Decision-making in healthcare is a massive subject of study and debate. But plenty of the decisions made across hospitals and health systems—from the back office and C-suite to the front lines—are subject to formalized procedures. A hospital’s policies extend even further, guiding its leaders and employees when new questions arise.
Unfortunately, several realities of modern healthcare, including the quickening pace of mergers and acquisitions in the industry, threaten the usefulness of these tools. This article focuses on one growing health system, Mountain States Health Alliance (MSHA or Mountain States), to illustrate these threats and explain the steps MSHA took to overcome them.
Background
MSHA is the largest healthcare system in Northeast Tennessee and Southwest Virginia, operating thirteen hospitals including a large tertiary hospital with a Level I trauma center, a dedicated children’s hospital, and a behavioral health hospital. The system also comprises two long-term care facilities, home care and hospice services, and outpatient services, as well as a comprehensive medical management corporation.
Threats: Inefficiency, redundancy, distrust
Before 2006, Mountain States’ hospitals were doing what a surprising number of health systems continue to do today: using a combination of paper manuals and a homegrown electronic site to manage the hundreds of policies and procedures in use across its facilities. This non-standard, decentralized process can certainly be made to work. But, as MSHA found, the process of locating, communicating, and updating these disparate files ate up valuable staff time, sometimes even resulting in duplicated policies in different departments. The in-house system built by the organization’s IT department often confused and frustrated its users, which in turn sustained people’s reliance on the paper manuals.
MSHA recognized that the problems of inefficiency, redundancy, and weak search functionality would only become more acute as they brought new facilities into the system. Understanding that responsible growth requires a functional way to store, disseminate, and search for policies across the entire organization, they sought out software solutions that included:
• improved accessibility in real-time by all team members,
• easy uploading of documents to the system,
• a robust, simple, Google-like advanced search feature,
• system alerts for when updates and reviews were required,
and other features that would help them decrease duplications and replications
In 2006 they adopted PolicyMedical’s PolicyManager™, a SaaS-based policy and procedure management solution designed for healthcare that met these criteria. PolicyMedical also promised responsive, knowledgeable customer service to help answer staff questions and make adjustments as needed.
Threat: resistance to change
Following implementation of PolicyManager, the management team at Mountain States Health Alliance met with some resistance to eliminating the paper manuals, especially after the staff’s experience with the earlier, less navigable IT solution. These staff opted in many cases to print out documents from the new system, which led to some situations where they were relying on outdated policies rather than the ones that were automatically updated in the system.
However, people soon recognized the full advantages of having the new software, not only to the business itself but also to their day-to-day work. In particular, front-line staff benefited from the improved efficiency of being able to access the most current policies immediately, no matter where they were. The clear, quick policy search and review feature meant that they weren’t fumbling through papers when in a pinch.
For management, operational efficiencies were even more obvious and substantial. The key time-savers included the quick electronic signature feature, the ability to easily find and replace documents, and the capacity to publish documents organization-wide as soon as they were approved.
Results: Greater operational efficiencies and improved patient safety
Since overcoming the resistance to change and putting PolicyManager to use across its growing organization, MSHA has improved its workflow, made compliance easier for new employees, and led to more confident patient care. Most important is this last effect on practitioner decision-making. With better document and version control, the software has helped MSHA eliminate the guesswork that had sometimes kept staff from acting swiftly and with certainty.
Another positive (unanticipated) result was the new level of accountability the software facilitated throughout the organization. Where hard copies of policies circulated without creator or owner attribution, the software made it possible to designate specific team members as “owner” or “manager” of the document, which they had to review, update, and revise as necessary. Clarifying the roles and responsibilities around these actions gave team members a true sense of ownership, and also created transparency around where and when in the workflow progress was being held back.
Looking forward, the software also allows hyperlinking to sites like the Learning Management System and Elsevier Clinical Skills, which helps management foster staff professional development in subjects such as EMR documentation, plans of care, physician order entry, and more. These resources encourage proper execution in those areas, answering the needs of staff seeking additional clarity and thus offering management peace of mind.
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