Hospitalists face many barriers when caring for patients. The culture of the team can either exasperate or improve these barriers, ultimately impacting patient experience and care, operations, hospital financial performance and the clinician experience.
Identifying Needed Improvements in Hospital Medicine
In order to overcome these challenges, your hospital medicine (HM) group must foster collaboration and engagement beyond the department. Hospitalist teams must engage their peers in the emergency room, case management and nursing to improve continuity of care and target key metrics. To achieve this, departments must see issues of continuity as collective problems. Setting clear expectations for tackling these issues must come from strong group leadership and clear direction and expectations. Most importantly, clinicians need internal advocates and champions.
TeamHealth’s Approach to Improving Continuity of Care
As an experienced innovator in HM, TeamHealth recognizes the degree to which morale and culture impact the ability to improve processes and quality for each hospital. Saint Vincent Hospital, a 260-bed facility just outside Boston, made the decision to transition the hospitalist service from another well-known national HM provider to TeamHealth. The team immediately began focusing on a core set of objectives: increasing leadership efficacy, providing transparent data, outlining clear goals and reinforcing collaboration.
TeamHealth’s support of the medical director, resources and data-driven approach to performance helped improve transparency and establish both short- and long-term goals. This collaboration aligned goals and valued metrics among individual clinicians, team leaders and facility leadership – eliminating the ambiguity under the previous group and providing clear strategic priorities for all stakeholders.
Furthermore, under the guidance of TeamHealth, the HM leaders and supporting staff began monthly meetings with hospital leadership to ensure alignment of goals. Moreover, regular meetings among the HM team allow for individual data comparison and coaching – increasing accountability. Departmental collaboration among the ED and case management, to name just two, improved patient flow processes. All these tactics work together to create an engaged team to deliver vital care.
Results and Success at Saint Vincent
At Saint Vincent Hospital, the energized HM team saw immediate successes. Retaining 100% of the incumbent clinicians, the facility was able to enjoy a seamless transition with swift improvements in clinical quality and key metrics. Some of the key targets included admission order time, discharge order time and query response time and a reduction in observation hours. The team has continued to enact positive change over the past year, with impressive results. It is worth noting that these accomplishments all occurred while the hospital experienced a prolonged nursing strike.
- Admission order time: The goal was to lower time to below 60 minutes, well under the previous average of 111 minutes before TeamHealth. Within two months the average was brought down to 40 minutes and continues to remain in the 30-minute range for the year.
- Discharge order time: Goal was to have at least 30% of discharge orders to occur before 10 am and 50% before noon. This was met for the enyire year and during the most recent month, 37% of discharge orders occurred before 10 am and 63% before noon.
- Query response time: The goal was to have query responses under two days with an agreement rate of 85%. Both targets were met for the whole year and current averages for the hospitalist team is .86 days with 91% agreement rate and 100% response rate.
- Observation hours: The goal was to have under 30 observation hours. The new average for the team is 26 observation hours.
Not only has the team seen enduring improvements in these key data points, but the hospital’s acuity and case mix have also increased, partially through better documentation, allowing the facility to provide higher levels of care to patients who need it most.
Sustained Improvements in Hospitalist Care
A healthy and successful hospitalist division is vital to a facility’s success and to the community’s wellness. Because of this, it is paramount that teams engage in sustainable tactics to enhance care quality and patient experience. Change must persist beyond quick fixes focused only on short-term metric improvement. With a sharp focus on long-term goals, TeamHealth’s HM program focuses on building steady, stable partnerships with our facility partners to ensure exceptional care delivery over the long-term.
To learn more about how our program can help transform hospital performance, get in touch with us.
Last Updated September 15, 2022.