To respond to staffing challenges and reimbursement changes, and to meet patients’ needs, Altru Health System worked to integrate three pillars of innovation: Technology+Process+People. By applying intelligent process design, they were able to remove inefficiencies in patient flow – adding access and more value to each patient visit, as well as increase staff engagement and satisfaction. This was accomplished by creating a space for staff ideas to take hold in the care process, through an efficient process improvement model – stimulating different conversations of how care is delivered and creating a shift in clinic culture.
Quantified Operational Improvements
- Decreased patient cycle time by 25%; from over 60 minutes to less than 45 minutes per visit
- Converted over 4,500 minutes each week of non-value-added time to value-added time
- Added 1,700 more patient visits, improving patient access
- Generated 92 additional surgical cases through expanded number of patient visits
- Reduced 2,264 nursing hours and reallocated nursing staff to other lines of service
- Drove a 24% increase in an annual net revenue – equating to significant changes to the bottom line
“With real-time data, we can test new models of care delivery and empirically validate how changes impact our capacity, profitability, and patient satisfaction.”
-Dr. Darin Leetun, Orthopedic Surgeon – Altru Advanced Orthopedics
Challenged to not just “randomly change” or add more to the care environment, Altru Health System took a new approach to operational improvement. Altru understood that today’s healthcare pressures of reduced reimbursements and staff shortages meant they needed to pull and understand data showing how care resources were being used and where inefficiencies in the patient visit were occurring.
Altru Advanced Orthopedics had precisely defined goals in their expansion project:
- Increase patient access
- Increase quality of care
- Increase patient satisfaction
To be successful, Altru knew that their efforts needed to be supported by:
- Technology – deploying technologies to support operational excellence
- Process – applying operational data to drive continuous process improvements
- People – growing a culture of innovation and capacity for change management
To deliver on their goals, Altru partnered with Eide Bailly to provide Business Process Optimization (BPO) consulting, Intelligent InSites to utilize their Patient Flow software solution, and Sonitor Technologies for their real-time location (RTLS) hardware.
According to Jill Wilson, Administrative Director at Altru Health System, who championed the initiative, “technology and data alone will not yield sustainable results. You need to commit to investing in process improvement.” Therefore, from the very beginning, she challenged her team to think differently, to use data to find root causes of process delays, and to break the status quo.
The solution has offered Altru new data to understand where pinch points are in processes that were not discoverable before. With the guidance of Eide Bailly’s consultants, they began to look at new metrics and learn why they are important and leveraged improvement tools to change processes, while having the opportunity to see in real time the impact of implemented changes.
New measures utilized by Altru include:
- Patient Cycle Time — the amount of time a patient is in the care environment from beginning to end. This data is crucial in understanding how to improve the continuum of care across different services areas and work better together to decrease overall patient cycle time. This was possible by leveraging automatically collected data from a real-time locating system (RTLS), which is unbiased, and by building a culture where questions and open conversations about processes were fostered.
- Utilization Rates — the amount of time resources are being used. The resource could be a physical space, a piece of equipment, or a staff member. This number is critical to know, yet only a few health systems use it to analyze their operational performance.
When it comes to driving patient access, resource efficiency, and patient and staff satisfaction, there are a few aspects of utilization:
- Room Utilization — the amount of time a room has a provider and a patient in the room at the same time. This information helps to avoid rooms being used as waiting areas and allows for better space planning and room assignments.
- Provider Value Added Time — the amount of time a provider is seeing a patient over total hours in the day. As recent research shows, physicians spend only 27% of their total time on direct clinical face time with patients. This area of focus provides great opportunity to increase access to care and improvements in The Clinician and Group CAHPS results.
- Daily Work — the amount of work left over from today’s care. Driving this metric towards a near zero level helps prevent staff burnout, provides proper work-life balance, and opens up the opportunity for employee creativity. This is especially important when researches show that physicians spend 1 to 2 hours of personal time each night doing additional computer and other clerical work.
- Capacity of care areas or points of the process — by seeing patient flow in real-time, care teams understand were bottlenecks are, or where they could potentially be happening, and take immediate actions to prevent them or open them up.
With a goal of continuously optimizing patient flow, Altru staff meets daily to discuss the day’s data – specifically patient cycle time and value added versus non-value added time for the patient and provider. Using Business Intelligence tools and visualization, the team is able to see levels of variation and establish context for outliers. By mobilizing the data and driving process improvement throughout the clinic, they are able to manage change more efficiently and effectively.
“Our conversations began to switch from being reactive to being proactive. We became ignitors for change.”
– Rhonda Enger, Advanced Orthopedics Manager – Altru Health System
One year after applying intelligent process design, Altru Health System has standardized their processes and decreased variation. Through cycle time reporting, they have implemented a number of processes to improve the flow of patients throughout the clinic. Variation in vital sign compliance has improved and order entry has been streamlined. Patients are spending less time in the clinic, yet more time with providers. Care teams continue to huddle about their cycle times at pivotal points in the day, adjusting resources accordingly.
As Wilson explained,
“We migrated from a place where our teams were overwhelmed, wondering how they were going to meet patient demand; and where physicians were always running behind. We are now to a place where our doctors and their teams are holding one another accountable to stay on schedule and to finish today’s work today.”
About the Healthcare System:
Altru Health System is a community-owned, integrated system with an acute care hospital, a specialty hospital, more than a dozen regional clinics, and a large home care network. Altru employs 200 physicians and 4,000 staff.
14,000 sq. ft., 24 exam rooms, 7 cast bays, 2 x-ray rooms
BPO Consulting: Eide Bailly
Software Partner: Intelligent InSites
RTLS Hardware Partner: Sonitor Technologies
Key Integrations: EHR (Epic)
Applied Processes and Technologies:
- Business Process Optimization (BPO)
- Real-Time Locating System (RTLS)
- Patient Self-Rooming
- Business Intelligence
 Source: American College of Physicians http://annals.org/article.aspx?articleid=254670450%
 Source: Physicians for a National Health Program http://www.pnhp.org/news/2016/september/physicians-spend-two-hours-on-ehrs-and-desk-work-for-every-hour-of-direct-patien