EON Blog

Imagine trying to do a critical, life-in-the-balance job under extreme time pressure while hundreds of random strangers wander around your workplace asking too many questions and getting underfoot. It would be disconcerting to say the least. That is a worst-case perspective of having visitors in a healthcare facility.

Doctor and patient communication has been ubiquitous in the American zeitgeist over many decades in the form of the empathetic bedside manner of television doctors. The likes of Marcus Welby (Marcus Welby, M.D.), J.D. Dorian (Scrubs) and Meredith Grey (Grey’s Anatomy) have modeled our ideal in their demonstration of care and communication with patients.

But what happens in the real world? A portion of doctor/patient communication comes from the personality of the physician or other healthcare provider. The larger part comes from the content of material that must be communicated and the trained skills of the communicator.

“For want of a nail…a kingdom was lost.” That proverb could certainly apply in the healthcare field: “For want of a working piece of equipment, a patient was lost.” Evidence-based studies indicate that in the United States, premature death related to preventable harm to patients may be as high as 400,000 per year. Tens of thousands of these deaths may result from equipment-related issues.

Imagine a defibrillator that doesn’t power up, an operating room laser that fails, a patient monitor that doesn’t alarm, a radiation device that shifts out of calibration, or a digital control system that just shuts down. When any of these situations occurs, it can lead to a bad outcome for a patient, even death. Hospital professionals rely on having working equipment to do their jobs well. Equipment maintenance is critical to make sure this happens.

While managing inventory of patients is a key requirement of healthcare facilities, managing distributed equipment inventory doesn’t fall far behind. Having the wrong equipment, too little equipment, contaminated equipment, or equipment in the wrong spot can mean problems for patients. On the other hand, holding more equipment than you actually need is very costly.

Fortunately, managing equipment inventory and distribution is not a new problem. Many industries have addressed and optimized inventory systems and developed methods to pursue continuous improvements. Let’s consider some of the distributed equipment needs in medical facilities and discuss best practices that might apply.

Do you remember the scene in Cool Hand Luke, where a “failure to communicate” brings pain and suffering to Paul Newman? It’s similar in a hospital, where miscommunications can have significant clinical repercussions. Beyond that, poor healthcare communication can result in poor non-clinical outcomes leading to low patient or staff satisfaction and higher costs.

At the core of a patient’s visit to a health facility is the “patient experience,” an all-inclusive consideration of everything the patient goes through from arrival to discharge and final transport. In truth, the experience extends even farther on either end of this physical journey to include scheduling at the front end and billing at the back end.  

“All we want to do is help our patients, but what they don’t teach us in medical school is that there are so many ways to do harm.” I picked up that bit of wisdom on The Resident, a new medical show on Fox. In fact, a 2012 study from the U.S. Department of Health and Human Services (a much more official source than any TV medical drama) reported: “More than one in four Medicare beneficiaries experience some degree of harm while hospitalized.” That’s a staggeringly large number.

The opioid crisis in America has heightened public awareness of the grave potential for health problems related to improper medication management. While the headlines speak of egregious over-prescription and gross negligence, any day-to-day process involving medications can be problematic if not managed well. 

If you want your hospital to operate effectively, standardization is one of the most important tools at your disposal. In fact, over 10 years ago, Dr. Peter Pronovost conducted a test across the state of Michigan of a revolutionary change in hospital I.C.U.s that dramatically reduced line infections. The high frequency and potential severity of line infections—possibly leading to fatality—gives them major importance. 

Inventory management seems like a simple concept. Any organization wants to have “what you want where you want it when you need it.” If it’s there, everything goes smoothly. If it’s not, things start to fall apart.

Patient safety and quality are the most critically important elements of patient care. Safety and quality cannot just be given lip service, but must be measured and monitored to ensure that they improving or at least not declining. Many health institutions have regular monitoring of KPIs (key performance indicators) for patient safety and performance quality.

In fact, Medicare and Medicaid require that certain measures, such as specific mortality and readmission rates, are reported regularly and often made public. This is a bit like restaurant public health inspection ratings that can draw people in if they’re high or make them shy away—as from the plague—if they’re low.

Without referring providers, many healthcare facilities would find themselves with numerous empty beds and idle medical experts, rapidly on the way to financial decline. Fortunately, referring providers do exist, and the cooperation between primary care providers and hospital facilities can provide the best possible healthcare for patients with serious or chronic medical conditions.

In healthcare, as in any organization, one of the major keys to success is the ability to retain qualified staff. Not only do engaged and capable employees deliver more discretionary effort to the business, but they also present a positive image of the organization to patients and their families and friends.  

In the very competitive healthcare field, keeping trained staff members is crucial to avoiding employee overwork and burnout as well as the high costs of sourcing, hiring, and onboarding new employees. At year-end 2016, average hospital turnover rate was 16.2% as reported in the annual NSI Nursing Solutions, Inc. survey. Financial impact to the organization adds up quickly when “the average cost of turnover for a bedside RN ranges from $38,900 to $59,700 resulting in the average hospital losing $5.13M to $7.86M, annually.”

What is the pacemaker in a healthcare facility? Not a medical pacemaker device, but instead the process step that determines the rate of patient throughput. For most surgical hospitals, it is the operating room (OR). The number of patients in admissions, pre-op, post-op, waiting rooms, hospital beds, and on the road back home ties largely to the flow rate or patient cycle time through the operating room.

To some extent, the throughput of your healthcare facility can be measured based on “bodies on beds.” As in hotel operations, if you’re seeing low occupancy of your beds, you may not be pulling in the required revenue to cover your fixed operating costs.

Given that consideration, one of the key efforts that you may need to pursue to improve operational performance is to get a new patient into a bed or room as quickly as possible after the prior patient is able to be discharged. This process is known as patient room turnover.

If you’ve ever been a patient in a healthcare facility, you’ve experienced the patient discharge process. When you know—even without a medical degree—that you’re on the road to recovery, you probably also have the thought: I just want to go home!

Before patients can be released, however, many things must happen as part of the managed discharge process. These include actions related to health assessment, forward-looking care, in-house administration, and billing.

When patients are sick, in pain, undergoing procedures, or simply getting routine checkups, they expect their healthcare organizations to deliver quality outcomes using efficient processes. Unfortunately, hospitals and medical facilities, even those with high-quality performance, often have reputations for poor efficiency and notoriously long wait times.