An aggressive managed-care environment in the San Diego area has pushed local institutions to take a hard look at how they can streamline delivery of care and cut costs.
For 124-bed Pomerado Hospital, this meant involving management and employees in developing its "PatientFirst" model of care.
"The imperative is clear for all providers to reduce their costs....What separates a provider from the rest of the pack is the ability to satisfy the customer," said Randy Middlebrook, administrator and chief financial officer at Pomerado in Poway, Calif., a northeastern suburb of San Diego.
The backbone of the first phase of the project was the creation of a new position called "administrative partner." Through a reorganization of job descriptions across several departments, the 15 employees filling the new positions took over some of the duties of the old job titles of unit secretaries, unit clerks, admitting clerks and financial counselors.
By cross-training the administrative partners, the hospital eliminated three management positions and 3.7 clerical positions, for a total savings of $281,200 in salary and wages. This surpassed the administrative team's initial goal of reducing operating expenses by 15% in admitting, nursing, medical records and registration, Mr. Middlebrook said.
Pomerado tested the concept from November 1993 to April of this year. The project began May 1.
Not all savings came from staff reductions. For example, the hands-on efficiency of the administrative partners in obtaining registration information and expediting discharges improved cash collections by 236%, Mr. Middlebrook said. Pomerado measured improvements in August against cash collection averages from February through April.
"If we can eliminate the number of steps it takes to accomplish something, we not only make it easier on ourselves and our patients, we end up saving dollars as well," Mr. Middlebrook said.
Improved patient satisfaction is the cornerstone of the program. It takes patients an average of 5.4 minutes from arrival to bed assignment, down from a minimum of 15 minutes.
Patients now go directly to the appropriate nursing floor when they arrive at the hospital. An administrative partner greets them at the elevator and takes them to their room where the registration process takes place.
A mobile wireless phone system allows administrative partners to be in continuous contact.
"The capital equipment has been worth every penny that we spent on it," Mr. Middlebrook said. Pomerado's investment for the program totaled $83,400. This included the $49,200 mobile phone system, $24,200 for training and $10,000 in computer costs.