5 key insights to boost hospital operational efficiency: Q&A with Philips consulting director

Rick McCraw, RN, CEN, FACHE brings more than 30 years of emergency, trauma, and physician practice leadership experience to his role as director of client development and operations for the Healthcare Transformation Services group within Philips.

A certified registered nurse, Mr. McCraw has consultation leadership experience as director and vice president of the emergency department performance improvement team with Philips Blue Jay Consulting, where he led the streamlining of nursing workflows and ED processes.

Here, Mr. McCraw discusses strategies to help health systems improve operational efficiency and how he and his team help clients achieve success.

Editor's note: Responses have been lightly edited for clarity and length.

Question: What are the essentials to improving operational efficiency in any hospital department?

Rick McCraw: One basic thing that you need to have in place is an organizational plan that supports the changes you're looking to implement. It needs to have commitment top-down as well as bottom-up. I think one thing that happens that puts hospital changes in peril is trying to implement department specific change without consideration all of the downstream consequences of the process changes. If the details do not all dovetail together well, it is doomed to failure. Also, the staff must have a connection to purpose and understand the need for change.

Q: How is your approach different, or more innovative?

RM: At Philips, we use a lean methodology and structured approach to drive process improvement. The most important aspect regarding who drives process improvement is listening to the stakeholders who perform the work. One of the things that we do not do is come in with a set playbook of industry best practices — we know them and leverage them, but the reality is that what worked well at one facility may not work well at another facility. You need a program for each client that will fit their footprint, culture, and staff's tolerance for change, so it's really got to be somewhat customized.

Every facility is unique, by layout, staff makeup, number of people, etc., so our approach is that we come in, spend time understanding the current state, and then we look at data to get an idea about what the data says is going on. We interview stakeholders to find out what they think is going on and make observations in the department. We marry those visions together to determine the current state and then map out the journey to their desired outcome. We work closely with each client’s leadership team and staff to help the organization's employees implement and adjust to the change. Each program has different needs – from a single consultant onsite to a larger team of consultants and subject-matter experts.

One of the benefits of what we offer is a bandwidth boost – we deliver extra staff to get a focused project done in a specific period of time. We provide training and transitional support - then, once it is over, we're gone and they can go back to their improved operations. Of course, we have regular follow-up to support them long-term.

Q: What is an example of an innovative approach you saw work very well?

RM: When you go back to the people who do the work, sometimes they come up with the most creative solutions on how the work can be done, such as approaches where staff willingly were able to dig deeper or use technology to change traditional roles and responsibilities. I think one of the most innovative projects I worked on was a project at a Texas-based health system. We were working on an industry best practice, nurses on the floor coming down and taking reports and bringing the paperwork back up to their patients. This can be very difficult to implement and not very popular among floor nurses. The interdisciplinary team we worked with, including inpatient, outpatient, and support staff, became so supportive of it that they developed a process using their own technology that created the outcome we were looking for. We helped them to implement it with no additional staff but with the technology footprint they had. The end result was a process that was better and more high-touch than what they had before.

Q: How do you ensure the changes remain after your consulting team leaves?

RM: Lewin's change management model involves taking a process, unfreezing it, changing   and implementing those changes, and then re-freezing them. The re-freezing part is where I think many people drop the ball. All staff will want to migrate back to old behavior after changes are introduced. The only way that doesn't happen is during this re-freezing period, making it essential that somebody is there to ensure staff do not migrate back. Typically, that would be a leadership function. Often it is labor intensive, particularly in the first 60 to 90 days post-change, and as result not get the attention the project needs.  

Our consultants stay onsite to assist with the re-freezing period and to lead the daily management. This involves talking about what happened yesterday, what are we going to do today, and what are we going to do different because yesterday didn't work as well as we wanted it to. They will discuss root causes such as was it a process failure, was it something that required a change, or did we need to go back and change the standard of work. This focused problem solving method can be arduous to manage. Often the process reviews consist of generic feedback such as 'Well it didn't work so well yesterday, but let's just give it a whirl today and see how it goes.' That's not a very scientific approach and we all know “Hope is not a strategy”. Overall, it takes about 60 to 90 days for things to really gel, before you can scale back your level of oversight and support.  

Q: What actions do you take to set your consulting team up for success?

RM: There are two things we do that I think really sets us up for success. The first is that we spend a lot of time connecting the staff involved in the process to the purpose or the need for change. It is not very productive to just come into an organization and tell the people there that they need to do things different. It is more effective to explain why and how a new process is better. Connection to purpose is the foundation that helps implementations to adhere and stick because people understand the value of it and as a result are more willing to commit to it and support the change.

The second factor of reaching success is that a project needs to be branded as a project of the facility. It's not Philips coming in and doing this to the hospital, this is the hospital's project and we're helping guide them along the journey. As part of that we develop champions or people who serve as spokespersons for the project. These are the staff who are willing to take the project on, and continue to lead it once we leave.

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