow Optimization approach different?
- How does Press Ganey’s PatientFlow Optimization approach compare with other performance improvement approaches such as Lean Management and Six Sigma?
- How can changing the OR schedule ease ED overcrowding and patient boarding?
- What is artificial variability and how does it cause patient flow problems?
- What is OR smoothing?
- Why is OR smoothing important?
- Can my hospital cost-effectively match demand and capacity without addressing artificial variability?
- What does it take to successfully implement patient flow improvements?
- What role does your staff play in a typical PatientFlow Optimization project?
- What are the data needs for a successful implementation project?
- How does PatientFlow Optimization ensure that the improvements are sustained in the long run?
Q: How would my hospital benefit from Press Ganey’s PatientFlow Optimization solution?
Do you have patients boarding in your ED due to a lack of ICU and medical/surgical beds? Does your ED go on divert periodically? Do you have overtime challenges in your ORs? Do emergent and urgent cases bump scheduled OR cases on a regular basis? Do you perform substantial add-on cases after daily OR prime time? Do you often place patients in non-preferred inpatient units?
A: If you answered yes to some or all of these questions, your organization can benefit substantially from working with us. You will see operational, financial and quality of care improvements within weeks of implementation of the first phase of work.
To quantify your potential benefits, check out our calculator (Note: This link will take you to a different web site. When you arrive, please scroll down to see the calculator).
Q: Isn’t adding capacity (physical and staff) in areas of unmet demand the right way to address overcrowding in the ED and other units, long wait times and patient boarding?
A: Adding capacity to select services, without streamlining overall patient flow through your hospital, could exacerbate wait times for patients ready to move to the next stage of care (ED to OR, ED to inpatient, OR to ICU, etc.). If, after streamlining flow, there is still unmet demand, you may in fact need to add capacity. When, where and how much capacity to add should be determined using data analytics in the context of a hospital’s unique characteristics.
Q: What are some of the available approaches to improving patient flow? How is Press Ganey’s PatientFlow Optimization approach different?
A: Several tools and services are available to help hospitals with their patient flow challenges. One example is electronic patient and asset tracking. The main process methodologies in the market are Six Sigma and Lean Management. These options can drive improvements in specific ways. As you consider alternatives, be sure to ask the following questions:
- Is the approach based in science or best practice at other hospitals? Approaches with a scientific basis are universally applicable. If the approach is based on other hospitals’ experiences, how can you confirm if it will work in the unique environment of your organization?
- Is the methodology based on system-wide thinking or applied to a specific department? If applied to a limited area, will improvement in one area lead to problems in other areas?
- Will the approach provide you with lasting improvements that your staff can sustain going forward?
Press Ganey’s PatientFlow Optimization offering is unique in that it is:
- A full implementation, not just a set of analyses and reports
- Comprehensive across key inter-related services, i.e., not silo based
- Robustly based in operations management science as applied to health care
- Tailored to address unique aspects of individual hospitals
- Applied deliberately using pilot testing
Q: How does Press Ganey’s PatientFlow Optimization approach compare with Lean Management and Six Sigma?
A: Lean Management and Six Sigma are process management and quality improvement methodologies that originated in the manufacturing industry. Since Lean Management and Six Sigma focus on optimizing individual processes, sub-optimization may occur in other parts of an organization. For example, if you improve the processes and patient flow through the cardiac catheterization lab, it could lead to pressures on your CCU and telemetry units. Press Ganey’s PatientFlow Optimization approach recognizes the inter-relatedness of health care operations. We believe that the benefits of applying process improvement methodologies like Lean Management and Six Sigma can be greatly enhanced by addressing artificial variability first, which is at the core of our implementation solution.
Q: How can changing the OR schedule ease ED overcrowding and patient boarding?
A: It has been scientifically proven that periods of ED diversions and overcrowding are more often caused by surges in scheduled surgeries than by problems with ED volume or internal processes. Surprisingly, the main root of ED overcrowding and boarding is the unavailability of inpatient beds that have been filled by scheduled surgical admissions, usually in the middle and later half of a typical week.
Q: What is artificial variability and how does it cause patient flow problems?
A: In any system, there are two kinds of variability. Natural variability, as the name suggests, is driven by natural variation, for example, across various clinical providers’ skill levels. Artificial variability, on the other hand, is typically introduced extrinsically by management practices like scheduling. The result is substantial fluctuation in patient volume through a typical day, week or month. Since a part of patient demand varies in a truly random fashion (e.g., most of the inflow through the ED), scheduling driven fluctuations result in further amplifying the variation. In the end, artificial variability in a hospital affects its ability to provide patients the right level of care, at the right place, at the right time.
Q: What is OR smoothing?
A: OR smoothing is the process of eliminating artificial variability in surgical volume. A common misconception is that OR smoothing can be accomplished by equalizing the number of scheduled OR cases done on each day of the week. While doing so might be an improvement over a hospital’s current state, it will not fully realize the benefits of smoothing when done correctly. The specific aspects of smoothing need to be tailored to each hospital’s surgery practice (OR schedule, individual teaching responsibilities, clinic schedules, etc.), service mix, ICU and step-down capacity and program sizes, in order to achieve a sustainable solution.
Q: Why is OR smoothing important?
A: No hospital can efficiently and effectively manage variability in demand that is both unpredictable and non-random. Variability in scheduled OR volume is a function of scheduling practices and staff preferences, which do not follow any statistical patterns. Such variability is best managed by elimination. Hence the need for OR smoothing.
Q: Can my hospital cost-effectively match demand and capacity without addressing artificial variability?
A: The only time that matching capacity (physical and staffing) to demand is an appropriate solution is when demand variation is entirely random in nature – typically not the case in hospitals. Artificial swings amplify peaks and valleys in daily volume.
Typically, hospitals cannot afford to always staff for peak demand – this leads to waste during the times when demand is less than peak. The alternate approach of staffing for average demand leads to stress on providers, as well as concerns about quality of care, when demand exceeds the average (about half the time). Finally, flexing capacity to match demand variation, apart from being operationally challenging, is inefficient due to the artificially exaggerated demand peaks. The only appropriate solution is to eliminate artificial peaks, and then build/staff to manage natural variations in demand.
Q: What does it take to successfully implement patient flow improvements?
A: From a consulting standpoint: Technical expertise in operations management, especially as it applies to the unique aspects of health care; clinical and hospital management experience; ability to generate buy-in from key constituents; extensive health care data analytics expertise; expertise in managing complex implementation projects; and previous implementation successes.
From a hospital standpoint: Support from the executive suite political will to try significant changes and agreement to develop and monitor certain measurements on an ongoing basis. Take a look at Press Ganey PatientFlow Optimization's unique blend of expertise.
Q: What role does your staff play in a typical PatientFlow Optimization project?
A: Our goal is to drive improvements in quality of care, patient safety, patient satisfaction and staff satisfaction. It is not possible for us to effect these improvements without working very closely with your staff. We provide wide-ranging expertise to help your providers and staff to develop and implement new practices specific to your organization. In many cases, our client’s staff helps to gather additional metrics needed to implement and sustain patient flow improvements.
Q: What are the data needs for a successful implementation project?
A: Typically, we start with a review of whatever data and reporting currently exists mainly for the ED, OR and inpatient units. We look for a variety of time stamps (e.g., arrival time, patient in-room time, discharge time) and patient classifications (e.g., emergent, urgent, ICU, telemetry). In some cases, it is important to look at other major services like the cardiac catheterization lab, radiology and specialty units such as heart hospitals.
Q: How does PatientFlow Optimization ensure that the improvements are sustained in the long run?
A: We work very closely with your administrative and clinical staffs throughout a typical project. Your staff plays a key role in developing and implementing new processes. The result is that there is a strong internal ownership of the process and changes. We are able to show strong positive results by the end of the first phase (about six months), which results in buy-in from surgeons as well as other key constituents. Finally, we believe in training staff so that they can continue to build on the successes achieved in the course of the project.