Rehab facility overcomes scarcity of models to make benchmarking pay
Bryn Mawr Rehab found two sites to source for unique caregiving model
When leaders at Bryn Mawr Rehab in Malvern, PA, wanted to create a new caregiving model that bucked tradition, they discovered what other cutting-edge facilities already know: If the idea is unique, you’ll have problems benchmarking it.
Bryn Mawr’s idea was to meld the traditionally separated disciplines of therapy and nursing into work teams reporting to the same supervisor as part of a patient-focused redesign aimed at cutting costs and improving care. Bryn Mawr found numerous hospitals that had restructured staff into work teams, but they continued to have nursing and therapy report to their respective supervisors.
Bryn Mawr managers could have foregone benchmarking and forged ahead with the creation of their own model, but instead they decided to learn from those that had taken the first steps. They visited Shepherd Center and Emory University Hospital, two preeminent rehabilitation facilities in Atlanta, picked up a few ideas, and returned home to flesh out their innovative model.
"It was very useful, very helpful, to have the opportunity to see what others were doing," says Daniel J. Keating, PhD, administrative director for the neurocognitive division at Bryn Mawr. "We had a few skeptics, but when they talked with people on the front lines, it gave them an understanding of how it worked. People came back excited about some things they saw."
Patient satisfaction hits new high
The benchmarking efforts paid off, Keating says. The redesign team developed an innovative care model that in the first two quarters following its July 1996 roll-out has resulted in the facilities’ highest patient satisfaction scores. In the first quarter, the hospital recorded 90.6%, placing it in the 99th percentile, according to a survey by Press, Ganey Associates in South Bend, IN. Keating says patients’ functional outcomes have also held steady or improved across the disciplines, which was the goal of the restructuring team. (See related story, p. 27.)
The benchmarking process
The team chose to benchmark Shepherd and Emory after reading about their restructuring initiatives in publications. Both facilities reorganized caregivers into teams, but the therapists and nurses reported to separate supervisors.
Six of the eight members of the redesign team went on the site visit, including Keating, who then was called the administrative director; a physician; the vice president of nursing; a staff nurse; a physical therapy director; and the brain injury division manager. The two other administrators on the redesign team who did not attend were the nurse manager and the director of materials management.
The teams visited Emory first, spending half a day talking with managers about its redesign. "We asked them what they liked, what they didn’t like, what worked, what didn’t work," Keating says. One idea that Bryn Mawr liked was Emory’s streamlined documentation process. Each patient has one chart that staff use for documentation. The chart crosses all disciplines, from admissions through discharge. "It’s one running document that everyone contributes to," Keating says. "It cuts down on duplication."
Next they spent the day at Shepherd. Each member of the visiting team met with their counterparts at Shepherd to discuss in detail the ups and downs of restructuring. The individual groups then gathered at lunch for a discussion.
"It’s very important that everyone got to talk with grass roots staff to understand how this impacted them," Keating says. "It impacts managers, too, but differently."
Of the two, Shepherd’s model more closely resembled what Bryn Mawr wanted to implement. In fact, the team learned that Shepherd was planning to integrate nursing and therapy but had decided to wait until staff was accustomed to the initial team redesign. This knowledge gave Bryn Mawr’s team the confidence to pursue its own integrated model.
"They were intending to go that way, so it helped us," Keating says. "It helped us see it was possible. We decided rather than wait, we should go for it. We decided it would be a smoother transition if we did everything at once rather than waiting until the staff got settled then changing things again."
Benchmarking tips
Benchmarking is useful, even when processes and procedures such as patient-focused care are still novel. To ensure your visit is productive, though, Keating advises teams spend time researching the field so they clearly understand their goals. He says his team spent three months researching the field. "That way we were able to formulate the right questions to ask other people to get the data we needed," Keating says.
He also suggests that teams visit sites where the process or procedure they’re reviewing has been in place for six months or more. "You don’t want to go too early," Keating says. "You want to make sure it’s functioning and they have some experience with it."
[For more information, contact Daniel J. Keating, PhD, administrative director, Bryn Mawr Rehab, 414 Paoli Pike, Malvern, PA 19355. Telephone: (610) 251-5416.]
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content