In recent months, consumers in various cities across the country have been presented with billboards that advertise their local hospital’s emergency room wait times in an effort to attract new patients. While these advertisements may be indicative of a health care system that relies too much on emergency rooms as the primary point of care, the fact that hospitals are beginning to capture real time performance is somewhat revolutionary. Despite knowledge that hospitals are significantly less efficient than other industries, documenting the process and cycle time data of hospital operations has been regarded as too difficult because of the chaotic nature of patient flow.
In recent years, as process improvement methodologies have experienced greater adoption among provider organizations, hospitals have established and implemented protocols that support the measurement of process and cycle times for critical functions. However, while many hospitals have become experienced in utilizing Lean, Six Sigma, TPS or other advanced operation improvement systems there was still a significant lack of real time data available to help hospitals allocate resources and adjust performance. This was caused by two issues: an approach to process improvement that stressed working on silos as opposed to implementing total hospital efficiency; and, a failure to develop IT applications that gave a system wide view of patient flow, productivity, demand needs, and other critical metrics.
Too often hospitals have pursued improvement efforts that focus on one specific department, like the ED. As a result, that care center will work smoothly and efficiently and allow for hospitals to promote the aforementioned wait times as a key differentiator. Yet, practice has found that unless other areas of the hospital like admissions, imaging, or the OR are integrated into the processes, bottlenecks will occur and sap the system of efficiency. As hospitals have expanded their optimization to other areas—or more wisely—undertaken total hospital efficiency in one integrated effort, the ability to measure and document critical performance measures in real time has increased.
Because so few hospitals had pursued total hospital efficiency the software to gather the data did not exist, but in recent years with more hospitals seeking the data, real time, system wide analytics have been developed to support performance management. Based on software commonly used in other industries, hospitals—like many other deeply integrated, process based organizations—now have the ability to use process and cycle time data to analyze past performance and anticipate future trends in real time. The benefit for senior executives includes the ability to analyze patient throughput and capacity management so they are able to make immediate decisions on staffing levels and resource allocation. This will help manage overtime and agency needs, two variable costs that can drive up care costs significantly.
Also, real time analytics help executives address issues as they occur. If the facility is routinely exceeding patient ALOS or if the time to admission and bed assignment is too long then administrators can identify and rectify the issue immediately. In the past the only way to know if there was a problem was to look at data retrospectively, often weeks or months later. In that time the hospital has wasted valuable resources.
With reimbursement levels facing sustained pressures, hospitals must constantly monitor performance to reduce unnecessary resource expenditures. The introduction of real time performance analytics and the ability to monitor a hospital’s total efficiency represents a dramatic leap forward in how executives manage hospitals and is the next evolutionary stage of a growing industry commitment to process improvement methodologies. For hospitals that already understand this, the transition to a post reform environment will be significantly smoother. For those who question the wisdom or applicability of process improvement and real time performance feedback the next several years will be very rocky.
Jim Rosenblum is Executive Vice President and CTO of Care Logistics