Category Archives: Operational Efficiency

Was Your New ED Designed to Fit the Way You Work?

computer simulation modeling

October 19, 2015  |  Delia Caldwell

Maybe you have a new emergency department (ED) under construction, or work in a newly built ED. But what if it wasn’t designed in conjunction with your specific operational processes? Either way, you will be challenged to work within the confines of the new space and meet the increased expectations that accompany it. Just because… | Read More

How to Prevent Reimbursement Denials Before They Occur

preventable denials

September 30, 2015  |  Dianne Foster

Overlooked reimbursement denials can put 1-3% (or more) of net hospital revenue at risk. In a billion dollar revenue health system, avoidable denials run $8-25 million per year. Clinical denials constitute one-third of this amount. Studies show that some health insurers reject 20% of medical claims. The Centers for Medicare and Medicaid estimate a 100-200%… | Read More

Why Enlightened Self-Interest Improves Patient Care

Why Enlightened Self-Interest Improves Patient Care

August 26, 2015  |  Dianne Foster

Which would you rather take part in: an opportunity to enhance your skill set, or, a mandated quality improvement program? A recent study illustrates that investing in the professional growth of hospital staff improves outcomes. What a person does to enhance their own circumstances also enhances the well-being of those they serve. Consider the words of… | Read More

How to Improve Operating Room Efficiency and Profitability

How to improve operating room efficiency and profitability

August 12, 2015  |  Michelle Mader and Jennifer Nussbaum

Just as in a lifesaving surgical procedure, every minute counts when optimizing the operating room (OR.) Saving even one minute per procedure adds up over the course of a year to a substantial time and cost savings for a healthcare organization. Optimize block schedules A computer simulation model quantifies the effects of various block schedule… | Read More

Rebuttal to “14 Things I Wish I Knew Before Becoming a Nurse”

“14 Things I Wish I Knew Before Becoming a Nurse”

July 15, 2015  |  Dianne Foster

Cosmopolitan magazine recently published “14 Things I Wish I Knew Before I Became a Nurse” that received a lot of attention and commentary on social media. I’m sure it also caught the attention of healthcare consumers and prospective future nurses. I found the article and its publicity disheartening. I’ve been a nurse for 36 years… | Read More

Bed Shortage? How to Stretch Hospital Capacity-Part 2

patient volume surge

May 27, 2015  |  Kathy Clarke

Every system has surges in volume, whether they are predictable or unpredictable surges. Most facilities were not designed to handle either type of surge – it’s simply not cost effective. But staff can make the best of their inflexible facilities by knowing what to do in case of a surge in volume. In the previous… | Read More

Bed Shortage? How to Stretch Hospital Capacity-Part 1

Patient volume surge stretch capacity

May 26, 2015  |  Kathy Clarke

Every system has surges in volume, whether they are predictable or unpredictable surges. Most facilities were not designed to handle either type of surge – it’s simply not cost effective. But staff can make the best of their inflexible facilities by knowing what to do in case of a surge in volume. There is a… | Read More

How to Catch More Illegal Weapons at ED Security: Expert Advice

How to catch more illegal guns at hospital emergency department security

May 6, 2015  |  David Martin and Kathy Clarke

“Security presence” in the emergency department can be as simple as an officer sitting in a chair at the greeter desk. Or it can be as involved as a metal detector, a canine team, and ambulance patient wanding. The level of security that is right for your hospital is best determined by local security and… | Read More

How the Best Nurse Leaders Decide Which Problem to Focus on First

How hurse leaders CNOs decide which problem to focus on first

April 28, 2015  |  Kristyna Culp and Dianne Foster

So you think you have a big chaotic mess and don’t know where to start? The Emergency Department (ED) boards patients. PACU backs up. Inpatient Average Length of Stay (ALOS) continues to increase. Patients wait for appointments. Patient satisfaction scores are not in the 90%+ category. Or, your facility’s market share is not at the… | Read More

Why Guess? Know How to Change Hospital Processes with Confidence

Change hospital processes with confidence

April 20, 2015  |  Kristyna Culp

If you don’t know for certain that a process change will work before you try it, you’re guessing. People guess because it’s easier than looking at data. Or because they have anecdotal evidence. “That transporter is always late and I have to take the patient myself!” Unfortunately a lot of anecdotal evidence just yields red herrings…. | Read More

How to Prove that Cutting Staff Won’t Actually Save Money

How to prevent hospital staff cuts

April 17, 2015  |  Kristyna Culp

When cutting costs, many hospitals trim less expensive staff, like techs and transporters. You may suspect this is a bad move, but we help you make the business case for creating the most efficient staffing model. We illustrate what happens when transporters don’t move admitted patients from the Emergency Department. When nurses pick up the… | Read More

The Truth About Unscheduled Patients: Predictably Reliable

order from chaos

April 15, 2015  |  Kristyna Culp

On any given day, a hospital knows its quantity of surgical patients because they schedule cases at least a week in advance. They can also predict the number of discharges and unscheduled patients even though they may seem random. With less precision, of course, but determining patterns and average ranges is not rocket science. When… | Read More

How to Make a Hospital Department Relocation More Successful – Part 2

transition planning for hospital department relocation

April 13, 2015  |  Dianne Foster

In Part 1 of this series, we discuss the scope, benefits, and different types of hospital transition planning. Today in Part 2, we cover the elements of a successful transition and different ways to distribute the workload. What does a successful transition plan entail? A customized playbook provides the leader with detailed work plans and… | Read More

How to Make a Hospital Department Relocation More Successful – Part 1

transition planning for hospital department relocation

April 6, 2015  |  Dianne Foster

Most hospital department leaders receive robust support, strategies, and tools to guide career transitions. Few, if any, receive the resources to navigate major construction and workflow re-engineering transitions. While redesigned space offers a chance for a fresh start, it also places the leader in a position of acute risk and vulnerability. They become the “lead… | Read More

How Hospital Staff Can Improve Patient Satisfaction With Scripting

March 11, 2015  |  Kristyna Culp and Kathy Clarke

We encounter “scripting”, or standardized responses, every day. Order a cheeseburger and the cashier will ask if you want to Supersize it. Rent a car and the staff will ask whether you prefer the gas purchase option. Fill up with gas and the screen on the gas pump asks if you would like a car… | Read More

What the Iphone Game “Diner Dash” Taught Me about Optimizing Emergency Department Throughput

February 19, 2015  |  Delia Caldwell

Like most people, within hours of purchasing my first Iphone, I discovered game apps. Since that time I have spent entirely too much time playing them. One game in particular, Diner Dash, has taught me some valuable lessons about optimizing emergency department throughput. The basic premise of Diner Dash is that Flo, the proprietress, acquires… | Read More

Hospital Construction Phasing Techniques to Mitigate Strategic, Operational, and Physical Impacts

December 12, 2014  |  Minta Ferguson

Hospitals have a tremendous opportunity to save time and money by addressing the phasing of capital improvement projects early. Here, we discuss phasing techniques to activate as soon as the Master Facility Planning (MFP) stage to maximize capital and reduce the potential for schedule delays and undesirable operational ramifications. A thorough phasing strategy defines an… | Read More

Three Ways ED Hallway Beds Make Your LOS Longer and Your Staff Less Productive

October 14, 2014  |  Delia Caldwell

I’m on a campaign to remove hallway beds from emergency departments across the country. Perhaps this seems like an unorthodox idea, but three factors convinced me that hallway beds do not belong in the ED. 1) Adding more capacity in the form of hallway beds typically increases LOS because it creates more places to “store”… | Read More

“We just moved in, it’s beautiful, but it doesn’t work!”

August 29, 2014  |  Delia Caldwell

After every conference presentation we give, at least one clinical department director will approach us and proclaim,  “We just moved in, it’s beautiful, but it doesn’t work!” Common signs that a new or newly renovated hospital department doesn’t function optimally: You may have long waiting queues Long process times (that should be short) Duplication of… | Read More

Four Ways Emergency Physicians Can Improve Patient Flow

August 27, 2014  |  Delia Caldwell

Emergency physicians can employ the following patient flow techniques to expand their capacity and evaluate more patients. USE OF SCRIBES Hospitals increasingly depend on physicians and nurses to capture data to help them meet reform requirements to earn incentive dollars and avoid financial penalties. Proper documentation to support the level of services provided is always… | Read More

Total Utilization Is Not an Option

August 20, 2014  |  Kristyna Culp

Whether you’re talking about the people, spaces or equipment in an emergency department, one can always find ways to increase efficiencies. But as you work toward that goal, it’s helpful to recognize that achieving 100% utilization or efficiency is simply not possible, nor even desirable. Rather, it’s wise to build in a little slack or… | Read More

Average Daily Census is a Myth

August 6, 2014  |  Delia Caldwell

The old joke about how even a broken clock is right two times a day has a lesson for hospitals — and in particular, one of the time-honored metrics they use. The average daily census (ADC) is derived by taking an average across all times of the day and night — numbers that often vary… | Read More

When is Wasted Time Really Customer Service?

July 30, 2014  |  Kristyna Culp, MBA

Across the healthcare system, people and organizations are seeking to increase efficiency. But not all “wasted time” in healthcare is truly wasted. Some of the most important aspects of healthcare are less than 100% efficient by nature. Of course, we can and should strive for greater efficiency. But we also must understand that absolute efficiency… | Read More

Three Ways Education about Care Improves Outcomes for Patients and Emergency Departments

July 24, 2014  |  Jane Stuckey

It’s easy to forget that not all of the health benefits that we provide to patients are in the form of actual medical treatment. In fact, some of the benefits come from educating patients about their condition and treatment leading up to and following discharge. Based on my own research and other studies of patients… | Read More

When “More Space” Becomes “Too Much”

July 17, 2014  |  Kristyna Culp, MBA

Give a gas more space, and it will expand to fill that space. The same goes for people — and this tendency offers some important lessons for emergency department planners. When an ED has too much treatment space, it can actually slow down the process. Finding the right balance When I’m on a project consulting… | Read More

There Are No Outliers in Healthcare Benchmarking … Only Real People

July 15, 2014  |  Delia Caldwell, MBA

For emergency departments engaged in healthcare benchmarking, it might seem natural to focus on tracking median statistics for patient care — such as Time to Provider and Length of Stay for Discharged and Admitted patients. But relying solely on median numbers, in my experience, tells only part of the story — and a slightly skewed… | Read More

Wouldn’t You Like to Prove that Your New Design Will Improve Productivity And Efficiency Before You Build It?

July 10, 2014  |  Kristyna Culp, MBA

Many healthcare providers ask these common questions: How many treatment rooms do I need in my Emergency Department? How many waiting spaces do I need in my Outpatient Imaging Center? How many Technicians do I need in my Urgent Care? How many EKG machines do I need in my Surgery Center? How many medication rooms… | Read More

Increasing Surgical Capacity without Construction

July 2, 2014  |  David White

During a recent engagement, we worked with a surgical department that was utilizing 24 operating rooms that were operating at close to full capacity (80% – 85%) during the peak periods of the day. And both the Pre Procedure and Same Day PACU were experiencing over 90% utilization during the busiest times. Volumes were projected… | Read More

Utilize Existing Facilities to Increase Efficiency

July 2, 2014  |  Kristyna Culp

Every emergency department is interested in improving efficiency — but not every one can afford to renovate. Fortunately, there are a variety of strategies an ED can adopt to increase efficiency using their existing facilities. In fact, many of our clients hire us to help choose the strategies that make the most sense for a… | Read More

An Analysis of VA Wait Time Data

June 27, 2014  |  David White

On June 9 the VA released the results from the “Accelerating Access to Care Initiative,” which includes wait time data for scheduling Primary Care, Specialties and Mental Health appointments for New and Established Patients. However, data is only as good as the usability of its format. We found it helpful to create an interactive graphic… | Read More

Why Should a Facilities Director Care About Operations?

June 24, 2014  |  David White

With aging facilities and underfunded infrastructure projects, directors of healthcare facilities are looking for ways to maximize capital. Counterintuitively, one source of significant savings in both facility construction and operating budgets is outside the typical purview of the facilities department: improving the delivery of care and flow. When the low-hanging fruit has already been picked,… | Read More

How to Smooth Out Patient Flow Bottlenecks and Increase Capacity in MOB Projects

June 23, 2014  |  Kristyna Culp

Outpatient centers have many opportunities to minimize patient flow bottlenecks through operational adjustments. Here, we discuss some of our solutions to move patients through their visits faster. Reducing Average Length of Stay (ALOS) increases patient satisfaction and allows more patients to be treated in the same existing space, forestalling physical expansion. Registration One of our… | Read More

Need To See More Outpatients and Reduce Wait Times but Can’t Build More Space?

June 19, 2014  |  Delia Caldwell

Do these sound familiar? Patients must wait more than three weeks for an appointment for a non-urgent visit such as a yearly physical evaluation. There are no available appointments within 24 hours. If patients are ill they are told to go to the ED. Once patients arrive at the outpatient center, their stays are longer… | Read More

Is the ED Too Convenient?

June 18, 2014  |  Jane Stuckey

Some people assume that one of the factors driving inappropriate use of emergency departments is the fact that they’re always open — and thus more convenient for patients. However, two recent studies, in Colorado and Oregon, have determined that time of day is typically not a factor in patients’ choosing the Emergency Department, even for… | Read More

Rethinking Registration: Changing the Check-in Process for Emergency Departments

June 4, 2014  |  Delia Caldwell

As EDs look for ways to improve efficiency, one possibility is to consider is the registration process. It’s an essential step in getting the patient into the workflow of the ED, yet in practice it can often become a bottleneck. There are a variety of approaches that EDs are following to rethink registration — ranging… | Read More

How Protocol-Driven Medicine Improves Emergency Department Operations

June 3, 2014  |  Delia Caldwell

Today, more and more hospitals are adopting protocol-driven (or template-driven) approaches to emergency department procedure. When an ED implements protocols effectively, these methods can dramatically improve emergency department operations and deliver care more quickly. Yet protocol-driven medicine is not a universal practice. Why are protocols important? How does protocol-driven medicine reduce wait times? And how… | Read More

More Physical Capacity Doesn’t Necessarily Improve ALOS

May 28, 2014  |  Delia Caldwell

As patient volumes have increased over the past 15 to 20 years, many institutions have chosen to expand their footprint, number of treatment areas, or both. Common signs that a department doesn’t optimize space appropriately: You may have long waiting queues Long process times (that should be short) Duplication of tasks Wrong staff completing tasks… | Read More

Data Collection and Healthcare Analytics Strategies for Identifying Superusers

May 21, 2014  |  Delia Caldwell

While emergency department usage is by its nature random for most individuals, there is a small percentage of the population for whom it is a more common occurrence. These are the superusers, and almost every ED has its share. For efficiency’s sake, what’s the best way to serve these individuals? Understanding Superusers To begin with,… | Read More

Improving Communication Between Nurses and Paramedics

May 15, 2014  |  Kristyna Culp

Emergency care is by its nature a complex, fast moving world, in which effective communication between members of the care team is vitally important. Todd Smith, a Ph.D. candidate and AG-ACNP student at the University of Virginia School of Nursing, is studying the communication between paramedics and nurses, and looking for ways to improve it…. | Read More

Triage Today: More of a Process than a Place

May 13, 2014  |  Delia Caldwell

When many people hear the term “triage,” they think of a place — a room or perhaps even a chair in front of an Emergency Department reception desk. In this case, triage is a noun, a physical space where a patient goes for initial evaluation and vital assessment before moving on to see a nurse… | Read More

Our Take: Top of License Practice and Highest and Best Use of Clinical Staff

May 12, 2014  |  Delia Caldwell

Recently a lot of articles and educational sessions have focused on using staff to their highest and best use, but any staff planning needs to incorporate flexibility. Ideally, there is always the right person available to complete a necessary task when that person is needed, and any capacity and process analysis can determine the ideal… | Read More

Mid-Level Providers in the Emergency Department

May 8, 2014  |  Delia Caldwell

There has long been a tradition in emergency departments — some might even call it a bias — of relying solely on physicians and nurses as the providers of medical care. Times are changing, however, and the use of mid-level providers, particularly Physician Assistants (PAs) and Nurse Practitioners (NPs), is allowing many EDs to bring… | Read More

Healthcare Strategy Lessons from the UK

May 6, 2014  |  Jon Huddy

As emergency departments continue to adapt to changing political and economic landscapes in the US, it can be instructive to look to strategies employed elsewhere for lessons. Hospitals in the UK offer examples of both adaptive tactics for more efficient emergency departments — and potential pitfalls. How do some prevailing approaches to emergency department design… | Read More

Team Staffing and Emergency Department Strategy

April 30, 2014  |  Kathy Clarke, RN

The team staffing model was originally established in California in 2001, and has since proven to be a highly effective approach — in part because it allows significant room for variation and adaptation to meet the particular needs of an ED. At the core of the model is the “ideal” or targeted ratio of 1… | Read More

Future Utilization and the Emergency Department

April 23, 2014  |  Jon Huddy

Many hospitals recognize that major decisions lie ahead for their emergency departments — beginning with how to meet demand that continues to increase, despite a variety of efforts to reverse the trend. ED usage soared over the past decade, rising from an average of about 380 ED visits per 1,000 population per year (or ~380/1,000/year)… | Read More