When educating healthcare executives to lead high-occupancy organizations, one of the fundamental outcomes-based measures to monitor is Length of Stay (“LOS”).
Usually, the organization has tried many approaches to solving capacity problems but many have failed due to some of the following reasons:
- Competing priorities
- Misaligned incentives for key stakeholders (physicians and hospitals)
- Perception of negative impact to revenue for percentage of charges and per diem payers
- Poor communication within and between departments
- Not aligning care models around the consumer experience
- Lack of data to drive transparency and accountability
When healthcare leaders approach us with a LOS problem, we ask them the following questions before advising on how to proceed:
- How do you define LOS? Current/in-house, discharged average LOS severity adjusted (comparing observed to expected benchmark)
- Is it isolated to a specific hospital, department (Emergency Department (ED), Post Anesthesia Care Unit (PACU), etc.), nursing unit, service, disposition, time of year, day of week?
- How much of a LOS problem is felt by a mid-afternoon census alert? Could it be a throughput/flow issue instead
We then want to understand the internal dynamics, such as:
- How would other leaders and disciplines respond to the three questions above? Does your organization have a single, consistent point-of-view?
- How frequently are LOS measurements and key process measures reported? Are department/hospital/system clinical leaders reviewing these metrics and continuously improving?
- Are incentives aligned for the key stakeholders (especially those that are not in your organization)? How can you influence those groups to help you achieve your goals?
Once we’ve obtained a high-level understanding of the challenge(s), the next step is to understand stakeholder involvement, alignment, and expertise.
Here’s a common scenario where health systems engage GE Healthcare Consulting, coupled with our approach to improving operations:
- 450 bed, Level I Trauma Center in medium-sized city
- State Medicaid expansion and physician recruitment have increased demand for IP beds
- Hospital is working through many solutions: co-locating patients, redesigning hospital beds, planning for IP and ED expansions, managing internal projects on discharge timing, readmissions, and bundled payments
The Performance Improvement department has recently assessed LOS and reported to its Senior Leadership Team that the organization has a LOS problem.
- Perform a ‘Flash Discovery’ by conducting key stakeholder meetings and data analyses
- Create/Modify a Steering Committee charged with engagement oversight, communication, resource allocation, and executing decisions
- Conduct a 3-5 month ‘Capacity Strategy’ engagement to model operations and unique patient pathways around 3-4 key strategic questions
- Create highly efficient/effective, daily multidisciplinary rounds to discuss each patient’s plan for the stay/day, progress towards transition/discharge with all key members of the care team
- Re-allocate beds to services based on historic demand, budgeted volume or other initiative to mirror the patient placement matrix
- Redesigning Case Management to ensure appropriate staffing, staff utilization, resource utilization, workflow and expectations align with efficiently delivering healthcare
- Target specific patient populations for administrative or clinical LOS opportunity (e.g., pneumonia, heart failure, hips/knee replacement)
- Reduce elective variation in the Operating Room and create a more predictable outflow with ‘priority discharges’ to better align demand and availability of beds
- Each healthcare market is unique, but in this example, the hospital was losing patients to competitors due to capacity issues. By creating organizational alignment, studying LOS and process metrics and selecting a few initiatives to impact LOS, the client reduced severity-adjusted LOS and created capacity to treat new patients.
- By treating more patients, referring physicians and network facilities were more engaged as the hospital was now more ‘accessible’ and information more widely trusted/understood.
There is great power in taking more of a transformative approach with this as a major initiative well supported by leadership, data driven, and executed in a way that involves a number of change management tools to help drive and sustain change.