Connected Thinking Blog - NACHRI Conferences

Closing Plenary - Forecasting the Impact of the Economic Downturn on Health Care

Jeff Bauer, Ph.D., closed out NACHRI Creating Connections 2009 with a rousing, down-to-earth look at the future of health care. Bauer, a partner in management consulting -- future practice leader, from ACS Healthcare Solutions, started his talk by clarifying the distinction between prediction vs. forecasting. 

Prediction is saying what will happen or what is likely to happen. Forecasting on the other hand, looks at the odds and at a variety of variables to see the likely outcomes. Bauer has an academic background in both models -- but he cited his most practical experience for the present as his time as a weatherman, with a background in research meteorology.

Underlying conditions for the future of health care

As the basis for Bauer's forecasting of the future of health care, he noted that the underlying conditions that defined health care in the past are radically different from the underlying conditions that will define health care for the future. Health care will change more between 2006 and 2015 than it did between 1965 and 2005. The medical marketplace will change more in 2009 and 2010 than ever before.

Health care reform will be confined by recession and recovery -- there is no modern precedent for where we are today. Precious radically recession have been more national vs. international -- the current recession is a global connected collapse with massive damage to be undone on the global scale.

At the moment, CHIP has been expanded, universal access has been pushed to the back burner,stem insurance mandates are conflicted, and reforms are trying to get their arms around reducing costs of a bloated system. Bauer expects a rising likelihood in reduced Medicaid and Medicare funding and an increased mandate for demonstrable community benefit. The delay in appointing a secretary of Health and Human Services is a challenge stalling all government leadership on health care issues.

Bauer's bottom line forecast for provider revenues for 2009-2010, is that there is only a 10 percent chance that the government will provide increased funding for health care; a 20 percent chance of constant revenue; and a 70 percent chance of declining revenue for health care -- far and away the most likely scenario.

Options for providers will be centered around entrepreneurial models and collaborative models pursuing new ways of delivering health care.

Three trends to be upbeat about, despite the economy

1. Medical Science: New Knowledge -- the biggest single factor that decides failure or success in medicine is the adoption of new technologies and accelerating incorporating of medical advancement. Personalized, predictive medicine will take on new significance and will radically transform models of care and reimbursement. Genetic understanding of disease and genetic treatments are revolutionizing research and medicine; drugs are being matched to genetic markers to improve care. These changes in treatment are necessitating greater involvement and team collaboration for diagnosis and treatment. Team management of chronic diseases is critical.
2. Technology: New Tools -- Integrated networks (universal connectivity, multiple platforms, new interfaces, multimedia, telemedicine, social networks, etc.), e-health technologies (hospital at home models and enhanced productivity).
3. National Population: (2007 was the highest birth numbers in the U.S. of any year in our country's history). Many more clinical trials are being done abroad, and sharing of information is critical to caring for all the different cultural, ethnic and demographic backgrounds in a way that is appropriate.   

Some advice for the present

• Efficiency can be done two ways: Most visits for a fixed cost. vs. Minimum cost for a fixed outcome. Either way, efficiency = no waste. Current estimates of health care waste across research sources shows 20-33 percent waste across hospitals. Find ways to eliminate waste.
• Effectiveness is that there is no unexplained variation -- you deliver what you say you will, the way you say you will. Efficiency and effectiveness are a delicate balancing act. Bauer recommends the following idea should be in ever mission statement: "Doing it right, all the time, as inexpensively as possible." 

For a copy of Bauer's slides and numerous recommended readings, he has placed a special page for NACHRI on his Web site where these resources are available.

For more context for Jeff Bauer's presentation, the following handouts are available on the NACHRI Web site:

• Forecasting the Impact - Econ 101 Handout (PDF File)
• Forecasting the Impact - Health Progress Handout (PDF File)
• Forecasting the Impact - Lean Times Handout (PDF File)
• Forecasting the Impact - Make Buy Partner Handout (PDF File)
• Forecasting the Impact - On Future Handout (PDF File)
• Forecasting the Impact - Production Factors Handout (PDF File)
• Forecasting the Impact - Productive Reform Handout (PDF File)

Keep Those Patients Moving - streamlining flow and eliminating waste

In a shared presentation, staff from Children’s Specialized Hospital, Mountainside, NJ, and Banner Children’s Hospital at Banner Desert Medical Center, Mesa, AZ, shared their experiences in streamlining patient flow and staff flow to see radical cost savings and patient satisfaction improvement. 

Michael Marranca from Children's Specialized Hospital closed their presentation with a quote from Shigeo Shingo of Toyota: "The most dangerous kind of waste is the waste we do not recognize." This idea was epitomized in the presentations, where careful, critical analyses of clinical flow showed numerous, unexpected areas for improvement.

The slides and session overview on the NACHRI site paint a detailed picture of challenges, findings and results, which saved hundreds of thousands of dollars, reduced wasted clinical time more than 50 percent, and made great leaps in Press Ganey patient satisfaction scores.

Check out the Children's Specialized Hospital presentation, Our Patients Shared, We Cared & Dared to Be Lean.

Check out the Banner Children's Hospital presentation, Keep Those Patients Moving!

Facebook, MySpace, Blogs - Oh My!

Yesterday's panel discussion regarding the addition of social media to the Marketing and Communications toolbox featured three case studies from Le Bonheur Children's Medical Center, the Children's Medical Center of Dayton and Children's National in Washington, D.C.  The three panelists described how their hospitals have embraced and successfully implemented social media to complement current marketing and public relations strategies.  Download their presentation here.

Le Bonheur Children's partnered with NACHRI to successfully use a blog during the 2008 Family Advocacy Day in Washington, D.C.  They chose a brain tumor patient and her father to visit Washington.  Zac, the patient's father, blogged prior to the trip and continued until they returned home.  Jennifer stressed the importance of preplanning and scheduling when taking on a short-term blog.  Because the trip's schedule was already booked solid, they scheduled specific times dedicated to the blog to ensure that Zac would have enough time to actually blog.

Le Bonheur Children's also stepped further into social media in their promotion of the blog.  From internal communications to external promotion, they embraced all that social media had to offer.  Centering around their already large group of fans on Facebook, the team was able to increase the number of visits to the blog by at least 1,100. 

The Children's Medical Center of Dayton is new to the social media world, but have already implemented tactics in YouTube and Facebook.  Betsy and her team upload all types of video to their YouTube channel as well as use the RSS feeds developed on YouTube to plug into their Facebook accounts and their web site.  Since Betsy has a small Marketing and Communications team, she stresses the importance of extending one task.  When uploading a video to YouTube, she uses that video embedded on their hospital Web site, and other areas.  Betsy mentioned that the use of YouTube has increased their search engine optimization by moving The Children's Medical Center into the Top 10 in the rankings.

Children's National displayed a stunning use of Twitter.  They use this tool for everything - fundraising, awareness, education.  Mark discussed the need to become an active member of Twitter personally before making your organization take the plunge, so that you can better understand the uses and functionality of the tool.  Mark also gave the audience insights into the power of retweeting.  One message that he had posted had the potential of reaching more thatn 16,000 active and engaged people. 

The biggest takeaway from this session is to remember - Social Media is a tactic not a strategy. We need to be mindful of the audience we are trying to reach and the types of information we want to convey before selecting the right social media tactic.  Also, they all stressed the importance of keeping social media inline with the rest of your organization's marketing mix.  Social Media cannot stand alone - but it can be a powerful addition to your campaigns.

A Brand New You: Building an Integrated Brand

I was so inspired by Helene Conway-Long’s presentation on building a brand. Helene is the director of development and marketing at The Children’s Institute in Pittsburgh. Helene has a long background in brand management, most notably at Tommy Hilfiger USA, but also with the Diocese of Greensburg and Carnegie Museums of Pittsburgh.

The main focus of Helene’s presentation was HOW you go about developing a brand. One point that stuck with me was that it doesn’t matter if you’re a fortune 500 or a small not-for-profit; the process of developing a brand identity is the same. Helene’s brand management experience in a variety of organizations gave credence to this point. She had five brand managers at Tommy Hilfiger and currently has a small staff at The Children’s Institute. I was so glad to learn that the PROCESS in which she developed those two, very different brand identities was the same. Obviously, how those brand identities are communicated (i.e. advertising, logos, etc.) are very different.

Helene explained how when she arrived at The Children’s Institute, she found that the community was confused as to what the organization did. A hospital, a day school, and a social service agency, the organization is committed to helping “amazing kids.

But based on the consumers’ very specific and different experiences with the organization or even their morning commute routes, most of the public only knew about one of the three sectors of The Children’s Institute. Through Helene’s research, she constantly heard the phrase, “I had no idea that you did that.” 

Helene explained that the discovery process is so important when trying to establish a brand identity. She relied on research to identify what parents and physicians were saying about their brand. She learned that both groups felt that they needed more information. What a great position to be in! That’s such a great opportunity to have your main stakeholders want more information. Ultimately, she discovered that the community is not aware of the scope of their services.

It was refreshing to see that Helene is so committed to the research/discovery process. So many times, marketing managers and organization leadership feel like they know already what their brands mean and how their stakeholders and consumers see it. Research serves as an objective check in the process and is critical in brand development. I’m sure she spent much more money in research and development at Tommy (as she lovingly called it) than at The Children’s Institute. Regardless, Helene’s commitment to the discovery process was essential.

Helene spent some time explaining the elements of a brand platform and how to develop a creative brief. 

The end result of The Children’s Institute’s brand identity building process was a cohesive family of logos that communicates all of the unique services that the organization provides. She developed much-needed brand and style guides, new marketing materials and web site. The brand identity was also integrated into a multi-media advertising campaign. Helene and her team continue to elevate her brand in the Pittsburgh market.

As a marketing professional who’s examining her organization’s own brand identity, I found Helene’s presentation extremely helpful.

Phoenix Children's Wins PR Impact Award

NACHRI awarded its second Impact Award recognizing excellence in strategic public relations and marketing campaigns to:

Phoenix Children’s Hospital – “Handprints” Campaign
Debra Stevens, Director, Marketing/Communications
Phoenix Children’s Hospital, Phoenix, AZ

NACHRI Announces Poster Winners

Congratulations to the top poster winners.  

Child Advocacy

#9 Youth Injury Prevention – The African American Initiative
Deatra Greene, MS, Injury Prevention Program Coordinator
Cincinnati Children’s Hospital Medical Center, Cincinnati, OH

Grants/PHIT/Analytics

#16 NACHRI Analytics - Reduce PICU Discharge Delays and Improve Flow
Larry Easterling, MD, Pediatric Critical Care
Cook Children’s Medical Center, Fort Worth, TX
Ellen Flynn, Director of Clinical Transformation and Safety
Children’s Hospital of Wisconsin, Milwaukee, WI

Quality

 
#38 TeamSTEPPS: Implementing Teamwork Principles for Quality and Patient Safety
Nora Bell, RN, Quality Facilitator, Pediatric Services
Sheila Lambert, RN, MSN, Director, Pediatric Services
Rebecca Clark, RN, PhD, Director, Nursing Research
Carilion Clinic Children's Hospital, Roanoke, VA

 

#26 Building the Clockwork Pediatric Emergency Department
Timothy Lee, MD, Pediatric Emergency Medicine Physician
Nicole Johnson, Nurse Manager
Children's Hospital Medical Center Akron, Akron, OH

Family-Centered Handoffs are Good for Patients and Nurses

Paula Forsythe and Joyce Deptola of Rainbow Babies and Children's Hospital in Cleveland, OH discussed how nursing staff handoffs with the patient and family and utilizing a standard format improved both family satisfaction and quality of communication. They described the PATIENT acronym used for the hand-off:
P: Patient data (name, age, presenting problem, diagnosis, history to date); Patient Profile
A:  Assessment of systems (significant findings); Assessment of current status (DNR, allergies)
T:  Tests (labs, results, outstanding tests, procedures)
I:  Interdisciplinary Plan of Care (overview & patient response); Interventions and medications
E:  Education, Emotional Needs
N:  Nurse’s focus for the next shift
T:  Timetable for discharge;  Discharge Plan
Variations of the hand-off structure have been expanded to other departments and care-providers. Process managers will continue to monitor compliance with the changes and outcomes in quality and satisfaction

Paula Dycos of Le Bonheur Children's Medical Center in Memphis, TN described their change to family-centered hand-offs at shift change in an effort to reduce both family and staff stress and dissatisfaction with care. After implementation of family-centered rounding, parent surveys showed increased satisfaction, particularly with the issues of: How well did the nurse keep you informed about your child’s treatment and/or condition? And, Did the staff on your nursing unit show respect for you and your child’s needs?  Nurse staff satisfaction with their work also improved, with nurses feeling much more informed and confident in providing care and wasting less time in report. Process managers reviewed the impact of the change on overtime costs and found a significant decrease in overtime hours after implementation of family-centered handoffs. Work continues on spreading these changes to other services and other patient hand-offs, such as leaving the floor for studies or therapy.

A good partnership with physicians is essential to meeting a quality agenda

Pamela Duncan and Kathy Jost of The Children's Hospital at Oklahoma University Medical Center in Oklahoma City, OK discussed how a little-used and attended physician’s committee on operations was transformed into an active and effective Shared Quality Committee. The IHI Framework for engaging physicians in a shared quality agenda was central to reengaging and refocusing physicians with the work of this committee. The hospital committed analyst, communication, and other resources to this effort believing that return on investment would be realized through improvements in care. The hospital and physicians worked together to identify improvement priorities through an objective and rational scoring system. The Quality Analyst was important in guiding, supporting, and reminding the teams to stay on task. Physician and nurse champions reported progress regularly and shared this information with their staffs, effectively reinforcing process improvements. Important lessons included targeting a process that is of a manageable size and ensuring you have data to track progress. Improvement efforts in many departments led to better patient outcomes and benefits to the hospital through decreased length of stay, reduced codes outside of the ICU, and less complications from treatments.

Craig Cordola and Amber McKenzie of Children's Memorial Hermann Hospital Houston, TX discussed how a new quality infrastructure was created to drive quality improvements. These changes included hiring a physician-in-chief and surgeon-in-chief, bringing a chief of infection control on board, and developing new committee structures to support quality initiatives. The quality structure also included building the data collection capabilities, establishing a relationship with NACHRI’s Case Mix Index database for external benchmarking, and developing a “Filter Process” to review all reported variances. Efforts have been successful in reducing morbidity and mortality among patients. The hospital, in conjunction with the medical school, has developed a Physician Quality and Safety Academy to advance expertise in the science of improvement and assure medical staff involvement in defining and attaining quality and safety goals. A similar effort to identify and train top nursing talent in quality and safety improvement has recently been launched.

Meeting the psychosocial needs of patients and families is essential to achieving quality

This presentation was a combined effort of three teams. The presentations were linked by the importance of meeting the psychosocial needs of families to improve the safety and quality of care.

Barbara Gursky and Kari Mastro of The Bristol-Myers Squibb Children's Hospital at Robert Wood Johnson Univ. Hospital in New Brunswick, NJ discussed the role of child life specialists in improving the quality of pediatric ED services and increasing parent satisfaction with those services. Interventions provided by professional child life specialists resulted in significantly less distress in children experiencing laceration repair and much improved parent satisfaction in services provided. In addition to improving the outcome of care, these improvements have potential direct financial benefits for the hospital. Greater satisfaction with services is expected to increase the likelihood parents will recommend the hospital to other and return to the hospital, if their child needs care in the future.

Kathryn Shamszad and Theresa Edmunds of Texas Children's Hospital in Houston, TX presented their efforts in revising the ICU visitation policy into a truly evidence-based practice. They showed how family-centered practices improved patient and family outcomes, while posing no additional risks to the care of the pediatric ICU patient. A key concern was risk of infection, a concern that was found to be unnecessary. The resulting policy change allowed siblings as young as 11 to visit without accompaniment by a Child Life Specialist – thus expanding the opportunities for siblings and families to support their loved one. The Child Life team hopes to use their ongoing experience with this new policy to add to the evidence base on the sibling visitation

Deborah Chasco of R.E. Thomason Hospital in El Paso, TX discussed how family satisfaction with patient-centered care is an important guide to achieving process improvements. She described how increased parent satisfaction with blood draw procedures was associated with lower contamination rates.  Ms. Chasco reviewed the Plan Do Study Act process used to identify, implement, and review the success of the interventions directed to improving blood draw process – a benefit to patients, families, and the hospital.

Residents can be an important part of advancing safety

Anu Sobramony and Lindsey Tilt of Morgan Stanley Children’s Hospital of NewYork–Presbyterian in New York, NY presented how teaching hospitals can effectively integrate residents in quality and safety efforts.  Resident involvement can benefit the institution today through the observations and efforts of these front line providers as well as develop knowledgeable advocates for safety and quality for the future. The activities also help residents meet ACGME requirements for safety improvement training. They discussed bringing residents into the process through the voluntary MERS process – resulting in increased reporting, greater appreciation and knowledge by residents of safety efforts, and initiation of several efforts to improve care processes identified through case review.

Drs. Subramony and Tilt emphasized the use of current cases and the importance of closing the loop with residents, nurses, and other staff entering MERS reports. Discussion with attendees resulted in ideas to include medical students in MERS activities and to ensure communication of resident activities to other safety efforts within the institution to prevent redundancy of efforts.