No More Crystal Balls

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Over the centuries, many people have believed it was possible to predict the future by reading tea leaves, consulting mystics, or looking into a crystal ball.  (Some still do, but that’s a topic for a different post.)

These days, most of us trust more scientific approaches for making predictions, and most mature industries rely heavily on science and technology to help guide decision making.  But not all: despite all of the technological capabilities available at our fingertips, some organizations still rely on a hodgepodge of disconnected data, institutional memory, and intuition for making decisions. 

Healthcare is one example of an industry that has lagged behind other industries in using well-established scientific and data-driven approaches to guide management decisions.  Contributing factors have included 1) lack of pressure to be efficient due to historically high reimbursement rates, 2) lack of formal training in operations science for leaders who rise through the ranks from clinical backgrounds, and 3) lack of access to timely and reliable data.  These are changing, but there is still significant opportunity to improve organizational efficiency as well as patient care by incorporating these approaches in hospitals and other healthcare organizations.

For example, many hospitals find patient admissions and census peaks to be unpredictable and therefore deal with them reactively, leading to delays between the times that additional resources are needed versus when they are actually added.  This puts stress on hospital staff and other resources, and makes care less safe for patients. Most experienced hospital managers know intuitively that census is higher on certain days of the week and times of day, but often don’t accurately anticipate severe peaks far enough in advance to take proactive action ahead of time.  This is something with which current science and technology can help, enhancing managers’ instincts and intuition with timely and actionable data.  

With Hospital IQ’s data science, predictive analytics, and powerful simulation capabilities, it is possible to predict patient census and discharge dates with an actionable degree of accuracy, giving hospitals a modern “crystal ball” to anticipate the future and take appropriate action.  For example, if predicted census for tomorrow goes above a threshold that would trigger a hospital’s “surge plan,” the hospital could take proactive steps to be ready to implement the plan quickly if the prediction turns out to be true.  These steps could include notifying on-call staff that they are likely to be needed tomorrow, and/or proactively staffing additional beds to accommodate the higher-than-usual number of patients.   In this way, hospitals are empowered to mitigate problems before they occur and to create a better environment for patients and staff.

Industry News: August 2017 Recap

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In a healthcare industry that’s always innovating, it’s a challenge to keep up with all the fast-breaking news. To make things easier, we’ve compiled some recent articles that reflect the news and trends of hospitals, health systems, and hospital operations and management last month.

The healthcare analytics market investment total is projected to exceed $18.7 billion by 2020, according to MedGadget. Rising pressure to curb healthcare costs, big data in healthcare, technological advancements, growing awareness about benefits of analytics, and increase in venture capital investments are just a few of the factors driving this spurt of market growth. Source: MedGadget.

Hospital and healthcare technology aren’t the only things that are changing. In the wake of innovation, the role of hospital executives and their decision making processes are also being forced to change, with new options and new goals in mind. Source: Modern Healthcare.

Healthcare big data analytics is becoming a platform for creating a new vision of what it means to be a smart society. According to a recent report by the Center for Data Innovation (CDI), a smart society is a healthy society – and a healthy society makes good use of its big data. “Investing in analytics infrastructure, including electronic health records (EHRs) and the Internet of Things (IoT), can help regional stakeholders contribute to smart societies prepared to meet the many socioeconomic and environmental challenges of the future.” Source: Health IT Analytics

Find an interesting article? Have an interesting perspective or insight? Share it with us in the comments section.

Why Great Software Is Never Enough

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Buying great software is never enough to truly achieve meaningful change. True change, in any organization, can only be achieved through a combination of three factors: people, process, PLUS technology.

While the mantra seems simple, understanding its composition is the best way to recognize the path to innovation.  Change requires that people not only see an opportunity to improve a business function, but they are also willing to be held accountable to take the necessary steps to improve it with the right support from the organization. When employees can visualize how their efforts will improve the business, as well as the lives of clients, and take ownership, the opportunities are boundless.

Another component to affecting change involves the processes for planning and evaluating the problems that need to be solved. It’s important to gain consensus regarding the right path forward, and come to an agreement on how a solution will be will be implemented and run. Assigning ownership and accountability throughout a process implementation is essential to its success. Without the right level of accountability, when strategic priorities change, initiatives can quickly lose momentum as attention and resources are directed elsewhere.

Once you see the opportunity to change, understand how you will ensure it is change for the long term, and have the commitment from all the key stakeholders, then you are ready to decide which potential technology solution will address the specific problem in a manner consistent with the aforementioned people and process you have already established.

Some of the key considerations, include:

  • How flexible is the solution?
  • How much customization is needed?
  • How user friendly is the tool (does it require access to IT and others) to make its data usable?
  • If you evaluate a range of potential outcomes, does the solution provide a compelling chance that it will generate (or save) a factor of at least 2-3X over a period of no more than 2-3 years? Does it require the need to acquire dedicated servers?  

Today’s hospital leaders are focused on initiating significant, yet meaningful change.  While profitability is always a motivation, the healthcare industry has the added objective to provide high quality of care to an ever-growing number of patients. To achieve this, organizations must focus on its people, processes, and technology to become more efficient. You can’t have one without the other (two).

 

 

 

Narratives and Data: Mixing the Culture of Healthcare with the Culture of Data Science.

Data scientists and medical clinicians look at things from different perspectives especially with respect to data.  Data scientists focus on what is most common, while clinicians tend to concentrate on what is unique.  In the real world of healthcare and hospital operations, this means data scientists will typically optimize for the most common type of patient, while clinicians instinctively optimize for the edge cases.

We call this “Conjoined Twin Syndrome.”  Conjoined twins are very rare, but equally notable.  A successful separation requires tremendous medical resources and planning – multiple teams of specialists working in multiple rooms for many hours.  There’s also typically media coverage and press interviews.  This is about as far away from a routine hernia repair as one can get.  But even with the huge footprint of a single conjoined twin separation, the hernia repairs take up significantly more cumulative OR time annually than the one conjoined twin every decade.

Hospitals need to be designed for the most common type of patient.  The edge cases are the stories we tell at the dinner table, but they don’t actually move the needle in terms of day to day operations.  The majority of patients at a hospital are routine treatments with predictable care pathways and foreseeable outcomes.  These are the patients we data scientists focus on and for whom we optimize.  The edge cases, by definition, can only be dealt with on a case-by-case basis by thoughtful and experienced staff.  These cases are too complex and unique to realistically invest in establishing a defined process that manages their throughput.

Conjoined twins are narratives, not data.  As humans, we’re naturally wired to narratives and give them oversized significance.  When Hospital IQ works with hospitals, we often hear narratives such as, “The ICU is always filled with behavioral patients.”  When we actually drill into the data, we often see this happened once or twice, but certainly not “always.”  However, this narrative persists because the impact on staff was sufficiently stressful to put everyone on high-alert whenever a single behavior patient is placed in the ICU.  “The ICU is always filled with behavioral patients” is not patently untrue, but a more accurate statement would be, “There were two instances in the last 18 months where more than 25% of the ICU census was behavioral patients.”  But which statement has more narrative appeal?

To be clear, data and narratives are not in competition.  Organizational change comes about when narratives are shaped by data – supporting some aspects while refuting others until the two are aligned.  Nobody can make a decision on data alone.  Without a narrative, hospital data is just rows of patients in tabular format.  The best decisions result when supported by a narrative that is both emotionally compelling and consistent with the facts.  This is why hospitals need data scientists, and why data scientists alone don’t run hospitals.

Managing Surges: Inpatient Triggers

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Surge plans are created so hospitals and health systems can mobilize to meet the challenge of census surges with responses that are early, organized and complete. In my last post, I discussed how overcrowding in the emergency department is often used as a trigger for surge responses. The ED is “the canary in the coal mine” indicating when the hospital census is reaching critical levels. However, it is also possible to use direct measures of inpatient capacity to trigger surge responses.

In choosing accurate triggers, the aim is to find the right mix of “sensitivity” and “specificity.” Triggers that are high on sensitivity catch most search situations, but also produce false alarms. Triggers that are high on specificity minimize false alarms, at the cost of sometimes not triggering with true surge events.

Traditional census measures, such as midnight and noon census, are blunt instruments. Midnight and noon are not the most critical times for census. More importantly, many hospitals have specialty beds that can only be used for a narrow range of patients, like obstetrics, pediatrics, and epilepsy monitoring. It makes sense to exclude the specialty beds, and have a measure of non-specialty bed utilization, preferably updated hourly.

The combination of non-specialty utilization, known incoming admissions, and anticipated discharges, can be a very effective, accurate, and early trigger for surge action. While utilization percentages in the high 80s and 90s often signal the need for action, it is important to “road test” any new measure to get a feel for which level of utilization translates to log jammed systems, and compromised clinical care.

It is also worth going beyond the overall non-specialty utilization rate, to look at specific levels of care and determine which will become bottlenecked worst and first. Targeting that level of care, for instance, telemetry beds, allows focused efforts to be made by case managers, nursing, hospitalists, and others towards prioritizing discharges and judicious use of beds for that level of care.

While it is possible to do some of this work without dedicated IT systems, the data collected and stored by Electronic Health Records and electronic bed management platforms is invaluable. An advanced operations management platform, combining and modeling this data from across all systems, together with forecasts of incoming admission volume, can produce accurate surge warnings days in advance which can not only maintain or even improve the level of patient care during a surge but also minimize or reduce unnecessary costs and prevent staff dissatisfaction.

Rather than wait for the ED to be bursting at the seams, it makes sense to trigger surge responses directly based on inpatient bed utilization. The key is getting the measure right.

Industry News: July 2017 Recap

Staying current with the innovative, always-changing healthcare industry is no easy task. To ensure you don’t miss a beat, we’ve compiled some recent articles that highlight the key issues and trends discussed during the past month regarding hospitals, health systems, and hospital operations and management.

  • Hospitals & Health Networks and the American Hospital Association recently released data from their annual “Health Care’s Most Wired” survey. The results showed that now more than ever, hospitals are using data and analytics to foster a culture of self-improvement. Source: Hospitals & Health Networks

  • Another study from the Ottowa Hospital caught industry attention, showing delayed emergency surgeries increased the risk of death and cost hospitals more money ($1,409 per patient that stayed in the hospital 1.1 days longer). Source: CTV News Winnipeg.

  • Industry consolidation continues to increase, according to data from HealthcareMandA. Acquisition activity in the hospital market increased slightly in the second quarter of 2017, with 23 acquisitions in the Q2, up 15% from the 20 publicly announced acquisitions in the first quarter of 2017. Source: Benzinga

  • The Society of Actuaries revealed the results of its 2017 Predictive Analytics in Healthcare Trend Forecast. This report found more than half of health payer and healthcare provider executives believe predictive analytics will save their organizations 15 percent or more of their total budget over the next five years. Source: Healthcare Informatics

Find an interesting article? Have an interesting perspective or insight? Share it with us in the comments section.

 

Hospital IT Underinvestment: The Roadblock to Modernization

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Early in my career I was fortunate to develop and market software that was used by the largest banks and Fortune 100 companies -  some of the most demanding and sophisticated IT consumers in the world.  As a vendor to these organizations, I delivered high-performance software designed to solve complex customer problems using practical, scalable solutions that leveraged new infrastructure models, like the cloud, long before it was considered a best practice.

Due to this experience, I saw healthcare as an ideal place to apply the hard fought lessons from previous industries to a market that had been historically underserved. My initial findings in talking with leading healthcare clinicians, consultants and hospital leaders was how poorly many healthcare technology vendors served their customers. Their software is developed on systems that many industries effectively retired decades ago; they are closed systems, the user interfaces are outdated and visually non intuitive, and hardware configurations are complex and expensive. Additionally, even with all of the successful commercial applications of cloud technology, most healthcare vendors are years behind in leveraging this lower cost infrastructure resource.

The consequence for the healthcare industry is that much of the technology used in hospitals today is hard to install, hard to use, cumbersome to adopt, expensive to maintain, and doesn’t leverage the ecosystem of modern IT and/or established best practices.

Healthcare needs to invest in IT and expect much more from its vendors.  At many hospitals, IT is conflated with the help desk function – run reports, keep the printers working and reset passwords every three months. But writing the off the role of IT in this way is only setting hospitals back further.  IT should be central to hospital leadership and should be a key stakeholder in modernization in partnership with its primary vendors.  Additionally, IT should play a key strategic and operational role and their vendors should make it easy.  I’m confident the entire healthcare system would benefit if customer expectations for what technology can do  was held to the same standard as in other industries.

I hear a lot of justifications from both vendors and some customers on “why healthcare is different” and how modernization needs to be slow, methodical and gradual – personally, I don’t buy it.  Meaningful Use has resulted in a workflow platform and treasure trove of data that can be leveraged to significantly improve hospital efficiency. Yet for the most part, vendors have not exposed these capabilities for customers to leverage, nor have they shown much proclivity for modernization. PHI is also a poor excuse to defer modernization. My previous financial clients had equally sensitive client information and successfully used technology as a competitive differentiator while reducing the risk of hacking, not despite the risk.

I made the shift to healthcare assuming my experience building and advancing great software would be an unqualified advantage for an industry this large and important. I’ve maintained my quality expectations, both because it is habit, as well as because it’s my belief hospitals will eventually come to demand the same of their vendors. In the meantime, Hospital IQ will continue to build innovative solutions based on modern technology that enables forward thinking customers to leverage all of the data they generate in a purpose-built, scalable, intuitive and fully-transparent system in order to bring their vision to fruition and deliver on their hospital’s mission. We will continue to educate and empower hospitals to understand the true value of the data it has at its fingertips and lead by example in showing what we believe are the best practice of an IT vendor.

Three Keys to Unlocking Block Utilization Improvement

Today’s high-tech ORs are a marvel of modern technology. Yet the planning and management of these ORs still rely on traditional manual methods that came into favor 20-plus years ago. Given that ORs are both the most expensive and most lucrative location in many hospitals, it’s crucial that OR time be optimally managed to maximize throughput and minimize waits, while still leaving enough room to accommodate emergency cases.

OR blocks are traditionally assigned to surgeons and/or service lines and only examined in a monthly, or even quarterly, committee meeting.  Traditional trend reporting is provided to make informed decisions – including the reallocation of blocks.  At the same time, perioperative managers are juggling the strategic objectives of the organization and pressure from surgeons who desire more time - relying on the same historical reporting methods to support their business needs.

Ultimately, the block scheduling and the utilization of the block is left to the surgeons themselves. There is very little transparency in the process.  The supporting reporting algorithms are tweaked to be as fair as possible to the surgeons operating within them.   This turns into a heavy effort that leaves little time to discuss the actual optimization of the block itself.

This doesn’t have to be the case.  Organizations can streamline their efforts by following three key principles to grow their perioperative services.

1.      Define a Clear Set of Rules to Execute on Your Organization’s Objectives.

Make sure that all parties involved understand the strategic implications of their actions within the process.    Many organizations are attempting to grow service lines, offer new services, and improve their position against competitive providers in the region.   Clear alignment behind the goals will help every leader understand how they can support the objectives.

To enable execution, it is critical for everyone to understand how block time is allocated and re-allocated.  A clear set of rules for surgeons and service lines that justify maintaining a block, or giving up block, is critical to everyone involved.  Not all decisions are popular, but it is easier for everyone to accept the decision when they understand why the decisions were made in the first place.

Hospital IQ’s Perioperative Planning & Management Solution allows organizations to strategically manage their block utilization.

Hospital IQ’s Perioperative Planning & Management Solution allows organizations to strategically manage their block utilization.

2.     Empower Service Line Leadership to Drive Growth.

Identify and support key growth areas with senior leadership that is empowered to not just oversee, but actively manage, the performance and utilization of a service line within your OR.  Deliver the right tools to review both historical and future block performance to help them better manage their business line.

Hospital IQ’s Perioperative Planning & Management Solution allows service line leaders to view past, present and future block performance.   

Hospital IQ’s Perioperative Planning & Management Solution allows service line leaders to view past, present and future block performance.   

3.     Provide Surgeons with Visibility into the Block Performance and Future Opportunity.

Too many conversations around block performance include removing block time from surgeons without attempting to empower the surgeons to deliver more care.  Surgeons must be informed about their impact to organization’s overall block performance, so they can understand the opportunity available to them.   This naturally creates a better environment for surgeons, administrators, and the patients that benefit from increased utilization. 

Hospital IQ’s Perioperative Planning & Management Solution allows surgeons to understand their performance, as it relates in relation to their peers and the organization’s objectives. 

Hospital IQ’s Perioperative Planning & Management Solution allows surgeons to understand their performance, as it relates in relation to their peers and the organization’s objectives. 

It’s time to take a technology-enabled approach to OR block management. Advanced technology-based analytics offer hospitals new insights into planning OR blocks in the most strategic and optimal way possible. Thanks to the power of technology, healthcare leaders are empowered to shift from being reactive to proactive in managing the OR, while delivering significant return on investment and improving patient care.

Managing Surges: Triggers in the Emergency Department

Photo by anirav/iStock / Getty Images
Photo by anirav/iStock / Getty Images

Curing capacity issues in a hospital involves actions ranging from long-term, strategic improvements in matching supply and demand for beds, through to immediate actions to address problems in the here-and-now. However, there are short-term preparedness measures, specifically defining triggers to action, that can mitigate or bypass the disagreements and loss of time in activating responses to census surges. The Emergency Department (ED) is a good place to start.

The ED is often the “canary in the coal mine” for hospital census surges. When the hospital becomes critically full, admitted patients wait hours or even days to be assigned beds, all the while “boarding” in ED stretchers. With stretchers in the ED full, new emergencies cannot be brought in. Meanwhile, the waiting room is full, and patients begin to walk out rather than wait to see the doctor. Ambulance dispatches may officially ask to take new patients to other hospitals in the area (“diversion”), or unofficially do the same thing as they witness the crowding and delays. Research has shown that ED overcrowding is associated with worse clinical outcomes and higher mortality rates for ED patients. ED overcrowding is a failure on all fronts: a failure in the mission to provide care, and failure in quality of care, and a serious financial failure from loss of case volume.

When is the right time to call for help? Doctors and nurses in the ED often say they know overcrowding when they see it, but struggle to have an agreed-upon measure. Hospital and emergency leaders want a measure that is backed by research, and validated so they can understand when overcrowding will lead to walkouts, diversion and delays in care.

But how can one scale represent an inner-city ED with 70 beds seeing 100,000 patients a year, and just as faithfully represent a rural ED with 12 beds and 20,000 patients? Researchers have developed standardized scales used internationally to provide standardized apples-to-apples scales and triggers to action, across EDs of different types and sizes.

NEDOCS  is the most widely used scale. The inputs include 1) Demand: total number of patients in the ED (and waiting room), the number of critical patients (1:1 nursing, on ventilator) 2) Supply: number of ED beds, number of hospital beds 3) Delay measures: boarders, length of stay in the ED, waiting room time.

Other scales include READI (more factoring of acuity, plus provider staffing), EDWIN, EDCS (includes hospital occupancy) and SONET.

There is a lot of debate to be had over which scale is best for a particular ED. However, the most important thing is to start measuring. It is relatively straightforward to measure all five of these scales four times a day. At the same time, get input from the charge nurse and from physicians on whether crowding is impacting patient care, patient experience and the sense of pressure in the work environment. Put these together with walkouts and ambulance diversion and after a month you will have a good idea of which scales can be a trigger for action.

Of course, all these scales have one thing in common – they tell you when the storm has hit. They do not offer a weather forecast. New computer-intensive approaches involving discrete event simulation and machine learning to predict incoming patients, plus a holistic model of patients already in the hospital, can offer several days of advance notice, providing crucial time to fill staffing gaps and address hospital census among other measures.

Finally, hospital crowding is not only about the ED, and there are triggers for action that should also be considered that have nothing to do with the ED. More on that soon.

Tackling On-time First Starts Can Be a Quick Win

Photo by GoodLifeStudio/iStock / Getty Images
Photo by GoodLifeStudio/iStock / Getty Images

Anyone working in the perioperative arena is familiar with the importance of on-time first starts, i.e. starting the first cases scheduled for the day in each operating room on time.  When these cases run late, it has a cascading effect on cases scheduled afterward, leading to overruns and inefficient use of costly operating room resources including staff.

Tackling on-time first-starts can lead to a “quick win” that’s easier to achieve and offers a bigger payoff than trying to tackle other frequently-mentioned issues, such as reducing turnover time between cases.  This is largely due to the fact that surgical team members tend to have similar perspectives and incentives when it comes to starting the day on time, but different perspectives and interests related to turning rooms over between cases.  Surgeons tend to view room turnover as unproductive/idle time because their work on a case typically ends when the patient has been stitched back up, while nurses and other team members, who actually perform room turnover, see it as active/work time.  In contrast, all team members benefit from starting the day on time because it contributes to a more predictable and productive work day for everyone.

Even so, many hospitals struggle to achieve a high rate of on-time first starts.  This is often due to lacking a culture of accountability, which leads to a sense of futility among relevant stakeholders.  However, a culture of accountability can be fostered by implementing several key initiatives:

Near-term reminders: Automatically send notifications regarding first-start procedures and start times to relevant surgical team members the night beforehand.

Immediate follow-up: When cases run late, send requests to all surgical team members for verification/correction regarding the reason(s) for the delay within a few hours.  This creates a sense that the organization cares about on-time starts and is monitoring performance in real time.

Full stakeholder input: Include all surgical team members involved in a case in each request for feedback regarding the reason(s) for delays.  This creates a sense of inclusiveness and promotes accuracy in recorded delay reasons. Instead of relying on one data entry point, organizations can use feedback from multiple stakeholders’ perspectives to abstract a more complete understanding of delay reasons and work to address them going forward.

Organizational support: All of the steps above should be part of an organization-wide effort to optimize timely starts. In addition, the feedback given by surgical team members must lead to organizational action to address common delay reasons and give surgical teams the best possible chance of succeeding in their efforts to start on time.

Within a few weeks of implementing such efforts, hospitals can improve on-time, first-start rates dramatically—in some cases from below 40% to above 70%.  While all of these steps can be accomplished manually, such manual workflows are prone to human error and lack long-term stability.  Hospital IQ’s solutions enable organizations to implement these highly beneficial initiatives using an operations planning and management platform that automates the workflow and makes the process more stable, reliable and sustainable over time.

Industry News: May 2017 Recap

It’s not easy to keep up with the endless cycle of healthcare-related news. In case you missed it, we’ve compiled an overview of the key issues and trends discussed during the past month regarding hospitals, health systems and hospital operations and management.

How effective data utilization is enabling a new group of health system leaders to emerge and drive much-needed change across the industry.

The premise of the show, Undercover Boss, is to allow top executives to anonymously work among the rank-and-file to really understand what is happening within their organization.  But one healthcare executive didn’t need to go undercover to learn some important insights that can benefit all hospital executives.

Found an interesting article?  Have an interesting perspective or insight? Share it with us.

 

The 5 Things Your Hospital’s Predictive Analytics Platform Must Do

Photo by Ifness/iStock / Getty Images
Photo by Ifness/iStock / Getty Images

A predictive analytics platform is an indispensable tool for improving hospital efficiency.  Whether you’re executing dozens of improvement initiatives, contemplating an expansion, or just trying to get a handle on what’s happening today, the right platform can provide the actionable intelligence to make faster and smarter decisions.  In fact, hospitals are finding they can’t afford not to leverage their data in this way. 

A useful predictive analytics platform is not “standard issue” in EHR offerings, unfortunately, and building one from scratch requires extensive expertise in engineering and data science.  Even the most advanced business analytics groups struggle to keep their home-grown models running with fresh data. 

As hospital leaders turn to the market for solutions, they should be aware that some platforms have limitations that lead to poor results, like ineffective reports, micro-optimizations that make the overall system worse, and “alert fatigue” that wears down staff.  To avoid these pitfalls, ensure your platform of choice can offer these things:

  1. A holistic, up-to-date view.  The platform bridges together disparate data silos, like ED systems, bed management systems and EHRs, and keeps that data timely.  Hospitals are complex operations, and without the complete picture the analysis falls short.  A comprehensive data set also provides a good baseline; only when you can truly see what’s happening today do you have the context to effectively evaluate potential changes.
  2. Historical accuracy.  It’s one thing to collect data, but another to trust it.  A proper platform collects and cross-references data across IT systems, and continually checks for discrepancies across data sources. Confidence in data integrity is a must, as there is too much data to rely on manual checks alone.
  3. Predictive accuracy.  The platform provides forecasts, such as predicted occupancy rates, surgical block fill rates, and appointment demand, in a responsible way, by providing clear prediction ranges (not just absolute numbers), measuring the accuracy of past forecasts, and using machine learning to improve.  Otherwise, how are the forecasts to be trusted?
  4. Actionable insights.  The platform’s analytics answers the “so what?” question by providing specific recommendations, like an early warning system for initiating a surge plan, a prioritized list of patients to check on for likely discharge, or an optimized staffing plan to implement.  And the reports are designed to identify outliers from normal activity.
  5. What-if capabilities.  The platform provides a simple and accessible way of running simulations to prioritize improvement projects based on anticipated clinical, operational, and financial measures.  With actual vs. expected reports, it also supports the plan-do-check-act cycle to verify initiatives are tracking to goals.

We’ve entered an exciting time in healthcare, where digitized activity is just waiting to be turned into actionable insights. With the right predictive analytics platform, you can drive both operation efficiency and better care.

How to Ensure Accountability in the OR

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Accountability in operating room block utilization is critical to an organization’s ability to optimize throughput, minimize cost, and provide the best care.  Without accountability, it’s nearly impossible to allocate block time equitably; often time is given to those with the loudest voices rather than those with the best performance.

Historically, accurate, accessible data regarding block and room utilization has been extremely challenging to come by.  While some healthcare organizations have a few capable analysts who churn out reports, the information is often “stale” by the time it’s reviewed, making it less actionable and more vulnerable to objections (for example, block-holders who want to protect their existing time or lobby for additional time).  Without timely, accurate data, it’s nearly impossible to establish and maintain a culture of accountability with regard to block utilization.

What hospitals need to ensure accountability is a platform that provides shared, accessible, timely, accurate, and “drillable” information. 

Shared: All stakeholders have access to the same data, creating a common point of reference. In the past, performance metrics were calculated inconsistently by different analysts in different departments, giving credence to objections and thereby undermining accountability.

Accessible: Users can access and interact with dynamic views of the data in a user-friendly interface, instead of piecing together information from multiple, less user-friendly systems or waiting in line for overworked IT departments to extract data.

Timely: Data is updated daily or weekly rather than monthly or quarterly, making it easy to verify or counter objections based on timeliness of the data.

Accurate: Set-up always involves a process of validation and vetting compared to existing data/metrics.  During this process we often uncover data issues and/or inconsistent rules for calculating performance metrics; these discoveries often help to improve data quality and establish fair and consistent performance policies

Drillable: Users can drill into utilization and surgical activity at any desired level of granularity, including service, surgeon, block, and individual cases.  This bolsters confidence and makes it easy to verify or counter objections related to the accuracy of the underlying data.

Accountability in perioperative performance empowers an organization to achieve results that are great for the bottom line, as well as patients and staff.  Hospital IQ’s solutions offer an accurate and verifiable view of OR performance, helping organizations create a framework of accountability and achieve superior results.

Do you need a surge plan?

Anyone in a leadership role at a hospital has seen what happens on days with a very high census. Critical patients wait hours in the emergency department because there aren’t any ICU beds. Patients in the ICU have had discharge orders for two days but there are no telemetry beds for them to move out to. There are anxious calls to make sure the PACU remains open overnight. Patients start to walk out before they are seen in the emergency department, and even without official diversion, ambulance dispatch is sending patients elsewhere.

As the magnitude of a surge in census becomes clear, leadership scrambles to respond. Calls go out asking nurses for extra shifts or calling in agency nurses. The COO opens a closed unit. Case management, social workers and physician leaders work frantically to find a few extra discharges and find post-acute placements. Admitted patients are routed to other hospitals in the system.

The problem for a hospital experiencing a surge is that more often than not hours go by before everyone recognizes and agrees that this is not a normal day. And once action is taken to mitigate the problems, it takes considerable time to get a variety of moving parts into place. There are phone calls to be made, requests and negotiations, and significant delays as people find childcare and change plans to come in to work. These actions must be renegotiated every time there is a bed crisis. Then there is the financial impact. Surges take key personnel away from patient care and important administrative work. At the same time, costs are driven up through expensive unplanned extra staffing, and revenue from external transfers and ambulance arrivals is lost and ambulatory ED patients walk out. It’s a triple-whammy to the bottom line. There has to be a better way.

To address this problem, many hospitals are implementing “surge plans” to formalize and improve the ad hoc responses that have been developed over time. Most surge plans standardize the triggers for action, which dramatically improves reaction time, and cuts through the debate that delays a response. Surge plans also tie specific actions to those triggers, formalizing the consensus around necessary responses and avoiding the need for making the case and negotiating in real time.

Having structure and detail in a surge plan help avoid missing steps, or leaving out groups and departments whose involvement is necessary. Surge plans can also help focus efforts on specific bottleneck areas so that if, for instance, the ICU is the most gridlocked point in the hospital, efforts can be concentrated effectively at that point.

Surge plans lend themselves to measurement, analysis, refinement and improvement over time. The final element that technology enables is census forecasting, giving hospitals precious extra hours or even days in which to recognize impending census surges and to deploy their response proactively.

Surges are a fact of life in hospitals, but new technology is allowing us to more quickly anticipate and respond to surges, and keep the focus on patient care. In future posts, I will discuss surge plans in greater depth, including triggers for action, scaled responses, actions in various disciplines, units and departments, messaging, building agreement and participation, and advanced warning systems.

Industry News: April 2017 Recap

It’s not easy to keep up with the endless cycle of news. In case you missed it, we’ve compiled the key issues and trends discussed during the past month regarding hospitals, health systems and hospital operations and management.

Hospitals and health systems continue to deal with shrinking margins and are looking for ways to drive greater efficiency in delivering healthcare.

What hospital leaders should know when it comes to clinical analytics.

Healthcare analytics continues to be a growing market and offers significant potential for hospitals that embrace it.

Found an interesting article?  Have an interesting perspective or insight? Share it with us.

Humanity and Data: Combining Mission and ROI in Healthcare Operations

Photo by mediaphotos/iStock / Getty Images
Photo by mediaphotos/iStock / Getty Images

 For the past eight years, my family and I have been hosts for Hospitality Homes,  a Boston-based organization that connects local volunteers who have a spare bedroom with out-of-town families of patients in Boston for medical treatment.  We’ve had guests from all over the word, and they stay for as little as one night and as long as four months.

Our participation in this program is a constant reminder that the data we study at Hospital IQ tells a very human story.  The rows of patient flow data we ingest are not just statistical components, but narrate each patient’s personal journey through the healthcare system.

For example, our surgical data has a column for “delay reason” when a surgery starts late.  It can be as simple as “surgeon late” or “incomplete consent”.  But seeing a recent value of “prior emergency case” reminded me of a guest we had a few years ago.

This patient and her family used vacation time from work to travel to Boston for a complex elective procedure not available in her home town.  A third family member was planning to arrive middle of the following week for a second wave of support when otherse had to return to work.

The family arrived two days before the procedure to get settled in and be at the hospital early on the day before the surgery for pre-operative tests. This included introductions to the surgical team that the family reported as being very reassuring.  When the family came home back to our house at the end of the day, they were exhausted.  Typical of healthcare, their day was “hurry up and wait”, mixed with getting lost in complex hospital corridors.  Their evening was spent on the phone and social media providing updates for a wider range of friends and family not in Boston.  Everyone was clearly nervous about the procedure, which was not without risk.

On the day of the surgery they left early for a 7:30 surgery start time.  All the preparation was complete.  They were ready. However, the surgery was cancelled because of an emergency case that caused an OR backup and bed shortage.  They were rescheduled for the end of the week.  Now what?  All their intracte plans have been thrown into chaos.  As wonderful a destination as Boston is, sightseeing wasn’t the reason they were in town.  They were left in a state of anticipatory limbo..

This would have been just one line of data in a feed we get every day.  But to this family, this one line represents a major distruption to their encounter.  From a financial perspective, the event was “revenue neutral”.  But that ignores the human emotional impact to both the patient and as well as the disruption to hospital staff tasked to provide their care.

In this particular case, I can’t know if the surgery could have avoided being bumped with better operations and planning – it was before Hospital IQ existed.  But for the hospitals that are our clientsusing our software, I think of this family every time we look for opportunites to improve access to care. 

 

Hey, That’s my Parking Space!

We had a snowstom in the Northeast last week but as far as I’m concerned, the real storm is the one over parking that immediately follows the one with the snow.  Few local customs generate as much controversy as the tradition of “space savers.”  These are objects such as broken lawn chairs or traffic cones people use to “reserve” their parking spaces after spending time and energy to dig their car out of the snow.  People who remove a space saver to park there have been known to have their car vandalized in retaliation.

Some people consider the right to temporarily own a public parking spot the legitimate reward for investing time to dig out their car.  Others feel street parking is a shared public resource allocated on a first-come, first-served basis and there is no justification for even temporary ownership.  Local government had historically stayed out of the controversy, but in 2015 Boston Mayor Thomas Menino instructed garbage crews to remove space savers 48 hours after a storm ended.  This essentially enshrined a policy of two-day holds on parking.

From a resource allocation perspective, this is a terrible use of shared property. This hoarding behavior reduces utilization for everyone.  Hoarding happens when there is unregulated scarcity and cooperation breaks down. 

This issue is not unlike what we sometimes see in the perioperative suite.  Tenured surgeons claim ownership of OR blocks because they’ve historically used those blocks and have come to rely on them being available at their convenience.  Management is often reluctant to alienate those long-time surgeons and impose policy that would improve utilization of blocks by re-allocating them to someone with a larger caseload.  Newer surgeons are forced to “drive around in circles” looking for OR blocks, while prime time goes unutilized.

The following anecdote illustrates an alternative path forward.  I got my haircut this morning and was making small talk with my barber about the space savers and he told me about the time he took someone’s space saver when he arrived at his shop in the morning.  I was shocked to hear him admit to such a blatant violation of street rules.  But instead of just tossing the space saver aside, he placed it on top of his car with a note on his windshield saying:  “I took your space.  Please call me at 617… and I will give it back to you.”

Around 4:30 PM his phone rang from an unfamiliar number.  He answered and said: “You want your space back?”  Sure enough, it was the original parker.  The barber went out to move his car, prepared to apologize, but instead of being upset, the parker was grateful to him for keeping her space with an actual car.  She was nervous someone would take her space and she admitted she was unwilling to do anything to retaliate.

She then said, “I actually have something to ask you … can you do this again tomorrow?”  For the rest of the week, they arranged over text messages to share the space, allowing the barber the space during the day when he was at work and her the space overnight when she was home.

I share this story because it illustrates how cooperative behavior can lead to optimal utilization of resources.  Both parkers had the peace of mind to know their space would be available, and the space was also fully utilized.  Neither parker had to waste time looking for parking.  Hospital ORs can also benefit from this sort of shared behavior where, instead of competing for scarce resources, users coordinate to maximize utilization.

For more on space savers: http://lmgtfy.com/?t=i&q=space+savers+boston

Trailblazing a Path to the Future of Healthcare Operations

Photo by wildpixel/iStock / Getty Images
Photo by wildpixel/iStock / Getty Images

Joining Hospital IQ has allowed me to return to my roots: tapping the power of data and business intelligence to improve healthcare. Through the years, I’ve seen healthcare pioneers transform their operations through data.  Until recently this type of work only took place at a handful of healthcare systems, ones with access to specialized resources. Today, we find ourselves at an exciting crossroads where the combination of people, processes and technology can transform every health system, not just the fortunate few.   

At Hospital IQ, we have tools to make this operational transformation possible.  As we set out on this journey, it’s important to keep in mind three basic tenets:

1.    If you can’t measure it, you can’t improve it.

Most hospitals and health systems today stuggle to understand critical performance metrics. And if they can’t undertand the metrics, they can’t optimize them to improve patient care. This is not the fault of the leaderhip. Technology has failed them.  Many vendors have created point solutions providing moderate assistance for managers trying to improve operations. Enterprise business intelligence projects have also attempted to ease the burden, but there is an endless queue of work to serve an organization.  Both solutions fail to meet the mark and leave managers trying to pull together insights from multiple IT systems.  They often rely on their own Microsoft Excel skills or overworked analysts to get the ball rolling.   This leaves a manager living in a queue – hoping to one day receive their information to efficiently and effectively run their part of the organization. 

2.    To understand the future, you must understand the past.

When data is hard to come by, day-to-day activities easily consume the ability to look ahead.  Managers struggle to deliver their monthly performance reports.    The goal of being predictive, or even optimized, seems impossible to reach.  The technology exists to automate the routine activities, analyze past performance, and proactively share what lies ahead. Our platform will enable healthcare providers to understand their performance and have the proper decision support tools to affect future performance.  

3.    Statistics are no substitute for judgment.

It is easy to become fascinated with data, visualization and advanced analytics.  The real magic happens when healthcare professionals use the the information to make better decisions.  This is the power that we’re unlocking for our customers everyday at Hospital IQ. They  can use the data, combine it with their expertise and improve the quality and efficiency of care delivered to their patients. 

“Statistics and Compassion”

Photo by sindlera/iStock / Getty Images
Photo by sindlera/iStock / Getty Images

I watched the “Lego Batman” movie over the weekend.  And yes, this is highly relevant to healthcare analytics.  But first some background.  In the movie, Batman’s one-man crime-fighting prowess is thrown off balance when a new young police commissioner takes over from a retiring commissioner Gordon.   Instead of simply activating the bat-signal every time Gotham is in trouble, she wants to actually partner with Batman to get at the roots of crime instead of just reacting to the symptoms. The new commissioner gives a Powerpoint of where she reports on her adoption of “statistics and compassion” to effectively fight crime. 

At Hospital IQ, we also use “statistics and compassion” to fight waste and inefficiency at hospitals.  We don’t show up to clients in tights and a cape, but we do have a toolbelt of sophisticated waste-fighting operations planning and management software worthy of the bat-cave.  And like the new commissioner, we don’t just churn through data – we also have a deep appreciation and respect for the mission of healthcare.

In a fully logical world run by computers without emotions, the numbers would speak for themselves.  We would blindly apply the lessons of modern management research to hospital operations and call it a day.  In fact, we’ve seen academics present the results of “ideal hospital” simulators and then express befuddlement when their perfectly balanced OR schedule or inpatient bed layout is not immediately implemented by the hospital.  This bull-in-the-china-shop approach is not only strategically and politically unwise, it also misses the bigger picture of what healthcare is about.  Unlike many business that are fundamentally transactional in nature, healthcare is different.  At its core, it’s driven by doctors, nurses, and other providers with a genuine desire to help people.

When we at Hospital IQ help a hospital run more efficiently, it not only pleases the CFO because we’re treating more patients at a lower cost, it pleases the doctors and nurses because they can get services to their patients quicker.  We’re helping hospitals implement their mission by ensuring the best patient care with the least amount of waste.  It’s not just about saving money and it’s not just about adding more services.  It’s about true efficiencies by smarter allocation of finite resources.

“Statistics and Compassion” for Hospital IQ means using data to combine “solvency with humanity.”  We help hospitals meet their financial targets by getting patients the treatment they need faster.  It’s a textbook win-win situation where the only losers are the “bad guys” of waste.

At Hospital IQ, we’re not just a bunch of MIT-trained data wonks blindly chugging through simulations.  We have a deep respect for the mission of healthcare and want to use our talents and experience to help hospitals reach efficiencies that provide better care for patients, and better resources for doctors, nurses, and other providers.

Industry News: February 2017

It’s not easy to keep up with the endless cycle of industry news. In case you missed it, we’ve compiled the key issues and trends discussed during the past month regarding hospitals, health systems and hospital operations and management.

The role of software and big data continue to take center stage, with a great deal of attention given to the role both will play in the transformation of healthcare.

Driving operational efficiency continues to be a critical need for hospitals and health systems around the world.

And of course, HiMSS generated plenty of chatter around the progress that’s been made within health IT, as well as the struggles remaining around the practical use of technology

Found an interesting article?  Have an interesting perspective or insight? Share it with us.