Five Key Strategies for Results-Driven Patient Throughput

Audio transcription is below.

Welcome to Chapter 3 of the Navvis Executive Playbook. We’re diving into five key strategies for achieving results-driven patient throughput. At Navvis, we believe that improving care delivery and throughput requires both a strategic, and integrated approach that combines strong leadership with close collaboration at every step. Our comprehensive solution aims to improve hospital efficiency, patient experience, care delivery, and financial performance. Join us to learn how to map patient care journeys, utilize data to drive improvements, empower care managers, align providers, and establish the operational infrastructure necessary to manage patient flow effectively.

Number 1: Map Patient Care Journeys Through the Health System and Document Current Bottlenecks and Areas of Greatest Opportunity

The flow of patients through a hospital and out into the extended ecosystem, the services patients use, and the providers that patients access are typically documented through an in-depth assessment of current state practices. Throughout this process, current state findings are verified with hospital leaders and incorporated into a review of relevant hospital reports, as well as procedures, and processes from top to bottom. This process results in a clear understanding of current needs and priorities that translate into agreed-upon priority initiatives. 

The overarching goals of a throughput initiative vary depending on hospital pain points, market dynamics, and population needs, but the general aim is to identify both clinical and operational barriers that are preventing efficient patient progression across the continuum. Barriers can include delays in discharge processes, disparate communication and hand-off processes, and disconnected post-acute-care options. 

The initial phase of the effort should enable hospitals and healthcare organizations to:

• Open hospital capacity for higher-acuity admissions: This can reduce excessive length of stay to open up hospital capacity for new admissions and specialty services and to ensure care is provided to those who need an acute level of care, leading to increased profitability and improved outcomes.
• Fix the “front door”: Focus on reducing inappropriate emergency department visits, and limit unnecessary hospital admissions from the emergency department.
• Create efficiencies at the “back door” for safe and timely discharge: Reduce long lengths of stay among patients ready to be discharged but awaiting placement in skilled nursing facilities, home health, or other appropriate options. This group often has the largest opportunity related to avoidable days. 
• Forecast financial outcomes: Identify the areas, magnitude, and impact of achievable financial improvement on value-based contracts.

Number 2: Let Data Guide the Way

By gathering and analyzing such data as length of stay, readmission rates by service line, mortality rates by service line, and quality outcomes, hospitals can pinpoint where bottlenecks and inefficiencies are occurring and where focused tactics should be deployed. In addition to focused tactics, it is essential to establish a process for continuous improvement, to sustain operational efficiency.

• Targeted interventions: A focus on specific patient groups or areas with the highest potential impact can lead to significant improvements. For example, data analysis might reveal that oncology patients or Medicare patients in intensive-care units are major length of stay outliers.
• Data transparency: Sharing information with unit managers and frontline staff can help break down silos within the organization. Improving communication by sharing information ensures that everyone understands the impact their role has on the big picture and that everyone is working toward the same goals.
• Continuous improvement: Data should be used not only to identify initial bottlenecks and challenges but also to track the effectiveness of interventions as a way of making necessary adjustments. The ongoing process helps maintain progress and make adaptations to changing circumstances.

Number 3: Leverage Care Managers
Care managers are an integral component of improved throughput. Their role in ensuring efficient discharge planning, follow-up care, social determinants of health considerations, and the use of appropriate resources, is the essential ingredient to providing continuous, coordinated, patient-centered care, leading to better outcomes and optimized operations.

• Care Coordination: Care managers play crucial roles in ensuring seamless transitions between care settings, which includes coordinating care as patients move from the emergency department to inpatient units or from the hospital to their homes, or from the hospital to a post-acute care facility. By managing the transitions effectively, care managers help avoid fragmented care, thereby ensuring that patients receive continuous and coordinated care throughout their healthcare journeys.
• Oversee and lead discharge planning: Care managers drive the development and implementation of effective discharge plans. They work with multidisciplinary teams to identify – and mitigate – barriers to discharge, ensuring that patients leave the hospital as soon as they are medically ready. Care managers also provide the resources patients need to avoid re-hospitalization.
• Manage follow-up care: Care managers are responsible for ensuring that patients receive appropriate follow-up care after discharge, which includes scheduling follow-up appointments, arranging home health services, and providing education on the management of medical conditions at home. By coordinating follow-up care, care managers help prevent readmissions.
• Help optimize hospital resources: Care managers ensure that patients receive the right care at the right time, in the right setting, and with the right resources, which reduces unnecessary admissions and readmissions and frees up resources for other patients. They also focus on managing high-risk patients who require more intensive care coordination. By targeting such patients, care managers can have a significant impact on overall throughput and resource use.

Number 4: Align Providers and Build the Operational Infrastructure to Manage Throughput Across the Continuum

It is crucial to have the support and engagement of health system leadership, clinical leaders, and operational managers. The alignment of those groups ensures that everyone is working toward common goals and supporting initiatives aimed at improving throughput at every point in the chain. Bringing together a multidisciplinary team that includes primary care physicians, specialists, nurses, care managers, and other healthcare practitioners is essential. Members collaborate to address patient flow issues and ensure that care gets coordinated effectively across different departments and care settings. 

• Take a multidisciplinary approach: Bring together a multidisciplinary team that consists of physicians, nurses, care managers, and other key stakeholders. This approach enables team members to have focused collaboration on how care gets delivered and coordinated effectively across different departments, units and care settings. A multidisciplinary approach informs the operating model and should include best-practice-based roles and responsibilities, standardized tools for mobility, education, and new discharge procedures.
• Designate resources: Ensure that adequate staffing and resources are available to meet patient needs, including the right-sized staffing of care managers, nurses, and support staff to manage throughput efficiently. In addition, ensure staff has the necessary information to anticipate demand and manage hospital capacity, including bed availability.
• Extend investments the hospital has already made: For example, ensure the integration of electronic health records across all care settings so that all providers have access to up-to-date patient information, which facilitates better coordination and continuity of care.
• Involve specialists: Engage and integrate specialists so they are actively involved in throughput efforts. Their involvement is crucial for creating effective care pathways and ensuring that patients receive specialized care promptly. Specialists should collaborate with primary care providers and other members of the care team. Such collaboration ensures that:
  • Care is coordinated seamlessly between different levels and sites of care,
  • Condition-specific care continuum pathways are developed and implemented, and
  • Treatment protocols are standardized for specific conditions, thereby ensuring consistency and quality of care across the healthcare system.
• Establish policies and procedures that will support the new care pathways: Developing and implementing standardized care pathways for common conditions helps ensure that patients receive consistent and appropriate care. Standardized care pathways outline the steps and interventions required at each stage of the patient journey. Standardization of discharge planning processes ensures that all patients are prepared for a safe and timely discharge, including the identification of potential barriers to discharge and addressing them proactively.

Number 5: Develop top-down culture change.

Cultural change is an important component of any successful throughput program. To achieve significant operational improvements, healthcare organizations must make a fundamental shift in the way their staff, their processes, and their policies are aligned and implemented. More often than not, some degree of cultural transformation is required to ensure that all team members understand and are committed to the shared goals of optimizing throughput, and improving care delivery.

Importantly, The senior executive team plays a pivotal role in leading and sustaining change. The team must be an active champion of the change process by setting the tone and expectations for the entire organization. The team’s involvement is necessary to:

• Set a vision: Clearly communicate the vision and goals of the throughput improvement efforts, ensuring all staff understand the importance and benefits of a new way of delivering care.
• Dedicate resources: Assign necessary resources, including time, funding, and personnel, to support the implementation of new processes and technologies.
• Lead by example: Demonstrate commitment through actions and decisions, fostering an environment in which change is embraced and valued.
• Encourage accountability: Establish accountability measures to ensure that staff at all levels of the organization are contributing to and are responsible for the success of the throughput strategies.

Tina Pike, Senior Vice President of Throughput Client Partner Operations at Navvis had this to say about the importance of having a top-down culture.

“We need to think about delivering care differently. At times that requires a reorientation from top to bottom. Whether a hospital is pursuing a value-based care model or not, it will be implementing change one step at a time. You need a culture change. Or more simply said, a mindset change. It is really about the continuous internal reflection that says what we did three months ago may not be working now. The population changes. Market circumstances change. Your approach needs to be nimble enough so that you can flex when you need to.”

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In this chapter, we’ve explored the importance of a strategic approach to patient throughput, emphasizing the need for a comprehensive solution that improves efficiency, patient experience, and financial performance. By mapping patient care journeys, leveraging data for continuous improvement, utilizing care managers, aligning providers with operational infrastructure, and fostering top-down culture change, hospitals can enhance their throughput and overall care delivery. As the healthcare landscape continues to evolve, these strategies are crucial for adapting to new challenges and ensuring optimal patient outcomes.

Thank you for listening. If your hospital system is looking to enhance performance and achieve the operational, financial, and clinical benefits of a results-driven patient throughput strategy, contact Navvis today. 

Ready to get started with a patient throughput strategy?