Northwest Community Healthcare, an independent community health system in Arlington Heights, Ill., recently announced the launch of a new care coordination model that improves how staff manage and monitor patients during their hospital stay. Using a technology-enabled process, they closely follow patients through admission, scheduling, transport and discharge. Northwest Community is the first hospital in Illinois to adopt this new patient-flow model.
Referred to as Aim for Excellence at Northwest Community, this new model is designed to help staff:
- better anticipate the need for services;
- improve the ability to schedule inpatient tests and treatments;
- decrease the time between interventions;
- reduce infection rates;
- minimize a patient's length of stay by half a day or more.
More than just a technology implementation, Aim for Excellence represents a fundamental organizational transformation, from the front line to the C-suite. For the first time, patients will receive a daily schedule that tells them when procedures, diagnostic testing or potential discharges or transfers will take place. Knowing what to expect and when reduces anxiety and make it easier to schedule visits from loved ones.
The New Care Delivery Model
At the core of Aim for Excellence is "the Hub," a central control center managed by specially trained staff to help physicians and employees manage patient flow throughout the hospital. Northwest also created a new clinical role — the clinical care coordinator, or C3. C3s monitor the status of patients, provide support for test and treatment schedules, and facilitate smooth and timely transitions throughout a patient's time at the hospital — from admission to discharge.
More than 60 C3s have been trained and now are working with all inpatient units, including the emergency department, surgery, interventional radiology and the cardiac catheterization laboratory. This new position requires a high degree of clinical expertise plus knowledge of payer requirements. Northwest Community recruited these individuals from various case management and nursing leadership roles and gave them four to six weeks of intensive training. The C3's role in determining correct patient status (observation vs. inpatient) is critical.
Training the Leaders
Northwest Community initiated Aim for Excellence as a transformational project to improve not only length of stay, but also to develop a culture that was simultaneously patient-centric and performance-focused. To ensure that leaders were consistently engaged and visible to all clinical staff, the executive team implemented a formal program of leadership rounding. The performance improvement team trained front-line leaders in performance improvement methodologies and asked them to work with their departments on unit-level initiatives related to an overall system theme. Unit leaders and staff present the work of these unit-based initiatives to senior leaders during the biweekly rounding sessions.
This rounding process is still evolving, but has resulted in:
- increased organizational focus on a single goal, such as inpatient transportation;
- early identification of systemwide barriers to efficiency, such as the medication reconciliation process;
- increased visibility and engagement of leaders in solving patient-flow challenges;
- development of performance improvement skills in front-line leaders, including the ongoing use of real-time operational analytic information.
The technology implementation included two integrated systems to monitor all aspects of patient flow and the scheduling and sequencing of tests and treatments. For the first time, Northwest Community can schedule tests to meet not only clinical urgency needs, but also to meet LOS goals for individual patients. Northwest Community identified eight operational milestones as critical to improving overall LOS. These milestones include time from:
- bed request to bed assigned;
- bed assigned to patient in bed;
- test ordered to test completed;
- test completed to results available;
- transport request to transport completed;
- room cleaning request to room available;
- pending transfer order to transfer completed;
- discharge order to room available.
The C3s, unit leaders and the director of care coordination monitor these milestones for both inpatients and observation patients on a daily basis.
Evidence for Improved Hospital Performance
Northwest Community Healthcare is at a very early stage of Aim for Excellence implementation, yet we are already seeing improvements. There have been cycle-time improvements in four of the eight milestones one month after system go-live. Cycle-time improvements related to bed assignment, transportation and environmental services were realized fairly quickly; improvements in patient transfer and discharge activity are being realized more slowly. It is expected that as the C3s gain expertise in their role, we will see improvements in those areas as well.
Overall LOS was at 4.2 days prior to implementation; initial improvements associated with leadership rounding dropped LOS to 3.93. The LOS increased during the immediate post-implementation period, but now r has eturned to pre-implementation levels. Various DRG-based initiatives and an increase in organizational efficiency are expected to decrease LOS over the remainder of the year.
The performance-based cultural transformation continues to evolve. The availability of real-time operational performance data has enabled front-line leaders to focus on system goals. The transition from project implementation to stabilization is well underway. Clinical and support services leaders are in the process of identifying opportunities for optimization as an important phase of the project. These phases are illustrated in the figure below:
We expect the full operational benefit of the Aim for Excellence project to be realized over the next six to 12 months. Organizational performance is expected to improve in LOS as well as in patient satisfaction.
The impact of the efforts to develop and enhance performance improvement skills in front-line leaders will be beneficial, but may be difficult to measure in the short term. Nevertheless, as we closely and carefully measure the results from this initiative, we anticipate that Aim for Excellence will prove to be a pivotal change for Northwest Community.
As the U.S. health care system transitions to a value-based purchasing environment, Northwest Community counts Aim for Excellence among its most critical transformations. As an independent health system in the northwest suburbs of Chicago, we are proud to be a leader in rethinking high quality and efficient health care.
Pat Stack, R.N., B.S.N., M.B.A., is the vice president of performance improvement at Northwest Community Healthcare in Arlington Heights, Ill.