September 06, 2016

What the Most Efficient Hospitals Know

We’ve written previously about how quality care occurs at the intersection of time and efficiency — interestingly, though, the most efficient hospitals have systems in place that translate directly to high-quality care. The concepts, it seems, are inextricably linked. To wit: Out of nearly 1300 hospitals, the authors chose four hospitals to profile for a recent report on the subject, and found several key themes that arose again and again. Here are insights into what made these top-performing hospitals stand out as models of efficiency.

1. Improving quality, expanding access

The most efficient hospitals strive to expand access, remedying disparities in healthcare access, meeting of healthcare needs and delivery of medical services that occur in different populations that fall along racial, ethnic, or socioeconomic lines. Populations with more barriers to care are more likely to use emergency services and other cost-ineffective interventions, because they do not have regular access to low-level interventions or maintenance care. The best hospitals balance competition and collaboration to provide integrated care, developing partnerships and pathways to provide pharmacy, primary care, urgent care clinic and hospital services, preventing patients from needing critical care or hospital stays. Within hospitals, it is important to harness technology to capture patients falling through the cracks and to streamline their care journey; to open up communication between providers, as well as between providers and patients, particularly through improved access to documentation; and to use patient feedback to learn which logistics (such as location of pharmacy or layout of a medical building) make it easiest for them to obtain care.

2. New models for enhancing communication and organizing teams

Improvements should be aimed at positively influencing clinical quality, operations and finances, and patient satisfaction. Once upon a time, “more physicians” was the answer — unfortunately, the physician shortage isn’t going anywhere fast. Although the number of medical students is outside your control, retaining and supporting physicians by innovating staff models are something you can do to meet these three goals.

Empower emergency department physicians to alert the cardiac catheterization lab about incoming patients. Shift responsibilities so that hospitalists see only the most-acute cases. Supplement the physician team with physician assistants, who can diagnose illnesses, write prescriptions and counsel patients on preventive care; in some states, advanced practice nurses can also provide these services under the supervision of a physician. In addition, nurses can be tasked with placing “risk-ranked adherence calls, [with] call scripting focused on identified risk areas” to help patients with chronic conditions in managing their ongoing care and prevent them from returning to the hospital unnecessarily. Use medical scribes — an option the Mayo Clinic is considering — to keep up with the greater number of patients being cared for. With scribes seamlessly creating thorough documentation in real time, running notes between providers and setting prioritized task reminders, physicians can focus on patient care. In addition, the comprehensive documentation that results will help enhance communication between providers and with respect to patient education at discharge, as well as create a strong foundation for post-discharge care.

3. Leveraging technology to support patient care and management

According to the case study report, the most efficient hospitals are making the most of technology to “retrieve patient information quickly and conveniently, access best practices at the patient’s bedside, promote patient–provider communication, and track patient flow.” One hospital is using online patient portals that let patients communicate electronically with doctors, so they can complete online visits for nonurgent health needs, refill prescriptions and schedule appointments — all of which are also keys to expanding care access. Other strategies:

  • Restructure electronic health records (EHR) with the goal of aggregating and analyzing data in mind. Build user-intuitive pathways into the EHR, for example, having the system alert nurses if a patient’s condition is deteriorating based on the data entered to the system.
  • Implement digital bed-tracking systems and patient care dashboards that let staff know where patients are in the process to discharge, allowing triage and intake to anticipate where inpatient beds or emergency bays will become available and assign patients accordingly.
  • Combine documentation at the point of care with software that makes coding easier, to help optimize the revenue cycle.

Bundled payments are being expanded, the reach of the Value Modifier is expanding, an orthopedic episode-of-care model is in pilot mode, and the Core Quality Measures are being adopted. Learning from the most efficient hospitals and implementing their lessons can help hospitals meet these and future challenges in efficiency, value and reimbursement being set by the Centers for Medicare and Medicaid Services.