The first three articles of this series explain why hospitals and health systems are facing an urgent need to become more flexible, and provide meaningful examples of how hospitals are purposefully flexing in the face of changing needs.
This final article outlines both the benefits and challenges to prepare for along that journey.
Top Benefits of Flexible Healthcare
Hospitals and health systems that undertake the work to become more flexible, adaptable and longitudinal are trying to achieve the following benefits:
- Faster speed-to-care
- Operational efficiencies
- New opportunities for virtual care
- Workforce stabilization
- Improved patient satisfaction outcomes and satisfaction
Faster speed-to-care. Bringing the appropriate level of care to a single patient room, instead of moving them based on changing acuity, means patients can receive care as soon as possible, rather than having to transfer to a different unit or floor and potentially be subjected to wait times and bottlenecks caused by unpredictable changes in patient care demand or unscheduled admissions1. Reducing patient transfers also decreases risks associated with moving individuals around the hospital, such as patient falls, hospital-acquired infections, and medication errors2 .
Operational efficiencies. The flexibility that enables patients to remain in one room significantly decreases the number of thorough room cleanings needed. Additionally, staff spend less time transferring people and more time focusing on patient care needs. Reducing transfer times also can lead to significant cost-savings. A large academic medical center, in a research study3 spanning 4 hospitals and 5 years, found that delaying transfers from the ICU to non-critical beds resulted in $587,790 in associated costs, or $21,547 per week.
“If we’ve learned anything from the pandemic, it’s that we should have processes set in place to quickly mobilize certain patient care needs in a specific area and bring those resources to the patient.” — Chief Nursing Officer, Midwest health system
New opportunities for virtual care. Acuity adaptable care models enable hospitals to equip rooms with digital tools to optimize resources and improve longitudinal patient care with virtual expertise — whether a remote intensivist is required, tele-nursing is needed or tele-sitting is the most appropriate option. Deploying those same digital tools is also critical to preparing for the next healthcare crisis.
Workforce stabilization. Reducing patient transfers, streamlining efficiencies, and transitioning care to virtual options can help ease some of the frustrations that often lead to clinician and staff burnout. Additionally, acuity adaptable models with standard well-understood capabilities and technologies allow hospitals to adjust staffing based on expected workload.
Improved patient satisfaction. Longitudinal, flexible and adaptable care models enable patients to stay in one room for their entire visit. This reduces stress which, in turn, increases satisfaction. Also, the continuous monitoring models described earlier in the series can help provide peace of mind for both patient and family.
Common Challenges to Anticipate
Hospital leaders who are helping their organizations adapt a more flexible approach should expect the following challenges:
- Determining where to begin
- Managing the culture change
- Implementing the technology infrastructure
- Leveraging data to drive meaningful change
- Protecting the investments
Determining where to begin. In the years since the acuity adaptable model was introduced, organizations have recommended cardiac units as a starting point, others have suggested oncology or pediatrics. The optimal facility, floor, or department will vary from one health system to the next. The Center for Healthcare Design noted in a report4 that acuity adaptable initiatives “work well when surgeons and intensivists can interact with a smaller staff throughout the recovery process, building close relationships with the staff and patients.” Flexible care models, including acuity adaptable care, should include representation from all key stakeholders – including nurses.
Managing the culture change. In lockstep with the work to determine where best to start implementing greater flexibility, leaders should be planning how to manage the change that such initiatives will demand. Nurses and the rest of the clinical staff flexed beyond what many thought possible during the pandemic.
Staff were called on to do more with less. ICU nurses, for example, practiced under the top of their license. Clinicians were assigned to a different floor or department. Those are just a few examples. As with other change management initiatives, communication, listening to the workforce, and incorporating feedback as appropriate are critical. It’s important for leaders to be conscious of the impact of placing more change on a team if it’s not properly involved and engaged.
“Change management isn’t as effective when the guiding members are burned out—already a common problem in health care—and feeling like they’re not getting anything done,” according to Harvard School of Public Health[5]. “Throughout the process, leaders need to work on refining and growing their leadership and management skills. Change management requires them to toggle effectively between the micro- and macroscopic needs of the project quickly and effectively, without being either overconfident or indecisive.”
HSPH, in fact, cites John Kotter’s 8-step process for leading change, which begins with creating a sense or urgency and establishing a strategic vision and includes steps to remove barriers and achieving short-term wins before instituting the change across the broader organization.[6]
“Managing the change requires changing the hearts and minds of the workforce by demonstrating that flexibility leads to better clinical outcomes and a better experience for patients and caregivers.” — CIO, Midwest academic medical center
Implementing technology infrastructure. Parts 2 and 3 of this series explain that continuous monitoring in the ward can serve as a key enabler to a more flexible approach. Hospitals need continuous monitoring technology that can flex up and down immediately, as patients’ acuity level changes. This technology should also be standardized across the organization to drive both efficiency and scalability. Flexible, adaptable patient journeys from the ED and ICU to health-at-home, also require the ability to seamlessly flow across multiple systems and care settings, as well as wireless and mobile monitoring devices that can extend into a variety of settings.
Leveraging data to drive meaningful change. Once continuous monitoring is in place in the hospital ward and extended into health-at-home models, data will be coming to care teams via multiple streams. The opportunity is to deliver the right data in the right format at the right time, thereby improving outcomes by reducing unnecessary ED visits and hospitalizations and limiting preventable adverse events. Successfully using that data requires enough visibility to understand the accuracy and quality of the information.
Protecting the investments. As with any large-scale organizational change, the personnel, technological, and financial resources allocated toward increasing adaptability and flexibility should be safeguarded as much as possible. That will mean re- or up-skilling staff, harnessing opportunities to establish new service lines to generate revenue, reducing unnecessary care expenditures, and planning for the future with extensible and wireless sensors, monitoring devices, and digital tools that can be upgraded as needed so hospitals do not need to continually re-invest.
A Critical Inflection Point
The economic, health, and workforce crises that have dominated the industry since 2020 also accelerated another reality: hospitals and health systems can institute large-scale changes more rapidly than previously thought.
Now, healthcare executives have the opportunity to lead their organizations in maintaining that innovative mindset to drive flexibility and adaptability, leverage data, improve outcomes for patients and reduce expenditures to achieve financial sustainability.
Previous articles in this series:
- Part 1: Three Areas Where Hospitals are Becoming More Flexible
- Part 2: Expanding Continuous Monitoring Capabilities
- Part 3: Building Blocks of Acuity Adaptable Healthcare
References:
[1] Maugel Architects (2019). Acuity Adaptable Rooms: What They Are and Why Hospital Needs Them. Maugel DeStephano Architects. https://www.maugel.com/blog/acuity-adaptable-rooms-what-they-are-and-why-hospitals-need-them
[2] O'Neill, L., Park, S. H., & Rosinia, F. (2018). The role of the built environment and private rooms for reducing central line-associated bloodstream infections. PloS one, 13(7), e0201002. https://doi.org/10.1371/journal.pone.0201002
[3] Nepogodiev, D., et al. (2019). Global burden of postoperative death, on behalf of the national Institute for Global Research Unit on Global Surgery, The Lancet, 393 (10170) 401 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)33139-8/fulltext
[4] Zimring, C. Seo. H., (2012). Making acuity-adaptable units work: lessons from the field. The Center for Health Design. https://www.healthdesign.org/system/files/Zimring_Seo-2012-CHD-KPS.pdf
[5] Igoe, K. (2021). Change Management: Why It´s Important, and So Challenging, in health Care Environments. Harvard T.H. Chan. https://www.hsph.harvard.edu/ecpe/change-management-why-its-so-important-and-so-challenging-in-health-care-environments/
[6] Kotter. The 8 Steps for Leading Change. Kotter. https://www.kotterinc.com/methodology/8-steps/
