Five strategies to improve your ER

Emergency rooms are the “front doors” of hospitals, Chris Van Gorder, president and CEO of the five-hospital Scripps Health system in San Diego, said at the HealthLeaders Media Rounds event on Tuesday. That’s a great way for hospital leaders to think about ERs.

Many patients’ and their families’ first interactions with your facility will be the emergency room. But how do hospitals improve ERs, especially when it comes to bottlenecks?

Hospital leaders at the Rounds event provided these strategies:

• Appoint emergency room “czars” to manage hospital beds
• Place patients in recliners if they don’t need an ED bed
• Contract with whole physician groups to take responsibility for ED calls
• Explain specific timeframes to patients
• Use volunteers to help answer patients’ questions

All of these tips can help improve the patient experience, while relieving the bottleneck issue. Check out what these leaders had to say about these and other proven strategies—and how these strategies helped their facilities.

Don’t ignore patient experience

Who cares about patient experience when your hospital’s finances are struggling and uncompensated care worsens? Senior Finance Editor Karen Minich-Pourshadi this week profiled five hospital leaders who connect patient experience with better finances.

These leaders say patient experience is important—even during these difficult economic times.

For instance, Steven M. Safyer, MD, president and CEO at Montefiore Medical Center, in New York, says, “Uncompensated care and patient experience are two issues that tug at each other, because often better patient-centered care requires more resources,” says Safyer.

Montefiore is a nearly 1,500-bed facility in the Bronx, which includes some of the poorest neighborhoods of New York City and a 15% unemployment rate. This combination has led to growing uncompensated care rates.

In response, Montefiore helps patients by promoting the continuum of care through better technology. The facility has created a clinical and management information system to manage patient information and through that work has helped create the Bronx Regional Health Information Organization with all major providers that allows for borough-wide exchange of patient information.

Montefiore is also embracing the medical home concept, which is particularly critical for a facility in an area with large chronic illness rates. Through the medical home, patients are benefiting from disease management programs that includes patient remote monitoring.

“The medical home is the way to feel plugged in and connected,” says Safyer. “This all pays off too when the patients do better.”

Three-thousand miles away, UCLA Health System in Westwood and Santa Monica, CA, CEO David Feinberg, MD, MBA, needed to change the hospital’s culture as it faced low referral scores. The first step: They listened to their patients.

By getting patient input, the health system saw its patient referral numbers improve. In fact, some units now enjoy a 99% rate.

“That means our hospital is at full capacity and our payer mix has gotten better. Patient satisfaction is really driving our business and making a position margin allows us to keep our door open to everyone,” says Feinberg.

So, you see, patient experience is more than a way to please your customers. There’s also a bottom-line advantage.

What do our survey results mean to the industry?

With the release of HealthLeaders Media Industry Survey 2010 results last Thursday, our editors have dug deeper into the findings and featured some of the highlights over the past week.

Here is what the editors focused on in the different coverage areas:

Senior leadership editor Philip Betbeze wrote about how healthcare CEOs are concentrating on getting through the current economic issues rather than long-term goals of quality and patient safety.

Senior Finance Editor Karen Munich-Pourshadi talked to five healthcare leaders about how they are handling the rising tide of charity care.

Senior Technology Editor Gienna Shaw wrote about how money remains the leading issue for health IT.

Senior Physician Editor Elyas Bakhtiari wrote about the pressures that influence physician decisions.

Senior Health Plan Editor Joe Cantlupe talked about how many health plan executives see the opportunity in the individual insurance market, but many have not invested in that growth area yet.

Filling in for Senior Community and Rural Editor Cheryl Clark, I wrote about how physician recruitment remains a top issue for rural hospitals, but they are not so concerned about controlling costs.

Marketing Editor Marianne Aiello showed that many CEOs don’t appreciate the work of hospital marketing departments, but there are opportunities for marketers.

Senior HR Editor John Commins warned health leaders that layoffs might be an effective strategy during these difficult economic times, but the C-suite must understand possible downstream costs.

Senior Quality Editor Janice Simmons wrote about how quality/patient safety remain a top priority for hospitals, but not quite as important as in the previous year’s results.

HealthLeaders Media’s editors will continue to dive into the survey results in the coming weeks and provide more coverage about what these findings mean to the healthcare industry. Stay tuned.

Scripps learns from Haiti disaster

Scripps Health CEO/President Chris Van Gorder recently returned from his second trip to Haiti since the Jan. 12 earthquake that killed at least 230,000 people.

Van Gorder and the Scripps response team went to the devastated country to provide medical care to survivors and learn about disaster preparedness. Van Gorder tells the heart-wrenching story of death and destruction, but he says health leaders can learn from the experience.

Though Van Gorder doesn’t think the US would face the level of destruction seen in Haiti, he said the experience of providing care in the worst of environments can help US healthcare professionals face future disasters.

Van Gorder lives in Southern California, which is an area that could one day see a massive earthquake. A California earthquake will likely not cause the carnage left in Haiti, but learning from that experience will help Scripps deal with future disasters.

Whistleblower case should concern health leaders

A jury acquitted a Texas nurse who was charged with a felony after notifying the state medical board about concerns regarding a doctor.

Anne Mitchell, RN, was charged with “misuse of official information,” a third-degree felony, for reporting Rolando Arafiles, MD, to the Texas Medical Board. Had she been convicted, Mitchell could have faced up to 10 years in prison. However, after a four-day trial, a state jury in Andrews, TX, needed less than one hour to acquit Mitchell.

As expected, state and national nurses associations are applauding the decision.

“If anything was to be gained from the absurdity of this criminal trial, it is the reaffirmation that a nurse’s duty to advocate for the health and safety of patients supersedes all else,” said Susy Sportsman, RN, president of Texas Nurses Association.

American Nurses Association President Rebecca M. Patton, RN, feared that a guilty verdict would have had “a lasting and negative impact on future nurse whistle blowers.”

“Nurses play a critical, duty-bound role in acting as patient safety watch guards in our nation’s healthcare system. The message the jury sent is clear: the freedom for nurses to report a physician’s unsafe medical practices is non-negotiable,” Patton said.

That said, the ANA is still concerned about the trial. “Nurse whistle blowers should never be fired and criminally charged for reporting questionable medical care.”

ANA’s comments echo what our Senior Nursing Editor Rebecca Hendren wrote earlier this week about how the case could set a dangerous precedent.

She wrote that the case is a “warning for healthcare leadership about handling complaints about physician or nurses.”

“Caregivers must feel they can bring concerns to the appropriate people in their own organizations, and that cases will be investigated thoroughly and fairly. In light of the incident in Texas, hospitals should examine their policies to ensure concerns are properly addressed internally,” she wrote.

Nurses and future whistleblowers dodged a bullet this week, but the fact that this case made it all the way to a courtroom should concern everyone in healthcare.

Get inside the mind of healthcare industry leaders

One of the highlights of our editorial calendar each year is the industry survey. It’s actually seven concurrent surveys that are filled out by healthcare leaders from seven segments: CEO, finance, technology, physician, health plan, marketing, and quality leaders.

Our 2010 survey includes 1,210 leaders from across healthcare and as usual features some interesting findings. I could spend hours combing through the surveys and comparing physician leaders’ responses to CEOs, CIOs, CFOs, and health plan leaders.

It’s fascinating to see both the disconnects and agreements among the varied healthcare stakeholders. For instance, in the 2010 survey, when asked which particular aspects of healthcare reform would have the greatest influence on their future business, physician leaders were the highest percentage who chose a public health plan option. They were followed closely by quality leaders.

Nearly half of health plan leader respondents think episode of care/bundled payments will have the greatest influence and another 39% of health plan leaders said nonpayment for readmission with the same condition would have the greatest influence.

More than 60% of finance leaders, meanwhile, pointed to health IT funds from the stimulus law and HITECH Act.

What other discoveries will you find in the 2010 HealthLeaders Media Industry Survey? Here are three:

• Reducing costs is a higher priority for hospitals than in previous surveys. Thirty-five percent of CEOs put cost reduction as one of their top three priorities. It actually ranked number three among all the CEO respondents, which is four slots higher than the 2009 survey.
• Physician leaders are optimistic about growth in several service lines. Nearly 30% of the respondents believe there will be 6% or more growth in geriatrics and nearly one-quarter sees that same potential for orthopedics.
• Though CEOs rank quality/patient safety as their top priority in the 2010 survey, the percentage actually dropped from 2009. Timothy Ranney, MD, a physician and vice president for medical affairs for Good Samaritan Hospital in Kearney, NE, told Senior Leadership Editor Philip Betbeze that the result could be because “everyone talks a good game around quality and while that’s all well and good, most people who make the financial decisions on what quality is view it as a cost, and therefore it’s a budget item that they try to cut.”

Check out both the cross-section analysis and the results from each of the individual market surveys. But I must warn you. Once you start reading and analyzing, you won’t be able to stop.