4 Steps for Hospitals to Reduce Their "Silo-ization"

When Mike Sniffen arrived to St. Mary's Hospital in Passaic, N.J., almost three years ago to take over as president and CEO, the hospital was in a tough spot, financially.

The 287-bed hospital with a 115-year history had just emerged from Chapter 11 bankruptcy. As a Catholic hospital, St. Mary's has a historical mission to serve the urban poor and those who were not treated at other facilities. St. Mary's stuck to its mission, but it came at a cost.

While St. Mary's is doing better financially since its bankruptcy days of 2009 — and now may be acquired by St. Louis-based Ascension Health Care Network — Mr. Sniffen knew protocol had to change so the hospital could stay financially viable while still adhering to its mission and values to provide care for those most in need.

"We found ourselves challenged, as we were a hospital of last resort for those with complex medical problems or those with severe social issues, behavioral and alike," Mr. Sniffen says. "Those patients tend to fall through the cracks when it comes to reimbursement purposes."

Mr. Sniffen and the St. Mary's administration decided to partner with Care Logistics, a hospital operations company that focuses on improving patient flow, reducing average length of stay and keeping hospitals on a workable path. They found the following four steps changed their organization's paradigm. Instead of working in silos — the buzz word in healthcare today — that cause communication lapses and large amounts of waste, St. Mary's worked to ensure physicians, clinical staff and patients became part of a more reliable and efficient environment.

1. Create a culture of patient-centeredness. The challenge with hospital operations today is that hospitals are historically set up in silos through the different service lines and medical departments. Physicians, nurses, lab technicians and other staff across those different service lines work in fragmented stages, and communication is often staggered along the way, leaving patients and time behind.

"Systems orchestrate resources. Silos compete for them," says Ben Sawyer, executive vice president of Care Logistics. "In each hospital, we help them establish a system aim, like, 'The patient is first.' Once they have established the aim, we help them make sure that action is on time with zero defects."

Mr. Sawyer says if hospitals instill a culture of patient-centeredness, then a hospital usually becomes more efficient. The silos can fade away as each member of the hospital care team focuses on patient throughput and on making sure the system is moving well, and this inevitably helps the bottom line as better patient throughput equals more opportunities for reimbursement.

2. Centralize a care coordination model. From an organizational standpoint, if a hospital wants to track if patients are moving through the system seamlessly, there must be some type of centralized hub. Mr. Sawyer likens this to an air traffic control center.

The hub also has case management professionals who understand all there is to know about the patients being admitted — the severity of injury or illness, what type of bed is needed, inpatient or observation status, etc. "By putting those people up front, there is no waste," Mr. Sawyer says. "The hospital staff and physicians get all the support they need."

3. Implement an "enterprise logistics" platform. Hospitals must have the right culture and setup to weed out the silo approach, but there also must be a technology solution to track that the new approach is working. Technology that tracks patient condition, MS-DRGs, case mix index and all other patient factors gives physicians, staff and management an idea of where there are gaps and how the continuum can more effectively be organized.  

"Once you have these workflows facilitated, phone calls are eliminated, and there is an abundance of data on how everyone is doing from a time and performance standpoint," Mr. Sawyer says.

4. Monitor the new system closely. If a hospital makes a commitment to an efficient, patient-focused system, a care coordination model and the right technology to monitor it all, Mr. Sawyer says it could see a 20 to 25 percent reduction in length of stay, a 40 percent reduction in infection rates and an increase in hospital capacity. However, there must be diligence in monitoring it. Mr. Sawyer explains that as hospitals gain more data on their patient flow and capacity benchmarks, they must interpret it in a "meaningful and interesting way and translate that into action" if needed.

"As a Catholic institution, we were founded to serve the individual's needs," Mr. Sniffen says. "The technology does not drive the solution. It's brought in after we change our culture and after we make sure we are being respectful of all involved."

More Articles on Hospital Efficiency:

The 5 "S's" to Creating an Efficient Hospital Environment

4 Key Strategies to Improve Patient Flow in Hospitals

5 Common Mistakes Affecting Hospital ORs

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