The way toward prioritizing patients while optimizing efficiencies
While evaluating and improving care has always been an essential part of delivering healthcare, recent trends are driving hospitals and health systems to look more closely at a comprehensive approach to care redesign. These trends, including the escalating cost of healthcare, diminishing hospital margins, staffing shortages and customer preference for the site of care have all been compounded by the pandemic.
“The way healthcare providers were forced to deliver care during COVID, utilizing telemedicine and remote office visits combined, highlighted that we could be using these different methods to deliver safe and effective care,” says Kim Wright, RN, AVP, Clinical Services, HealthTrust.
What is care redesign?
Care redesign, a systematic approach to improving the quality, efficiency and effectiveness of patient care, focuses on an evidence-based and patient-centered approach.
Government programs, such as the Hospital Readmission Reduction Program (HRRP), and bundled payment models, are essentially enacting care redesign at the regulatory level, says Holly Moore, MSN, CCRN-K, Director, Clinical Services, HealthTrust. “These programs look at better ways of delivering care on the national level, but internally, hospitals are looking at ways of doing things better as well.”
“Care redesign should always be driven by data and an identified need. But within that need, hospitals are also interested in applying change across a health system so it’s more standardized,” says Moore. She adds that care redesign now looks at the whole patient experience. “There’s a stronger focus on care redesign along the continuum of care. The patient is looked at holistically across all levels of care.”
Care redesign in action
Community Health Systems (CHS) is one of the largest health systems in the U.S., with 83 hospitals across 16 states. In 2021, it began three care redesign pilots: a care team model to address nursing shortages, a telesitter program to reduce patient falls and a new perinatal technology to improve patient outcomes.
“It’s been a progressive study and pilot to find the best approach. Because we have a number of hospitals in different settings and with different variables, that brings forth some excellent information as to what the best practice for care delivery will be,” says Pam Rudisill, Chief Nursing Executive at CHS.
The team implemented their new care team model first in the medical surgical units of five hospitals in June 2021 using an RN-CNA model. They later launched an RN-LPN-CNA model with another group of six hospitals. Both sets use a team-based care approach, focusing on the RN as the team leader and the LPN and CNA working to their capacity and skills. “We emphasize that the RN is the individual responsible for delegating tasks,” explains Rudisill.
Moving away from the more traditional RN-based model to a team model allows CHS to manage the impacts of the nationwide nursing shortage while supporting nurses at the bedside and improving job satisfaction. “Nurses want to practice at the top of their licensure,” adds Rudisill.
While results are still preliminary, so far, it’s looking promising. Directors of the units involved in the pilot meet every week with Chief Nursing Officers and the corporate team. They’re starting to see a change in staff turnover and engagement, as well as in patient experience scores.
Best practices in care redesign
There is no one approach or gold standard for care redesign. “It’s different for every hospital and every market, but the overarching concepts are the same,” explains Wright. These “triple-aim concepts” include improving patient care quality and patient satisfaction while reducing costs.
The patient should always be at the center of the program, says Moore. “If you focus on the patients and improve patient outcomes and satisfaction, the cost reduction will just flow.”
Lynn Simon, M.D., Chief Medical Officer at CHS, agrees the benefits are intertwined. “The care redesign at CHS was originally focused on supporting the bedside nurse, but increasing patient satisfaction is the common thread through it all,” she adds. “This enables us to support the nurses at the bedside, potentially mitigate some of the workforce challenges, and produce a higher level of safety and quality all at the same time.”
Moore recommends building a multidisciplinary team to tackle care redesign, including multiple stakeholders like physicians, nurses and data analysts, as well as patient representatives. The team’s composition may vary, but in every case, having innovative leadership on board who are willing to make and back change is essential.
Another essential element is access to comprehensive data. “Multiple data elements can be monitored for various reasons that are financial-, efficiency- and patient-outcome related,” says Moore. “You need data to identify the problem and the data to continue to monitor as you make your changes.”
The type of data collected depends on the redesign program. “For instance, if a team is worried about readmission trends, then they would need to have data on what is driving their readmissions,” explains Wright. “The data needs to be driven by what they’re trying to accomplish.”
At CHS, data from their patient safety organization drove the decision to look for solutions for patient falls and improving safety. “Going forward, we are following that metric to see if we’re achieving the intended results, but we’re also looking for other benefits such as patient satisfaction,” explains Dr. Simon.
Getting started
To start down the road of care redesign, Dr. Simon recommends clearly understanding and communicating your motivation and goals for the process. “Start small, test to make sure what you’re implementing is getting the intended results, and then scale quickly once you’ve found what is working well,” she says.
Scaling might involve multiple departments in one hospital that are encountering similar challenges or multiple hospitals in a system. “If one facility is having that issue, multiple facilities might be as well,” shares Moore. “It’s important to find out how to translate what a facility learns across the hospital or system in such a way that everybody benefits from it.”
The Clinical Services team at HealthTrust has over 20 years of experience in service line care redesign. Using evidence-based research, data and analytics, they help health systems gain insight into opportunities for progress.
Begin your care redesign conversation. Contact Kim Wright at kimberly.wright@healthtrustpg.com for more information.
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