Smoothing patient flow

It was at a conference of the Institute for Healthcare Improvement that Anne-Marie Audet had her notions confirmed. During a conference-related site visit, she went to a local Marriott hotel. The goal was to see how such an organization manages crisis and large groups.

“A Marriott is much like a hospital providing both customer service and safety,” said Audet, the vice president for the Delivery System Reform Program at the Commonwealth Fund. “There are a lot of similarities and this is an industry that has mastered flow better than healthcare.”

[See also: NJ hospitals reduce ED waits, cut costs]

Audet contends that, though healthcare has been a closed system for years, it is time to bring external processes from the likes of engineering and aviation in to create some predictability to the erratic industry.

A recent study by researchers at the Commonwealth Fund looked at ways to improve flow in various healthcare organizations.

There are general principles that can be applied across the board to most industries to improve a system’s flow, including healthcare, Audet said, and the main one is analytics.

“Every organization definitely has to know the community they serve,” she said. “Look at patterns over a few years and some will become obvious.”

An organization has to understand its staffing, availability and patterns. A primary care practice or emergency room may look at the visits over a couple of years and see that flu season and spring allergies cause a gridlock. It can staff heavier to accommodate during those times.

A couple of organizations in the Commonwealth study used analytics to relieve their problems.

New York University Langone Medical Center, in Manhattan, like most hospitals, used to discharge patients late in the day. In order to improve flow and ensure patients could receive their medications or have a visiting nurse come in, they decided to enforce a policy to have patients leave early when possible. They educated staff about the change and created an electronic dashboard to track progress on the goal. Now, more than 40 percent of patients are discharged in the morning.

Monmouth Medical Center in Long Branch, N.J., had a flow problem with its surgery scheduling. Postoperative units were crowded because physicians were scheduling their elective surgeries early in the week to avoid patients recovering on the weekend. They performed a gap analysis to see what postoperative care was needed on the weekends. They then developed a schedule with patients spread throughout the week and provided incentives for doctors who would perform surgeries on Fridays.

A similar plan could be used in a physician’s office, said Owen Dahl of Houston-based Owen Dahl Consulting. Routine rechecks are something that can be scheduled in advance. They can be avoided on Monday and Friday, when there are likely a lot of call-in appointments. Or if an office has a lot of diabetic patients, for instance, a shared medical visit might be an option. It can be planned in advance and treats a lot of patients in a short time frame.

Frank Cohen, a consultant with the Frank Cohen Group, also relies on analysis to improve patient flow. One cancer center he worked with had patients spending nearly a whole day waiting around unnecessarily. Patients were arriving in the morning and getting lab work done. The labs determined if they needed to see a doctor before receiving chemotherapy and how their medication should be compounded. An easy fix was to get blood work done 48 hours prior to an appointment. When they arrived at the center, their medications and doctors were ready.

“You can’t change something until you analyze it,” Cohen said.

Another issue he found through analysis was with a primary care practice whose wait times were out of control. He went to their waiting room and found that patients were consistently going back to the desk asking questions. When he asked the front desk staff why patients were returning, they said patients come back asking two things: an explanation of the financial policy and assistance reading the paperwork.

Cohen realized that many of the patients were over the age of 50 and had forgotten their reading glasses. The font on the paperwork was really small. He went to the store and bought a basket and 20 pairs of reading glasses and put it at the front desk. The group also simplified its financial documents. The two changes reduced the time it took to check new patients in by seven minutes each.

“Customer flow through a Walmart has the same foundational techniques as they do in a physician’s office or hospital,” Cohen said. “The lowest priority for physicians is to have an efficient office, but that is changing as profitability is being tied up in efficiency.”