Like hospitals everywhere, Chilton Memorial Hospital in Pompton Plains, N.J., wanted to re-engineer its patient-care processes. But the hospital also wanted to measure the results of re-engineering.
Working on a program to quantify changes at the 270-bed hospital were Deborah Zastocki, Chilton Memorial's senior vice president for clinical services and operations, and Lisa Tracey, a nurse consultant with Odyssey Partners in Atlanta.
That program will be the subject of a presentation at the ACHE meeting titled "Patient-focused Care: Isn't It High Time the Discussion Turned to Results?" It will be held at 4 p.m. Monday, March 2, and 8: 30 a.m. Tuesday, March 3.
Hospitals put a lot of money into work redesign, Tracey says. "When people ask, `What have you been able to achieve?' it's difficult for hospitals to come forward with quality and cost achievements."
Tracey's company has designed a program that helps hospitals develop long- and short-term targets, and shows them how to gather information to meet those goals. The second component of the program is setting up systems that hold people accountable for specific results.
Chilton Memorial approached work redesign with the goals of improving quality of care, service and customer satisfaction, and reducing the cost of care. The hospital wanted to establish performance baselines so it could determine whether quality improved or deteriorated as work processes were redesigned.
The hospital's traditional departments were reconfigured as care centers based on diagnostic groups. Through work redesign, such specific functions as drawing blood or performing echocardiograms were removed from support departments and given to caregivers in the units. Those people had to be cross-trained and found competent before performing those functions. Their performances are monitored on a continuing basis. At monthly practice council meetings, the disciplines in the care centers evaluate whether quality targets are being met.
One interesting highlight, Tracey says, is that the real amount of nursing care in the hospital does not seem to necessarily decrease as patient volumes decline. Instead, nurses spend more time at the patient's bed.
The hospital has achieved remarkable results. Before re-engineering, the average length of stay for pneumonia patients was 11.5 days. Now, just over a year later, that figure is down to 8.1 days. Processing of those patients used to be very inconsistent, Zastocki says. Now there are clinical pathways to indicate how quickly antibiotics must be administered and the sputum test must take place.
"The cardiopulmonary-care center has ownership of these patients," Zastocki says. "They're our quality champions for that care path."
Another measurable result: In 1995 nurses spent 25% of their time documenting medical records. By 1997 that was down to 20%. That's because the hospital had trimmed the number of forms used for charting to four from 22 used in 1995.
"That translates into adding 5% more time to delivering care to the patient," Zastocki notes.
And one result that needs no translation: Chilton Memorial got a 100% on its most recent survey by the Joint Commission on Accreditation of Healthcare Organizations.