Staff are in sweats, jeans, but the work gets done
Saturday sessions foster teamwork
Saturday staff retreats, held every six weeks at her home, are helping one regional admitting director keep managers at the 10 hospitals she oversees "on the same page."
Learning the different cultures at the hospitals that now make up the Clearwater, FL-based Baycare Health System is the biggest challenge of her job, says Martine Saber, CHAM, director of admitting. "We’re spread out all over the place," she adds. "One hospital is 60 miles away, and others are 20 to 30 miles from each other." There are 12 managers and a total of 219 full-time equivalents (FTEs) at the 10 hospitals.
Standardization of policies and procedures is the ultimate goal, Saber says, but getting there is a complicated process of determining best practices and gaining buy-in from managers accustomed to doing things their own way. The staff retreats are a forum for brainstorming and for assessing "where we are with our goals," she notes.
Casual environment makes it fun
Originally, the plan was to meet quarterly, but Saber says she quickly realized there was too much to cover to wait that long between sessions. The managers come in shorts, jeans, or sweats, she notes, and "we try to make it fun. I feed them and have little gifts for them, and we talk about what we’ve done."
For example, Baycare is gradually implementing bedside registration in the emergency department (ED), and three of the hospitals have achieved that goal. The retreats give managers, who consider the retreats a part of their job responsibilities, an opportunity to update each other on what has been accomplished, Saber says.
"We start our meeting with quality," she adds. "We talk a lot about the good things first."
Saber occasionally schedules guest speakers. They have included a motivational speaker well-versed in quality management; Saber’s boss, Baycare’s regional vice president of finance, who talked about the coming year’s budget and goals; and the health system’s director of corporate compliance. "At our next meet ing, we may have someone from hu man resources," she says. "All the managers seem to have problems handling family medical leave and want to know what their rights are. When I see there’s a pattern like that, I invite someone who can help."
Although tiring, the daylong retreats are popular with managers, she says. "They see, from beginning to end, how much better we know each other. We laugh and have a good time, but we really work. By the time we go home, everyone has assignments for next time."
One of the goals for the coming year, she notes, is to form teams, of perhaps four managers each, to look at the system’s policies and procedures. "We’ll have one team look at the ED, for example, and another at financial counseling. "They’ll rewrite [policies and procedures] and give them to the entire group to review."
Cost per registration examined
As part of the drive toward standardization, Saber and her managers are monitoring the cost per registration at the Baycare hospitals, she says, with a goal of reducing those costs by 5% by the end of 1999. As a baseline, she is using the budgeted figures for 1999, dividing the department’s monthly expenses by the number of projected registrations that month.
Using a grid designed with help from her boss, she determined that overall registration costs range from $4.07 to $11.36, with an average cost throughout the Baycare system of $7.29. (See registration cost worksheets, pp. 30-31.)
Because the hospitals vary in staff makeup and services provided, Saber is breaking out costs for specific functions. For example, some hospitals have cashiers and others don’t, and some have bed control and others don’t. Emergency department costs were the simplest to compare, with a range of $5.85 to $9.02 among the facilities. "It’s OK to be a little different [in costs], but we’re trying to break down the variables. I want to look at where we’re spending more and why." For example, she asked, "Am I top-heavy [in staffing]?"
Other factors also figure into the equation, Saber points out. One of the facilities that is highest in cost per registration, for example, takes in some $500,000 per year in upfront cash collections.
Getting a handle on the cost per registration, she notes, will help her meet the 5% cost reduction goal. "We’ll reduce waste and streamline our processes by benchmarking with each other and with other hospitals across the country," Saber says. The plan is that the increased efficiency will allow staff levels to remain the same as patient volume increases, she adds.
As part of the ongoing examination and comparison of procedures at the various Baycare hospitals, Saber and her managers already have made some improvements, she points out.
"One change is in our outpatient area, where we’ve really been stumbling a lot in getting authorizations," she says. "We don’t have an automated way to let registrars know that authorization is needed for a certain procedure. They use cheat sheets’ [to check the rules for different insurers] and each registrar was calling for authorization after finishing the registration."
At one Baycare hospital, the procedure was changed so that one registrar became "the insurance person," she says. "That registrar spends the whole day calling for authorizations."
After one quarter, the number of cases in which an authorization was not obtained before service dropped from 633 to 74, she notes. The next three-month period saw a drop to 27 cases, and the next, the figure was 47, she adds.
Still, there is resistance from managers who say if their way of doing things is working, why change it, she says. "I haven’t been pushing them because I want them to come up with [the changes] themselves." For those who think their way is best, "I say, Start measuring.’"
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