During the inaugural 2010 Innovation and Leadership Awards ceremony held August 19th, Clairvia presented Catholic Health Initiatives (CHI) of Denver with this year’s Innovation Award, and presented Midland Memorial Hospital of Midland, Texas with this year’s Leadership Award.

“Clairvia is very excited to unveil our new awards program because it gives us the opportunity to formally recognize how our customers are extending the boundaries of healthcare innovation and leadership,” says Beth Pickard, Clairvia president and CEO.

“By honoring these premier organizations and highlighting their exceptional results, we’re able to share remarkable success stories with our customers, partners, employees and the healthcare industry at large.”

The Innovation Awards are presented to recognize ground-breaking advances in the application of Clairvia CVM solutions and business process transformation.

By integrating a new, collaborative care management strategy and Clairvia’s CVM Patient Progress Manager technology, CHI is tracking patients’ progress and expected length of stay (LOS) against Medicare Severity Diagnosis Related Groups (MS-DRG.)

With these benchmarks in place, CHI’s care teams can communicate clear, team-centered clinical goals for each patient, optimizing the LOS in each unit and guiding patients toward discharge.

Through this innovative care management approach and Clairvia technology, MS-DRG and LOS are no longer in the ‘back-office,’ but managed at the point of care during daily collaborative rounding. Eight CHI pilot hospitals have implemented CVM Patient Progress Manager, and early results reveal increases in patient and caregiver satisfaction.

Click here to read the CHI success story

The Leadership Awards are presented to recognize extraordinary leadership in incorporating best-practice business processes and Clairvia CVM solutions to achieve positive clinical and financial outcomes.

By tracking and predicting patient demand through CVM Demand Manager and implementing staff management process improvements, Midland Memorial significantly reduced labor expenses while improving employee productivity and caregiver collaboration.

Monitoring and measuring patients’ demand for staffing care provides Midland with the means to assign role-specific staffing workload throughout each patient’s hospital stay, more efficiently use its staffing resources, and estimate future staffing scheduling needs and trends.

Specific outcomes Midland Memorial achieved included:
- The elimination of agency staffing, reducing labor costs by as much as $6 million per year
- Improved staffing productivity in key units (benchmarked to the 25th percentile with Solucient Action O-I data)
- Reduced overtime use

Click here to read the Midland Memorial success story

“These success stories are remarkable examples of how our customers are Optimizing Every Moment™, which is central to the overall Clairvia mission, and was also the theme of this year’s user conference,” says Phillip Madden, Clairvia’s vice president of Client Services. “This year’s conference was truly a customer-driven event. Many of our customers were actively involved in planning and leading conference sessions, and I want to express my sincere thanks to them and to all of our customers who joined us in Orlando.”

• ShiftAlert Mobile delivers mobile alerts to physicians and hospital employees on open shifts that have come available, and need to be filled now. Caregivers simply respond to text-alerts to sign up for open shifts and receive real-time confirmation of their new assignment–saving staffing managers the time-consuming hassles of making multiple phone calls.
• Physician Scheduler MobileConnect extends the self-service functionality of Physician Scheduler, empowering physicians to stay constantly informed of scheduling issues that effect their work and free time, as well as receive and respond to alerts, take steps to adjust their schedule, and interact with colleagues. Advanced interface enables physicians to view their individual schedules and swap shifts, as well as enter vacation requests and schedule changes.
• Care Value Management™ (CVM) MobileConnect – Provides hospital enterprise employees with the same, interactive scheduling functionality offered through Physician Scheduler Mobile Connect. At any place and time, staff members can view current and future schedules, stay up to date on evolving scheduling issues and needs, submit requests, and exchange shifts and collaborate with co-workers.

With these powerful new tools, you can put real solutions to your scheduling challenges right in the palm of your physicians’ and staff members’ hands.

See our full press release (PDF)

When asked what CHI is doing to figure out the business case for nursing and the business case for quality, Sanford replies:

“At Catholic Health Initiatives, we are doing two things. We are installing a software product that will help ensure that we are matching the right nurses with the right patients—so that more severely ill or complex patients are matched to nurses with the most advanced clinical skills. Not only will this software help us with daily patient assignments, it will give us data to understand typical nursing needs of patients according to their severity of illness. We will be better able to plan for the nursing needs associated with different diagnoses and comorbidities.”

The Clairvia technology has enabled CHI to have resource care patterns for each patient throughout their stay by working MSDRG and final MSDRG. Click here for more information on CVM Patient Progress Manager.

As it sought to achieve this objective in its 13-hospital, not-for-profit system, Aurora determined that Clairvia CVM® Staff Manager offered the best solution. “With Staff Manager, we’re implementing an evidence-based staffing system that offers measurable, valid and sustainable benefits in delivering high-quality, cost-effective and safe patient care,” says Jean Beaudette, MA, RN, NEA-BC, CNE and Director of Patient Care Services at Aurora. Moving forward, Beaudette says, the organization intends to investigate how best to share and leverage the data in Staff Manager with other information systems to improve system-wide efficiencies and results.

In their article, Anderson and Kerfoot ask whether nurse leaders are “positioned and prepared to use data to determine their appropriate evidence-based care model and translate those data into budget and staffing decisions.” Of course, we believe Clairvia CVM offers an excellent answer to that question, but we’d also like to learn from your perspective. How is your organization creating optimum value at the point of care?

Working directly with patients at every moment of every day, nurses can play a transformative role in raising the value of care. When the right nurses are assigned to the right patients, at the right time, outcomes are improved, costs are reduced, and patient, staff and physician satisfaction are increased. Evidence-based staffing models are key to achieving these transformative benefits, and can be implemented using existing information and technology.

Patient-Centered Alignment of Systems

Concrete value is created patient-by-patient, at the point of care. Tracking each patient’s condition, along with the individual and unlicensed assistive caregivers, across the entire episode of care, we can create a vital link between patients and the cost of services they receive.

Tracking Patient Progress to Expected Clinical Outcomes and Length of Stay

Once systems are aligned, tracking each patient’s condition and progress, hour by hour, throughout their stay, must be individualized to expected clinical outcomes and expected length of stay. This tracking can be tailored to individual patient needs via information such as admission diagnosis, ICD9 and DRG, as it exists in current electronic registration systems. Then, a methodology that measures the need for nursing care based on real-time patient outcomes, as opposed to merely census or care activities, can be implemented.

Transforming the Patient Assignment

The patient, condition and caregiver information that forms the foundation for evidence-based staffing is at hand, but needs to be aggregated into an effective decision support system. Combining data such as real-time patient admission, discharge, and transfer (ADT) information, plus patient-specific characteristics (e.g., admitting diagnosis, physician, gender, age, and isolation precautions), as well as nurse and staff licensure, competencies, education, certifications and compensation, we can transform the assignment process by providing charge nurses with evidence that complements their expertise – and empower them to get the right nurse to the right patient at the right time.

Leveraging Electronic Medical Record Data for Patient Outcomes, Risk and Cost

Using existing electronic medical record documentation, patient-specific data can be mapped to clinical outcomes on a Likert scale, making each patient’s current progress, or lack thereof, immediately visible to the nurse and the care team. This provides invaluable evidence to support staffing decisions that will add quality, improve cost performance and deliver real value to the consumer.

Leveraging Embedded Documentation for Outcomes-Driven Acuity and Workload

Using an innovative methodology that translates routine documentation of patient observations, interventions, and lab values into a Likert scale, we can precisely calculate workload for care hours and skill mix based on population-specific outcomes. In addition, we can reduce personnel expenses by accounting for the workload associated with ADT.

The technologies that can integrate patient, condition and staff information for evidence-based staffing are here. Using available evidence, they can drive resource decision making for positive patient outcomes and strong fiscal stewardship while creating a more satisfying workplace.

Your insights and experiences are vital to creating optimal solutions. How is your organization making use of existing information and technology to move toward evidence-based staffing? What obstacles have you encountered? What results have you seen?

You can get more staffing information on the RN Safe Staffing Act on ANA’s safe staffing website, www.safestaffingsaveslives.org.

The other day I heard that even with increased taxes and program cutbacks, within a few years the rising costs of medical care would overcome those efforts to keep the US financially healthy. While we might not have “signed up” to solve the country’s financial problems, you can bet that those who did sign up to solve them will be putting huge pressure on the health care industry to control costs, while maintaining care quality.

Hospitals costs make up about 31% of total healthcare costs (that’s counting dental, nursing home, drugs, clinics, etc.), by far the largest sector, growing at 8.6%/year (1). Moreover, hospital spending is about 41% of total publicspending for healthcare.

Inpatient costs break down percentage-wise as follows (2):

Nursing                 50%
OR                        10%
Lab                         8%
Radiology               4%
Supplies                 8%
Pharmacy               8%
Everything else    12%

With this in mind and from a hospital management prospective you might ask which parts of inpatient costs can be managed for lower cost at the same care quality?

Two ways to think about this:
1) Which parts are affected by length of stay? Or, if you could reduce LOS without lowering quality, what gets saved? Clearly nursing, supplies, pharmacy, and some of “everything else”. The OR, lab and radiology are more tied to “per admission”, and what is ordered for the patient.
2) Which parts are affected by productivity considerations? Clearly Nursing and OR, and to some extent Radiology and Lab.

Two very promising areas for management, then, are ways to reduce length of stay and improve nursing productivity without compromising care quality and safety.

Length of Stay (LOS)
When looked at as its effect on costs, LOS must be divided into how long a patient stays on each “type” of unit. For simplicity, let’s say there are four types of units: the ER, Intensive Care, Intermediate care, and the Floor. Cost saving are available by making sure that each patient stays no longer than necessary on each of these four, as they have significantly different costs per hour. And, for some patients, staying an extra unneeded 6 or 10 hours on the ICU doesn’t translate to either shorter overall LOS or better quality. Same for intermediate units.

So then, for LOS, the objective should be to have each patient stay on each type of unit only as long as is necessary for quality and safety, which should also decrease overall LOS (but maybe not as much as the sum of savings, depending on what part “nature” is playing in recovery).

But what’s the “correct” amount of hours on ICU for patient Jones? Or, is there some way an evidenced-based expectation for how long patient Jones “should” spend on the ICU could be established as a guideline, and as a measure against which patient Jones could be compared while he’s there on the ICU?

Here’s how our Patient Progress Manager approaches this. For a particular DRG — say the most often admitted to your hospital — a report is generated showing how long each of the last (say) 100 discharges stayed in the ICU, sorted in shortest to longest stay. Say they range from 4 hours to 72 hours in the ICU. Now a small group of clinicians who are familiar with these patients establishes a “target” LOS on the ICU for this DRG (say “16 hours”), where they agree that, after this amount of stay, it’s legitimate to ask “is this patient about ready to be transferred”.  Of course, in many cases, he won’t be ready, but if there’s a way to have the question asked the right way at the right time, some cases would indeed be able to transfer earlier than if the question were not asked.

Upon admission the Patient Progress Manager captures a working DRG for each patient, then tracks each patient’s stay on each type of unit, using links by HL-7 to the hospital’s ADT system. When a patient is approaching or has passed the “target” LOS on a unit for his DRG, and alert is automatically generated for caregivers and/or case managers. These “alerts” are a list (or screen) — always available and up to date — of all patients on the unit approaching their target, plus those past their target, to be reviewed. For those patients where it’s clear that they are going to stay past their “target”, a new target departure is set based on the current condition of the patient so that he can continue to be monitored against this updated target.

If a new working DRG is set for the patient, his targets are automatically updated  (unless his target has been manually changed after an assessment of the patient on that unit).

The same technology is applied to each patient’s stay on other units, and separately for his LOS overall.

Our users call this “managing to departure” for each patient, whether it be the next transfer or discharge.  A small gain in time here can mean big cost savings, when applied to all patients who could have left a little earlier.

See the description of the Patient Progress Manager for more detail.  

In a later blog — “Part 2″ — we’ll talk about managing costs and quality looking at productivity.

Love to hear your comments and  questions.

1) National Health Care Expenditure Data, CMS, January 2010.
2) Kane, Nancy and Siegrist, Richard, “Understanding Rising Hospital Inpatient Costs” , on www.selectqualitycare.com, 2002

Energy and passion for quality and safe patient care permeated the 43rd Annual AONE Meeting with over 2200 attendees this past weekend. First to inspire us was poet and scholar David Whyte.  Interpreting Shakespeare, Frost and other poets to what is important in our lives, we were lifted away to consider our three ”marriages in life”: our vocation, our family and finally our self. How well to we pay attention and nurture these trio?

His poetry evolved into how we have courageous conversations in all three of our marriages.  The ones we do not want to have in order to work in the world in a very different way. Thus, keeping us alive as leaders to inspire, foster intellect, discovery, innovation, and imagination. Throughout the conference, threads of his poetry were woven into our conversations. I’d never experienced poetry as a leadership thought tool.  

Dr. Lucian Leape reminded us of the value of teamwork in all of our hospital safety efforts. Envision for a moment the plane that Captain Sully landed in the Potomac with all the safe passengers standing on the wings– this was the first slide. Captain Sully said, ” I am not a hero, it was the team.” The outcome? …a few wet shoes. And joy for a country for lives saved.

His talk reminded me of our new tag line, “Optimizing every moment,” tracking the patient condition moment by moment and the collaboration among caregivers about what interventions, monitoring or referrals are required to help the patient move the next level of wellness.

Ohio State University Medical Center Nurse Researcher Dr. Esther Chipps also presented on safety behaviors among nurses with the use of vignettes. The study was elegant and the vignettes proved a powerful teaching tools for nurses and leaders about the various and complex circumstances that may lead to an error and its impact to patients. There were so many themes relevant to our work with you…staffing, unexpected workload shifts, charge nurse handoffs, new graduate workloads, and many more. We will look forward to seeing this work in the literature soon and getting it to everyone! Congratulations Esther!

One last plenary session highlight was the research and translational work by Donna Havens, Professor at The University of North Carolina presenting her work to strengthen staff nurses input into decision-making. Among the many variables analyzed, nurses wanted more input into the scheduling and staffing process. The results foster conversations about engaging staff in the relevant areas of patient care in new ways. Her work among rural hospitals in Pennsylvania was elegant. The survey called the Decisional Involvement Scale (DIS) has been used by several of my master’s students and is very easy to use. CNO Bob Dent at Midland Memorial in Midland Texas is considering the use of the survey in the next few months. Here is the best news, the survey tool is in the public domain (love free things!!). Let me know if we can send you the tool / article and introduce you to Donna.

As always, the best fun is connecting with all of you every year, our Clairvia colleagues sharing stories of their Care Value Management journey, or questions and colleagues inquiring about our innovative systems and commitment to quality for patients, families, a positive workplace and strong fiscal stewardship.

Many thanks to Dr. John Welton- who recently accepted a new Deanship!, Blessing Hospital CNO Jill Mason for her wonderful presentation on Outcomes-Driven Acuity, CNO Bob Dent, and UVA Health System Project Manager Linda Dedo for joining us and talking with colleagues! Karen, Kate, Logan, Michele, Mike and I thank you all for your partnership and we look forward to seeing you at the Magnet Conference in October. 

Cheers, Sharon

Sharon Eck Birmingham DNSc, RN Clairvia

According to Dr. Leape, 10% of patients account for 70% of all healthcare costs, however that was not the case 50 years ago, so how did we get here?   Dr. Leape identified a few areas that he thought shifted the focus of healthcare away from the patient:

Growth of Specialization:

• Innovation Flourished
• Patient Outcomes Improved
• Technology played an ever increasing role in healthcare
• Care became infinitely more complex

Specialization Downside:

• Costs soared
• Patient expectations rose:  They expected to be treated and relieved of symptoms
• More patients were harmed as newer technologies were implemented
• More graduating physicians chose specialties: Starting treating disease and not patients
• Healthcare became industrialized:  States focusing on Staffing ratio’s instead of nursing

 Societal Changes:

• 4 wars over the past 50 years:  Vietnam where authority was questioned
• Civil rights
• Explosion of Information Technology
• Increasing affluence
• Government funding of healthcare:  Medic-aid

  Effects of Societal Changes:

• Patient Empowerment
• Explosion of Information Technology
• Increased cost of healthcare

So now that we have an idea of how we got here, where is healthcare to go?  According to Dr. Leape, healthcare needs to go towards a new or renewed focus on the patient.  At no other time in our history will patients have more say over their healthcare, and demand that the care they are provided is of the highest quality and administered in the safest manner.   This new model of healthcare is stimulated by relentless upward cost pressures, the chronic care model of integrated team based care, an increase focus on the patient, and finally the Massachusetts experiment of Accountable Care Organizations.  Dr Leape even argues that hospitals should refer to themselves as “Accountable Care Organizations.”  What makes a hospital an Accountable Care Organization?

1. Standardization: Do things the same way, same time, every time
2. Patient Engagement: Demanding the right care-safely
3. Inter-professional teams:  Physicians, Nurses, Case Management, all working towards a common goal, treating the patient.
4. Accountability:  transparency by publishing results to qualify for federal/state dollars

As I end this blog, a question keeps coming to my mind, not only will hospitals change their focus of healthcare, but will technology providers (vendors) change theirs to a more patient centric approach?  Hospitals and technology providers are inter-twined in this healthcare shift, and we are both Accountable Care Organizations.  Only time will tell if this paradigm switch will truly improve healthcare, but I cannot think of a better place to start, than with the patient.