Nebraska hospital brings services closer to patients - Bishop Clarkson Memorial Hospital - Provider Perspective

Healthcare Financial Management, Oct, 1991 by Deborah A. Teschke

As hospitals move to streamline operations and make more efficient use of resources, a Nebraska facility has implemented a decentralized, patient-focused method of delivering care that has improved service and efficiency while enhancing productivity.

Bishop Clarkson Memorial Hospital, a 372-bed tertiary care facility in Omahan, created individual business operating units to bring services closer to patients and broaden the responsibilities of caregivers. Services are grouped by product line, and patient floors were renovated to give each unit its own pharmacy, laboratory, radiology, and other ancillary departments, as well as admissions, dismissal, and medical record services.

In place of central nursing station, each patient room is stocked with patient charts, consummable supplies, telephones, computers for order entry, and other equipment normally found at a nursing station. Two floors are operating as patient-focused models and four others are in various phases of project design.

Reduce labor, wasted time

Clarkson officials undertook the restructuring after concluding that hospitals in general were providing "lousy" service to patients, said Mitch Galloway, a consultant to Clarkson's chief executive officer. Although Clarkson was spending 50 percent of its operating budget on labor and less than 10 percent on capital depreciation, Galloway said the hospital was not providing efficient service for the money spent.

"In the old world, the time it took for a patient to receive care from the time [he or she] walked in the door until the initiation of doctor's orders was seven and a half hours," Galloway said. "That's just too long a time for patients to be waiting."

Galloway blames the infrastructure that had been built throughout the hospital for long delays in delivering service. In the new patient-focused units, the time from admission to initiation of physician orders has been reduced to 23 minutes.

Moving to a charting-by-exception method helped cut documentation time by 50 percent, while locating ancillary departments on patient floors has reduced the scheduling and coordination of those services by 50 percent, Galloway said.

Teamwork is crucial

A key to the success of the patient-focused units is empowering employees to make decisions while broadening their role in patient care, accordint to Lisa Tracey, director of nursing for Clarkson's ninth floor, the first unit to go on-line with the new system.

Care partners, teams consisting of a registered nurse (RN) and another licensed health professional or someone pursuing a license, are responsible for the complete needs of their patients, including giving medication, drawing blood, giving electrocardiograms, scheduling X-rays or tests, and sometimes accompanying patients to surgery or procedures, Tracey said. Depending on a unit's patient population, the second care partner could be another RN, a licensed practical nurse, a physical or respiratory therapist, surgical technician, student nurse, or radiologic technologist.

"[The care partners] are the charge nurse for their individual patients," Tracey said. "We eliminated all middle management. Basically, we're trying to reverse the pyramid and put everything back on the floor."

A clinical manager on each unit has replaced the charge nursey system, Tracey said.

On day and evening shifts, each team works with four to six patients. Each night shift team cares for 10 to 12 patients. Tracey believes that continuity of care results when care partners transfer responsibility for their patients to the incoming shift, then receive the same group of patients the next day.

The care partner system also has decreased the number of hospital staff members who have contact with each patient. Under the old system, one patient saw 55 different staff members walk in and out of his room during a three-day stay, Galloway said.

A cross-training program for support and administrative staff also helped increase efficiency and productivity, he said. Support generalist personnel are cross-trained to do cleaning, transporting, supply restocking, and some basic patient care. Administrative employees perform registration, pre-registration, and dismissal activities, chart completion, coding and abstraction, quality assurance, and secretarial support.

"The number one measure for us is our patientss are happier, our staff is happier, and our physicians, for the most part are happier because their patients are happer," Galloway said. "And we are convinced we are not spending any more money."

Deborah A. Teschke is news editor of HEALTHCARE FINANCIAL MANAGEMENT. Suggestions for "Provider Perspective" topics should be sent to her at HFMA, Two Westbrook Corporate Center, Suite 700, Westchester, IL 60154.