A Case Study of Successful Patient Flow Methods: St. John's Hospital
Henderson, Diana, Dempsey, Christy, Appleby, Debra, Frontiers of Health Services Management
SUMMARY * Participating in the Institute for Healthcare Improvement (IHI) IMPACT collaborative has given St. John's Hospital the opportunity to improve patient flow and the delivery of patient care. This partnership has allowed us to experience a wealth of information shared by a collaborative network of hospitals. IHI has introduced rapid-cycle improvement methodologies, variability-reduction strategies, and strategies to aid in planning for the expected as methods that have enhanced our already established performance-improvement program. St John's has achieved breakthrough improvement with patient flow.
St. John's Hospital is a tertiary hospital located in Springfield, Missouri, serving 32 counties that cover 22,000 square miles in southwest Missouri and northwest Arkansas. The hospital has more than 30,000 admissions a year and an average length of stay (LOS) of 4.53 days for all patients.
St. John's senior leadership formed an alliance with the Institute for Healthcare Improvement (IHI) in May 2002 to assist our organization in achieving a superior level of performance. IHI measures of improvement include improved health status, better clinical outcomes, lower cost, greater access, greater ease of use, and improved satisfaction for individuals and their communities.
St. John's leadership team, including representatives from St. John's Hospital senior leaders and medical management services, selected "improving patient flow through the acute care setting" from the five domains offered by IHI. Perioperative services was identified as the initial focus of the project. St. John's perioperative services consists of 26 operating rooms in the hospital and 6 ambulatory surgery center rooms. An average of 25,000 cases are performed annually in these rooms. All specialties are represented, with the exception of organ transplantation. The rationale for selecting perioperative services was that it is a high-volume, high-risk, multifaceted area and displays strong leadership support. Issues with ontime starts, turnover times, and patient flow through the various areas of perioperative services are significant in terms of patient, staff, and physician satisfaction; cost and revenue; and quality of care.
Variability in caseloads, patient acuity, and specialty needs has a direct impact on not only perioperative services but also the hospital as a whole. This variability leads to the downstream effect of hospital bed capacity constraints, LOS issues, and intensive care unit (ICU) bed availability as well as the upstream effect of excessive emergency department (ED) waiting times. Therefore, to accelerate improvements in perioperative services, teams involving the ED (upstream effect) and the surgical ICU (downstream effect) were commissioned concurrently.
St. John's overall aim for this project is to ensure that patients receive timely access to appropriate care and move safely and efficiently through the system without unnecessary and unproductive delays. As discussed below, each team has established goals that contribute to achieving the overall aim.
Project teams were formed, and a physician champion and team leader were identified for each team. St. John's leadership team collaborated with the physician champion and team leader to determine what disciplines or stakeholders should be represented on the team. Team members were selected from each area affected by the improvement process. A walkthrough of each team's area was conducted to identify opportunities for improvement. Frontline staff not involved in the teams also played a crucial role in identifying opportunities for improvement by participating in individual department surveys. Performance-improvement tools were used to identify delays or bottlenecks in the process. Decisions were made scientifically, based on data rather than hunches. Once data were analyzed, changes were developed and tested. …