Creating The Ultimate Healing Environment

Key Thought:

Building a hospital based on Evidenced-Based Design, integrated IT solutions and Patient Safety. How to do it?

Summary:

Case of OhioHealth building Dublin (Ohio) Methodist.

OhioHealth believed that a guiding principle in the construction effort was basing building design on the best available research to positively impact balanced scorecard measures of quality and safety; patient, family and staff satisfaction; operational efficiency; and financial performance.

Another guiding principle was an investment in cutting-edge IT that assist in improving patient safety, at the same time allowing the hospital to be digital, wireless and paperless to the maximum extent possible.

Dublin (Ohio) Methodist was build by paying attention to stress-reducing design and creating a patient/family-centered environment that improves safety while respecting privacy and dignity.

Evidence-based design features:-

- Rooms are acuity adaptable, allowing patients to remain in the same room regardless of level of illness eliminating intra-hospital transfer

- rooms are like-handed (what is on the left in one room is on the left in the next room); diminish the need for care providers to search for what they need for patient care

- rooms has access to natural light to reach nearly 90 percent of all occupied spaces

- windows in patient rooms partially open to let in fresh air

- a waterfall and trees in the lobby help to reduce stress among patients, families and hospital staff

- decentralized work station bring caregivers closer to their patients

- sound-absorbing ceiling tiles and a noiseless paging system create a quieter environment

Weaving IT into evidence-based design:

- patient's medical information is accessible via networked PC, wireless tablet PCs, and handheld devices

- no admitting department but has a group of people who perform the admitting function in the patient's room upon arrival

- single sign-on with biometrics reader

- integration of patient call lights, cardiac monitor alarms and bed exit alarms with wireless communication badge and earpiece worn by each caregiver

- use of computerized physician order entry (CPOE)

- digital ED and surgery management systems

- bed management system allows proper placement of patients quickly and sends messages to environmental services when beds need to be cleaned

- only hire employees who were willing to use IT

- physicians applying for privileges at Dublin Methodist agreed to be trained in and use the available technology

- employees are required to attend 8 weeks of training before hospital opened

Evidence-based design was led by The Center for Health Design, a leading research and advocacy organization. Before design and construction started, a design company Big Red Rooster completed a cultural report by conducting research about patients and staff perceptions of hospitals and the environment. The research was centered around traditional hospital cultures to help identify areas for improvement such as healthcare quality, patient satisfaction, staff retention, operational efficiency and productivity, and attracting more patients.

My Comments:

Many of these principles can and should be incorporated into our new hospital tower.

Reference: Creating the Ultimate Healing Environment: integrating Evidence-Based Design, IT and Patient Safety by Cheryl L. Herbert RN and Lamont M. Yoder RN FACHE, Healthcare Executive, SEPT/OCT 2008, p17-23.

Technology in Healthcare

Key Thoughts:

Each budget cycle, we struggle to produce a reasonable budget by maintaining or reducing total FTEs, reigning in other expenses, (optimistically) projecting market share growth, approving a handful of new business initiatives and, not infrequently, negotiating the negotiating the margin target downward.

Each year it gets more challenging to find new, material expense reduction or revenue generation opportunities.Short of dramatically altering service to the community and, thus, your organization's commitment to the community, what else is available to address the complex business challenges we continually face?

The current revenue and expense environment makes every miss tougher to accommodate, making the organization's ability to fulfill its challenges more difficult.

EMR - if we ask why invest in EMR, you will get a reflexive response citing the imperative to improve safety, enhance quality and lower costs. If we ask what was the decision making process used to allocate significant capital toward an EMR, or ask about its return on investment or specific improvements in patient safety and quality metrics the EMR has produced a couple of years down the road, or what organizational performance dashboard has changed and by how much due to their EMR implementation, the frequent response is an awkward silence - a scary reaction about an investment hat costs tens of millions of dollars and untold millions in consulting expenses and staff time to implement and support.

Traditionally, organizations has sorted technology needs based on cost and perceived priority. They also continued to invest in new technologies without a more comprehensive understanding of their hard and soft yields and their relative ability to accomplish the organization's goals - a key miss when the available resource pool with which to invest in any technology is increasingly challenging to fund.

What we need is an awareness of how to leverage technology to solve our more vexing business problems, a systematic thinking about how a given technology can be creatively and strategically harnessed as a tool to support a process and facilitate fundamental operational or organizational improvement. Which purchase, for example, will help improve market share and by how much? And, why is it superior to the other capital budget requests vying for funding?

Summary - a organized, thoughtful approach in harnessing technology for healthcare delivery:

1. A strategic focus for technology review

What is it that you want technology to accomplish our mission and strategic plan?

2. A framework for assessing a technology's value to the organization

An organized method to evaluate any given technology's potential to solve business issues that extend beyond readily available information about what the technology promises to do.

3. Knowledge of technology trends

4. Tools for finding and staging high-value technologies

Summary - emerging technologies that solves operation problems

Ergonomics - patient mobility devices such as lean-stand assisted lifts, sit-stand wheelchairs, lateral transfer devices, gait belts and repositioning devices, holds great potential to decrease workplace-related injury and disability, reduce costs and help ensure a healthier work force that can remain working

Wireless communication - consolidation of multiple platforms - electronic whiteboards allowing real-time tracking of patients, lab and ancillary results, room status, equipment status and triage state, RFID which tracks and records patient, equipment and staff movement throughout the facility

RTLS (real-time location system) - reduces hunting time for supplies, staff and patients

Point-of-care testing - moves testing to bedside, offering faster test results with fewer transportation-related errors. The ability to obtain quicker test results can increase efficiency and lead to shorter hospital stays and reduced complications

Modeling and simulation - used for training and credentialing, and facilities design

Remote patient management - increase the coverage of scarce specialists clinicians eg telemetry ICU. increasing life expectancy and the rise in chronic disease are driving development of new technologies such as sensors for independent living; remote disease monitoring of asthma, diabetes and congestive heart failure; remote device monitoring for cardiac implants and artificial joints; video-based care for stroke, psychiatric and dermatology patients, cell phone platforms for management, monitoring and testing; and TV, PC and robotic platforms for communication, education and information.

My Comments:

Technology plays a key role in improving healthcare delivery across the board. 'Innovation and care system transformation through technology are inevitable...Making this transition will require a willing ness to replace the standard practice of viewing technology as a capital budgeting decision with a a systematic, comprehensive approach for evaluating technology and its potential to address vexing business challenges and be innovatively leveraged in the service of mission and margin.

Reference: Technology in healthcare: leveraging new innovations by Marc G. Larsen FACHE, Healthcare Executive SEPT/OCT 2008, pg 9-14.

Strategy Execution & Leadership in Today's Uncertain Times

Key Thought:

A very popular topic at the moment in light of the financial crisis around the world today. Presented by Professor Paul Tiffany of University of California - Berkeley.

Summary:

- rationality is a western biased concept, there's a lot more at play particularly in Asian economies than hard, cold rational decision making - eg. fengshui, lucky numbers

- Risk management has always talked about pricing the risk, however, at some point, we moved to uncertainty, and that cannot be measured/mitigated using traditional understanding of risk or rational thinking

- things happen for a reason, people (customers) do not choose randomly, they choose for a reason, find out what is the reasons

- China will not be a dominant economy in the 21st century. Reason: innovation belongs to the second and third child, not the first. With China's one child policy, it will not work

- Interesting tidbit: UCB Nobel prize winners gets free parking. Greater incentive than money or position

- Paul Tiffany & associates will never recommend hiring first child as HR Director!

- On corporate structure, we optimize for effectiveness and efficiency, not suitable when we need to be flexible and responding to marketing changing condition

- Marxism concept: Marx was a change agent. Things happen oftentimes because of the environment condition, eg. Khmer Rouge. Kill everyone with glasses, start from a clean slate, too hard to change people

- Many CEO are Marxist and don't know it. Wholesale changes alienate the very people they are dependant on to make changes to turnaround company

- Hawthorne Studies - besides employees being more productive when being watched, recognition also improves productivity

- GURU - Geee...You are You, and being asked to pay for it.

- Values in a company is What You Are Willing to Reward

My Comments:

This presentation was part of HASS - KMDC Executive Series Co-Presentation. It was a useful synopsis of Strategic Planning and Execution. Good for those who are new to this area, unfortunately I am already familiar with most of it. Key thoughts I learned in these two days was Risk and Uncertainty. The networking was also fantastic.

Reference: Strategy Execution & Leadership in Today's Uncertain Times by Professor Paul Tiffany, Haas-KMDC Executive Series Co-Presentation, Dec 1-2, 2008.