Competition is no barrier to cooperation for children’s hospital groups
Clients clamor for joint project on bed control
While many think the competitive nature of modern health care may preclude rival organizations from working together, two groups that specialize in children’s hospitals have proven that theory wrong by joining forces to benchmark on bed control.
The National Association of Children’s Hospitals and Related Institutions (NACHRI), an association of 150 children’s hospitals based in Alexandria, VA, has started a project with Medical Management Planning (MMP), a Bainbridge Island, WA-based benchmarking and consulting company. The two groups, which have some overlapping members and clients, are looking at how beds are used from admission to discharge and how hospitals can become more efficient in their processes.
MMP senior consultant Sharon Lau, who is based in Los Angeles, says bed control is "an age-old problem in health care. We can’t gets kids into beds and out of the hospital in an efficient manner. Some of this is social, some is process-related, and part of the problem is an unwillingness to just blow up what we do now and do it differently."
Bed control has been "a top-10 issue at children’s hospitals for about 20 years," says Lau. "When children come into the emergency department, you know you have to admit them, but it takes two hours to get them into a bed. It is a push system — where you push the kids into the units — not a pull system. We have to change that. It’s all about how you use your beds and making sure the right patients are in the right ones."
As long as it doesn’t benefit nurses and other staff to take another patient, the problems will persist, Lau continues. "An empty bed is a break. But you also have to be careful that you don’t reward staff for doing too much and accepting patients that they don’t need to." Proof of the scope of the problem comes from 14 of the 15 children’s hospitals involved in the program. While one of them had a wait time of only 36 minutes from arrival in the emergency department to going in a room, most wait times were well above 200 minutes. One hospital’s average time was more than 6.5 hours or 391 minutes.
While MMP clients were telling Lau and her colleagues that bed control was an important issue, members of NACHRI were telling that organization the same thing. That made the issue a natural starting point after MMP and NACHRI signed a letter of agreement to work together "in new areas," Lau says.
"There are only so many children’s hospitals out there," says Lynne Lostocco, RN, MSN, field director of focus group initiatives at NACHRI. "Our role isn’t to vie with others to provide the same services. It serves our members better if we do things together."
An unusual partnership
Lau says such a collaboration is highly unusual in today’s medical marketplace. "We are all here to make money, and there are limited dollars out there," she explains. "Coming together like this takes understanding that we can add value to each other’s products. And this idea is very well-received by our clientele."
"We had looked at collaborating for a long time," Lostocco adds. "This year, we finally ended up with something we were both working on. Our goal is to serve NACHRI members, and that’s part of what makes this a successful collaboration. We work with the same hospitals, and our members want this. It is less about us, the two organizations collaborating, and more about them, our members."
Judy Baker, RN, another MMP consultant, says it can take a while for two separate organizations to build the kind of trust they need to work together and drop the attitude that one will poach the other’s clients. "There is a certain loss of control that people fear," Baker says. But the benefits outweigh any perceived negatives. "We get a lot of kudos from our clients."
The goals for the project, which got off the ground with a group meeting among participating hospitals in May, is "cost, quality, and speed," says Lau. "We want to change waiting times and get the patient in the bed quickly with low hassle and no increase in cost."
How each member will go about that will differ depending on the internal culture and politics. "We don’t want to revamp a hospital’s culture, but we do want to change the focus. Now, wait times in the emergency department is a quality indicator. We want to make it a unit indicator."
Change the focus and change the process
Just changing the focus can change the process, Lau continues. "Do something that rewards units for keeping that indicator down, whether it is a trip to the Caribbean or some other thing that motivates staff on that unit. Find out what moves them, and use it."
From the perspective of some of the participants, the collaboration is a boon. Judy Blaufuss, RN, MSN, assistant administrator for patient care services at Primary Children’s Hospital in Salt Lake City, says with the two groups working together, she can see a merging of clinical and financial data that didn’t occur often with either group alone.
"NACHRI has always focused more on clinical issues, and MMP on process things," says Blaufuss. "Financial folks always have questions for us about how much a program will cost before there is a payoff. Working together gives us better resources to answer those questions."
Blaufuss was one of the most senior people to attend the meeting in May, and Lostocco says she provided an enthusiasm and concern from the highest level that gave a boost to some of the others attending.
"I went because our assistant administrator of inpatient nursing couldn’t, but I’m glad I did," says Blaufuss. "I was thinking about huge projects, and others were thinking about unit-based things. It was nice to know I wouldn’t have to reinvent the wheel."
She says that more nursing executives could have benefited from going to the conference and taking advantage of the networking opportunities it presented. "Even the time we spent at the airport comparing notes and picking each other’s brains was helpful. We find out what works for us, what works for others. And we get tools that can help us make necessary changes."
Paul Ocón, RN, critical care administrator at Childrens Memorial Hospital in Chicago, agrees that the informal networking was a big plus of the meeting. "I really worked the room," he says. "You hear stories that people tell about their institutions. And when you share like that, you can come up with a way to apply that story, use it in your own institution’s culture and ritual."
While MMP is great with data, Ocón thinks NACHRI is better with "global thinking. When you marry the two, you can get a synergy for some measured changes that are not reactive but based on solid methodology."
The next step in the bed control project is a follow-up conference call scheduled to take place as Healthcare Benchmarks goes to press. During the call, participants will review what they have done so far. Prior to the conference, each hospital is to complete a written plan listing 10 improvements it wants to accomplish and how the facility and its improvement team will measure them. "That is part of their contract with us," says Lau. A final review will occur at a meeting in May 2001, when improvements will be reported.
More projects to come
In the future, there will be more projects between MMP and NACHRI. Although many of MMP’s clients are children’s hospitals, it has other facilities, too, and Lau hopes that these efforts at collaboration will expand to others. "But so far, we haven’t had any luck with that. We have tried to get adult groups involved, but they just don’t see the need. Or they think the competitive issues are more important than the need. I think that part of why this has worked so well is that it is a children’s group."
Lostocco agrees that working with children’s hospitals is probably a factor in the success of this collaboration. "Most people working in these facilities have a special passion for their patients and families."
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