Rehabilitation Outcomes Review-Balancing expansion with cost-cutting measures
(Editor's note: Judy Waterston, chief executive officer of Schwab Rehabilitation Hospital & Care Network in Chicago, offers some examples of how a large rehab hospital attends to quality improvement issues while continually offering new services and staying abreast of the changing financial climate in the rehab industry. Schwab Rehab has 125 beds, including 30 subacute beds, and is affiliated with Sinai Health System, also in Chicago.)
RCR: Rehab Continuum Report recently wrote about a new cancer rehab program and a new aphasia center at Schwab Rehab. Schwab has a number of other new programs, as well. How does your rehab hospital maintain a balance between putting resources into starting new ventures and trying to find ways to make existing services more efficient while improving quality?
Waterston: In order to grow, an organization must be able to balance efficient and effective operations with the creation of new programs and services. New programs, which are key to Schwab's future growth and viability, are a way to increase volume while meeting the needs of the patients and communities we serve. If an organization is stagnant, it will die. We are an organization in transition, learning to adapt to an environment which is constantly changing.
RCR: Health care organizations often pride themselves on their successful efforts in improving quality and increasing customer satisfaction. But in at least some health care industries, the staff and time dedicated to quality improvement has been cut back because of financial constraints imposed by the Balanced Budget Act of 1996. Do you see this occurring in the rehab industry, as well?
Waterston: Time dedicated to quality improvement is very important. As health care providers, we must prove to our patients, payers, and the communities we serve that we add value. Our customer service and clinical outcome scores will show that we do.
RCR: What is one example of a simple quality improvement measure begun at Schwab Rehab that has had a big impact on the hospital's services, operations, or customer satisfaction?
Waterston: At Schwab, we have undertaken several quality improvement initiatives over the past year. We've looked at nursing response time, outcome measures, and patient accessibility to care. This last initiative focused on improving the hospital's appointment scheduling processes for Schwab inpatients who are being discharged into one or more of our outpatient therapies. Our efforts on this initiative have impacted numerous areas within the hospital, helping us to develop more efficient and effective discharge and outpatient scheduling systems.
RCR: How important have outcomes measurements been to a rehab facility's goals, and do you think this is becoming more or less important under the prospective payment system (PPS)?
Waterston: Outcome measurement under PPS will be very important. We have to be able to prove that our rehab interventions improve patient outcomes functionally. Under PPS, we will need to show our patients' outcomes justify the dollars spent on rehab care.
RCR: Health care organizations have tried to look at the glass as half full in recent years, many saying that they have improved quality in some areas by cutting patients' length of stay (LOS) and becoming more efficient in other ways. Can the managed care reimbursement cuts in rehab patients' LOS really be turned into a positive clinical outcome, and how is this possible?
Waterston: With the advent of managed care and other changes in reimbursement, organizations have been forced to partner with community agencies to identify alternative ways to care for our patients once they are discharged from the hospital. We also learned to think outside the traditional health care box, realizing that acute inpatient rehab isn't the end-all, but rather part of a continuum of care which includes many options for patients needing inpatient and outpatient rehab care.
RCR: Many of the recent managed care and PPS changes mean that some rehab disciplines have lost jobs, seen salary cuts, and otherwise faced career uncertainty; at the same time, those employed in the industry are expected to do more work in less time. How does Schwab Rehab maintain a happy or at least a content staff atmosphere in spite of these industrywide changes?
Waterston: I believe the key to change is communication. Frequent communication by management to all levels of the staff can go a long way in keeping them informed and reassured on what is happening throughout the organization. Communication between staff and management is also a way to plan ahead so that you can be successful as reimbursement and the delivery of patient care begins to change. Empowering staff to identify patient care solutions is also another way to keep them interested and involved.
Finally, I also believe that maintaining the hospital's focus on patients is paramount. Utilizing data, planning for the future, and piloting patient care studies are different ways to be innovative in creating the future of rehab. We are not victims of external forces, but rather instigators of change for the improvement of patient care.
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