Steps for evaluating and improving efficiency

How Hospitals Can Improve Efficiency at Various Points of Healthcare

The U.S. healthcare system is plagued by financial challenges that are caused, in part, by inefficiency. In the U.S., more than $2.8 trillion is spent on healthcare each year, and around 30% of that is estimated to be waste. The pressure to improve efficiency across the entire care continuum is shared by care providers from hospitals, to physicians, to nursing homes – and everyone is searching for ways to better manage costs. While no single provider or organization can solve the industry's spending problems, medical providers (hospitals included) can collectively drive greater efficiency into every part of the care cycle by making improvements on an individual level.

Any healthcare organization that is aiming to improve efficiency should start by conducting an internal audit. It may seem obvious, but before inefficiencies can be purged, they need to be identified. The first step to improving efficiency involves looking at internal processes to determine which efforts add value, which are wasteful, and where there are opportunities to drive measurable healthcare improvements and cost reductions.

To identify opportunities for internal improvements, hospitals can do the following:

Conduct a financial assessment. Closely examining budgets makes it easier to see where money and resources are being spent. A financial assessment is helpful for identifying waste and finding areas where there is potential for greater efficiency.

Map clinical processes. Mapping clinical processes is a good way to uncover efforts that do not deliver value to patients and that should be fine-tuned or eliminated. This exercise involves breaking down clinical routines and looking at each and every step in care processes. For example, hospital teams should map out (in order) each touchpoint that occurs when a patient arrives at their department for care. Charting the steps staff members take to provide care makes it easier to see where time and resources are going. With that knowledge, leadership can determine what efforts are essential for delivering value to patients. Conversely, they can pick out the non-essentials and then simplify and streamline.

Survey patients to get feedback. Patients should be surveyed and asked to submit feedback about their care experiences. Input from patients is valuable for evaluating performance and identifying positives and negatives about care delivery and efficiency. Often when patients are very satisfied it signals that processes and procedures are running seamlessly as intended. But when patients are dissatisfied, the opposite is true and hospitals need to investigate issues.

Once an internal audit is completed, teams should be able to answer "yes" to the following questions:

• Have we conducted a financial assessment to identify areas of waste?
• Have we reviewed processes, identified inefficiencies and developed a plan to address them?
• Have we standardized the processes that have proven to be most efficient?
• Have we made adjustments to respond to internal bottlenecks and streamline where needed?

Turn focus to external processes

Caring for patients has become a shared job between hospitals, primary care doctors, specialists, nursing homes, pharmacies and several other players. It takes effort from all those involved with patient care to make improvements. When considering efficiency, hospitals need to look beyond their internal processes and consider how they work with other healthcare providers. Tasks like communicating care plans for shared patients, sharing patient data, coordinating tests and medication, and processing hospital transfer information all need to be fluid. So, instead of focusing only on what is going on internally, hospitals need to work closely with the other providers in their community and decide how to most efficiently coordinate care.

Get input from staff

Regardless of whether the focus is on internal or external improvements, some of the best insights on how to improve efficiency often come from the staff members who perform routine processes and procedures. After all, the people closest to the action can share some unique perspectives on why particular processes or workflows are not working – and they typically also have suggestions for changes that would eliminate extra steps and other waste. It is important to solicit feedback from internal staff, listen to their concerns, and give strong consideration to their input. Better yet, managers and directors need to require staff members to routinely submit feedback and recommendations. This not only draws ideas for improvements, it also helps with getting buy-in when organizational changes are necessary.

People are generally more open to change when they feel they have a voice and opportunities to provide input.

Adopt efficient technology

For the most part, large hospitals and health systems are doing a good job of adopting electronic health records systems. With that said, there is always room for improvement when it comes to the meaningful use of EHR technology. Electronic health records are easier to access and more efficient than paper. So, hospitals need to be sure staff members are trained to correctly utilize EHR systems.

Take aim at readmissions

Tens of billions of healthcare dollars are spent on hospital readmissions each year in the U.S. By working to reduce readmissions, hospitals can do their part to help the healthcare industry improve efficiency and decrease spending.

In order to keep readmissions and related costs to a minimum, hospitals should take steps to:

• Ensure discharge orders are coherent
• Monitor high-risk patients and offer them additional support
• Optimize care coordination during transfers
• Follow up with patients after discharge

It takes fewer resources and less money to treat a patient once rather than twice. Hospitals can make a big impact on healthcare's efficiency by prioritizing the mission to stamp out avoidable readmissions.

Focus on quality to improve efficiency

Hospital providers don't always realize it, but there is a direct relationship between quality and efficiency. A good rule to remember is that by simply providing high-quality care, hospital teams can generally boost efficiency. For example, a hospital that works to make quality improvements can reduce infections that require additional care and lead to longer and more expensive hospital stays. The point is, safe, high-quality care is always most efficient. So, hospitals should make improving quality a primary aim.

Ultimately, one of the easiest paths to efficiency involves taking proper care of patients and doing things right the first time. For most healthcare providers, that is what is most natural. So, by doing what comes naturally – working to provide quality care and avoid mistakes – hospitals can be responsible for improving efficiency across a section of healthcare.

Richard A. Royer, MBA
Chief Executive Officer of Primaris
rroyer@primaris.org
573-817-8300

Richard A. Royer has served as the chief executive officer of Primaris since 2001. He has extensive administrative healthcare experience and is actively involved in several statewide healthcare initiatives. In 2006 he was appointed by the Missouri governor to the Missouri Healthcare Information Technology Task Force and chaired the resources workgroup. He also serves on the board of directors as treasurer for the Excellence in Missouri Foundation. In his over 35 years of medical business experience he has held positions as chief executive officer at Cuyahoga Falls, Ohio, General Hospital; executive director of Columbia Regional Hospital in Missouri; and founder and president of Avalon Enterprises, a medical financial consulting firm.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.

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