When CEO Dr. Steve Narang arrived at Banner-University Medical Center Phoenix in 2013, the hospital was well-known for the way it cared for the most medically complex patients. But Narang found patient outcomes told a different story—one that did not reflect clinical excellence.
“We had a lot of silos,” Narang said. “We had the quality department siloed in one area, finance in another, we had operations, and then we had our physicians, and in the middle of this there’s the patient.”
Narang said the hospital’s fragmented operations hindered care coordination and that negatively affected its quality and efficiency.
So in 2013 Banner formed “care transformation” teams that had data analysts and performance improvement experts working with clinicians to address three major issues: reducing patients’ length of stay, decreasing mortality rates, and lowering the average amount of supplies being used.
“We didn’t go to our physicians and say, ‘Hey, we need to reduce our length of stay or cut costs,’ ” Narang said. Instead the hospital went to the physician heads of their various clinical units and asked them to use data to implement best practices based on patients’ diagnoses.
The physician leaders’ input is compared with best practices found in literature. New clinical pathways, which are followed by the rest of the clinical staff, then are added to the electronic health record system.
Narang said the process significantly reduced both the average length of stay and the overuse of resources over the past three years. That happened by focusing on the top 20% of DRGs that were responsible for 80% of longer stays.
Banner’s length-of-stay rate was 2,871 days better than the expected length of stay in 2018. The system saved $2.1 million.
“That number is never brought to the docs,” Narang said of the financial benefits. “The physicians there are just taking care of patients and trying to get the best practices there; and behind the scenes, we’re working with them to translate that into a financial and operational model that makes sense.”
Narang said Banner’s success comes from a yearslong process of trial and error that continues to this day. He said it’s important to develop and commit to a strategy and to be patient when it’s not producing immediate results.
“We have failed, we have failed quickly, and then we scaled the best practices,” Narang said. “And we continue to fail quickly, and then try to learn and scale.”