Focus on patient flow

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Barb Sweet
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New report tells Eastern Health how to move patients through hospitals faster

Eastern Health released a $450,000 consultant's report on patient flow problems Thursday, but there are no timelines as to when the public will see a difference in services and wait times at two city hospitals.

The report by Global Solutions Healthcare Consulting, an arm of a major electronics and medical equipment supplier Siemens Healthcare Canada, was delivered to Eastern Health late last year. But it has been shown around internally before being released publicly, said Norma Baker, chief operating officer of adult acute care.

Liz Kennedy (left), Eastern Health's director of clinical efficiency, and Norma Baker, chief operating officer of adult acute care, discuss details of a patient flow study at a news conference Thursday. - Photo by Joe Gibbons/The Telegram

Eastern Health released a $450,000 consultant's report on patient flow problems Thursday, but there are no timelines as to when the public will see a difference in services and wait times at two city hospitals.

The report by Global Solutions Healthcare Consulting, an arm of a major electronics and medical equipment supplier Siemens Healthcare Canada, was delivered to Eastern Health late last year. But it has been shown around internally before being released publicly, said Norma Baker, chief operating officer of adult acute care.

The report tackles patient flow - getting patients in and out of the hospitals quicker - in a number of major departments at St. Clare's Mercy Hospital and the General Hospital, which is part of the Health Sciences complex.

The consultants found while Eastern Health seems to be striving for "excellence in patient and family centered care" and has made some strides towards better patient flow, "further progress will depend upon strong leadership and a project management approach to implementing improvement initiatives."

It also noted that staff are suffering from "varying levels of inertia" due to intense public scrutiny that has placed an "additional burden" on them. There are continuing challenges such as staff shortages and health-care professionals doing clerical duties, taking them away from their full scope of practice.

There are technological limitations, including data having to be manually tracked and the lack of electronic information integration between sites. The report also said a challenge for Eastern Health is there are members of the medical staff who "fail to comply with expectations, organizational polices and procedures."

The report acknowledges that Eastern Health has undergone significant organizational change with consolidation and site closures, a shift in the way programs are managed and changes in senior leadership.

"This has resulted in unclear channels of communication and accountability for decision-making," the report states.

"Differing cultures between the two sites and competition for resources has made process standardization more difficult to achieve."

The report notes there are a number of key personnel who are close to retirement, "making it challenging to implement newer initiatives for sustainable change."

The consultants also said lack of home care and rehabilitation services are affecting Eastern Health's ability to discharge patients to their community.

"Without a fully funded community-based model of homecare support, Eastern Health will not be successful in achieving length of stay targets and its commitments to the community and province," the report stated.

Many of the issues were already known and some recommendations are in the process of being implemented, Baker said.

"I don't think there were any huge surprises, no silver bullets," she told reporters.

"There is nothing totally shocking in this report that surprised us per se."

Eastern Health has hired a project manager to work on the report and appointed a steering committee. Working groups will come up with action plans that will eventually lead to timelines, Baker said. There is no estimate for how much it will cost to implement.

She defended the idea of bringing in consultants when many problems were already known within the system.

"We felt when we look at increasing pressure in the ER, increased patient occupancy and wait times, the onus was on us to be able to look at all the potential recommendations that may be coming forward," Baker said.

"We didn't have the expertise or resources to look at totalities at all over the various deficiencies."

Eastern Health released a summary report to the media, but Baker said even the full report did not breakdown what would result if the hundreds of recommendations were put in place.

"They didn't quantify in terms of how the results would be," she said.

As a result of the report, Eastern Health requested help in budget submissions to the province to beef up its ambulance service to cut down delays in transporting non-urgent and elective patients between facilities - and increased operating room capacity.

Baker said the already-in-the-works expansion to the Janeway hospital to add two OR rooms, an expansion of the St. Clare's emergency room and increased intensive care unit capacity will address some of the needs that were identified in the report.

Major, longstanding issues like the need for increased nursing home capacity to free up hospital beds also show up in the report, but Baker said there is "no quick fix."

Eastern Health had tried to find personal-care homes to take patients on an interim basis for certain patients who can't be released while waiting for nursing home beds, but the capacity wasn't there in the metro area, Baker said.

The report calls for an integrated long-term care strategy.

Among the other recommendations:

that Eastern Health look for more clinic space, such as it has on Major's Path for outpatient services such as psychiatry, physiotherapy, gastro-intestinal, as well as women's health. That would free up space in the hospitals.

dedicate more resources for housekeeping staff to turn beds around more quickly

have nurses carry out initial tests in the emergency room (such as blood tests and electro cardiograms)

adopt technology that tracks bed status

better organization of admission and discharge practices

external followup programs to reduce repeat visits of patients how have chronic diseases like hypertension, asthma, angina, diabetes, epilepsy and others.

better scheduling for operating rooms, a separate room for anesthesia and putting more technological devices in the OR so physicians don't have to leave between cases

staggering breaks and lunches for staff in various departments to better manage coverage of services

shift realignment to eliminate backlog of diagnostic imaging

hospital porters be given support training and technology to make their work go more smoothly

The consultants began their work in April 2009 and worked on it intermittently to the fall, spending less than half the time in the hospitals and completing statistical analysis and other work offsite.

bsweet@thetelegram.com

Organizations: Global Solutions Healthcare Consulting, Mercy Hospital, General Hospital Health Sciences Janeway hospital

Geographic location: Eastern Health

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Recent comments

  • Francis
    July 02, 2010 - 13:34

    Leadership is not what we need. Stop blaming the leaders. Who would you suggest to lead ? What we need is good honest workers. Get rid of the deadweight and people that are bleeding the system . Have a no sue policy. People have to stop screwing the government. Billions have been stolen over the yers in wages and supplies. If this keeps up the system will implode and many services will be privatized. The billions stolen over the years is taxpayers money. WHo is a high quality leader ? Tobin, Ed Byrne . THe current leaders we have are the only ones that have the guts to drasticly end this corruption.

  • I C Clearly
    July 02, 2010 - 13:34

    Good to see promising news related to healthcare. br Now that Eastern Health know the problems and have a playbook to make things more efficient - will they be funded to follow up on the recommendations or will government force them to continue in the same manner?

  • Money
    July 02, 2010 - 13:31

    New Tory strategy, run health care into the ground so patients wil have no choice but to FLOW to Florida on their own nickel. Hey it'll save us 2.6 billion and alot of childish politicians bullying the heart & soul workers.

  • ABACUS
    July 02, 2010 - 13:31

    IC CLEARLY. Wrong again.

  • Yvonne from da big lan
    July 02, 2010 - 13:31

    So we had to pay someone a half million dollars to tell us that the way to get people out of beds in corridors is to get them out the front door quicker? My god, I could have told the that for $300,000, and save the province some money.

  • ABACUS
    July 02, 2010 - 13:28

    HERE WE GO AGAIN. ALMOST HALF A MILLION ON PATIENT FLOW PROBLEMS. THAT USED TO BE SORTED OUT DAILY BY THE INDIVIDUAL HOSPITALS. AN OPERATING OFFICER FOR ADULT CARE !! WHAT NEXT. SURELY THE DOCTORS AND NURSES DO THAT VERY WELL. WHEN THIS EXTRA ADMINISTRATIVE NONSENSE STOPS, THEN THERE WILL BE SOME CASH FOR MORE NURSES AND PEOPLE WHO DO HEALTH CARE NOT DRIVE DESKS.

  • Member of the 93%
    July 02, 2010 - 13:27

    I C Unclearly that would happen if the place had better senior management and not have the doctors and nurses on the frontlines driving desks but rather putting out the big fires they were trained to do. They can't do it all, no human can do it all. Later when upper management gets started on doing something, they can focus on dousing the embers. br br Vicki Kaminsky was hired to prevent all this from ever happening again. That was her job. That's what she was hired to do. She should have made it her primary focus seeing how it was why she was hired - but she twiddled and twaddled until the the place was fully engulfed in flames again. She is truly, without a single doubt, a collosal failure, and I fully expect to see something interesting to happen to her when this all quiets down.

  • I C Clearly
    July 02, 2010 - 13:25

    Pssst - hey there Glo (AKA Abacus - the caps are a dead giveawa). The idea of efficiency is to realize long term operational costs by making the system more productive. More productive means that the staff that we have can do more with their time. If processes were improved, we wouldn't need to hire more staff or pay more salaries (and pensions). The money saved could be redeployed to make further improvements to health care. br Paper patient records cost 20X more to administer than electronic ones and extends the time for patient treatment - but there is a high up front cost. The payback is rather than to spend our budget on clerks, we can spend the money on resources that actually deliver health care indstead of pushing paper. Tracking bed use, location of equipment, staff deployment and workload are all necessary to realize efficiency. We need to modernize the system - not continue to throw money away on antiquated practices.

  • ABACUS
    July 02, 2010 - 13:24

    I.C. CLEARLY. YOU OBVIOUSLY NEED TO GO AND GET NEW GLASSES. WHEN YOU HAVE SPENT 50 YEARS AS A PHYSICIAN IN HEALTH CARE YOU PERHAPS COULD UNDERSTAND BETTER WHAT IS GOING ON.

  • I C Clearly
    July 02, 2010 - 13:24

    Nate and Abacus - you focus on your nose and not the path ahead. Eastern Health has not been able to sort out their problems for years and continue to throw good money after bad on poor practices. br The current practices are costing a lot more than $450,000 - each and every year. They need to change, and they need guidance on how to do so. br I'd rather see 1/2 million spent on doing this than say, donating it to Rolls Royce to set up shop in Mount Pearl.

  • I C Clearly
    July 02, 2010 - 13:23

    50 years as a physician in health care Abacus? What else would you be a physician in - bowling? br Why the xenophobic attitude? The problems exist - they have not been fixed. Local resources obviously do not have the answers - otherwise, the would not have hired the consultants and the problems would have been fixed long ago. Most docs with 50 years of experience can't use a computer properly. br BTW (that's computer speak for 'by the way')- the caps lock key is the one on the left - right next to the letter 'A'.

  • I C Clearly
    July 02, 2010 - 13:22

    GLO - you prove my point.
    You complain of health care staff doing everything but delivering healthcare. Inadequate systems due to too much manual work for process that could be automated. Sub-optimal utilization of resources available. Overworked staff because they have too much to do.
    Yes, systems wil take years to implement - and the process has already started. You cannot progress without taking steps. If you do not know where you need to be, how do you expect to find your way there? The consultants are giving you the map. You should appreciate it.

  • GLO
    July 02, 2010 - 13:19

    WOW, EASTERN HEALTH MAKES THE HEADLINES AGAIN. AND THIS TIME IT COST A WHOPPING $450,000?? br br THAT'S AT LEAST 7 NURSES EASTERN HEALTH COULD HAVE EMPLOYED FOR A WHOLE YEAR IN THE ER, WHICH WAS RECOMMENDATION #3, BY THE WAY... br br IF EASTERN HEALTH WANTS TO CONSTANTLY AND CONSISTENTLY CUT CORNERS BY REDUCING COSTS AND STAFFING NUMBERS, HOW CAN PATIENT FLOW EVER INCREASE?! br br I DO HOPE THESE NEW AND EXPENSIVE CORPORATE OFFICES WILL ENCOURAGE EH'S EXECUTIVES TO MAKE BETTER AND MORE TIMELY DECISIONS, HOWEVER I HIGHLY DOUBT MONEY CAN CREATE GOOD LEADERSHIP...

  • g-man
    July 02, 2010 - 13:15

    i feel that eastern health is too dominated by women.i never see a mans face when it comes to eastern health.health care is definatly a womens world.

  • Nasty
    July 02, 2010 - 13:09

    Eastern Health released a $450,000 consultant's report on patient flow problems.

    $450,000!!! No wonder we are in debt again.

    Williams, Kennedy and Kamikaze are fools. They have no trouble tossing cash around to friends and family, but not to the people that need it most.

  • GLO
    July 02, 2010 - 13:08

    I C Clearly: Don't be so concerned about the CAPS lock issue. CLEARLY you do not work on the frontlines for EH, and especially at the HSC. If so you would know the inadequacy of how the system actually works. What you speak of are idealistic scenarios that will take years to implement. We're talking about how to move patients in and out efficiently and proper availability of treatment and care, This is CLEARLY not about pushing an electronic documentation system, or increasing productivity with staffing numbers as they are; staff are overworked, too few in numbers and generally underpaid for expectations in work performance. Please spend a day on the front to see for yourself...

  • Steve
    July 02, 2010 - 13:08

    Eastern Health needs good leadership, something which they do not have at this moment. Those two children, Kennedy and Kaminsky MUST step aside and high quality leaders NEED to be put into place at Eastern Health.

  • Francis
    July 01, 2010 - 20:24

    Leadership is not what we need. Stop blaming the leaders. Who would you suggest to lead ? What we need is good honest workers. Get rid of the deadweight and people that are bleeding the system . Have a no sue policy. People have to stop screwing the government. Billions have been stolen over the yers in wages and supplies. If this keeps up the system will implode and many services will be privatized. The billions stolen over the years is taxpayers money. WHo is a high quality leader ? Tobin, Ed Byrne . THe current leaders we have are the only ones that have the guts to drasticly end this corruption.

  • I C Clearly
    July 01, 2010 - 20:24

    Good to see promising news related to healthcare. br Now that Eastern Health know the problems and have a playbook to make things more efficient - will they be funded to follow up on the recommendations or will government force them to continue in the same manner?

  • Money
    July 01, 2010 - 20:20

    New Tory strategy, run health care into the ground so patients wil have no choice but to FLOW to Florida on their own nickel. Hey it'll save us 2.6 billion and alot of childish politicians bullying the heart & soul workers.

  • ABACUS
    July 01, 2010 - 20:19

    IC CLEARLY. Wrong again.

  • Yvonne from da big lan
    July 01, 2010 - 20:19

    So we had to pay someone a half million dollars to tell us that the way to get people out of beds in corridors is to get them out the front door quicker? My god, I could have told the that for $300,000, and save the province some money.

  • ABACUS
    July 01, 2010 - 20:16

    HERE WE GO AGAIN. ALMOST HALF A MILLION ON PATIENT FLOW PROBLEMS. THAT USED TO BE SORTED OUT DAILY BY THE INDIVIDUAL HOSPITALS. AN OPERATING OFFICER FOR ADULT CARE !! WHAT NEXT. SURELY THE DOCTORS AND NURSES DO THAT VERY WELL. WHEN THIS EXTRA ADMINISTRATIVE NONSENSE STOPS, THEN THERE WILL BE SOME CASH FOR MORE NURSES AND PEOPLE WHO DO HEALTH CARE NOT DRIVE DESKS.

  • Member of the 93%
    July 01, 2010 - 20:15

    I C Unclearly that would happen if the place had better senior management and not have the doctors and nurses on the frontlines driving desks but rather putting out the big fires they were trained to do. They can't do it all, no human can do it all. Later when upper management gets started on doing something, they can focus on dousing the embers. br br Vicki Kaminsky was hired to prevent all this from ever happening again. That was her job. That's what she was hired to do. She should have made it her primary focus seeing how it was why she was hired - but she twiddled and twaddled until the the place was fully engulfed in flames again. She is truly, without a single doubt, a collosal failure, and I fully expect to see something interesting to happen to her when this all quiets down.

  • I C Clearly
    July 01, 2010 - 20:11

    Pssst - hey there Glo (AKA Abacus - the caps are a dead giveawa). The idea of efficiency is to realize long term operational costs by making the system more productive. More productive means that the staff that we have can do more with their time. If processes were improved, we wouldn't need to hire more staff or pay more salaries (and pensions). The money saved could be redeployed to make further improvements to health care. br Paper patient records cost 20X more to administer than electronic ones and extends the time for patient treatment - but there is a high up front cost. The payback is rather than to spend our budget on clerks, we can spend the money on resources that actually deliver health care indstead of pushing paper. Tracking bed use, location of equipment, staff deployment and workload are all necessary to realize efficiency. We need to modernize the system - not continue to throw money away on antiquated practices.

  • ABACUS
    July 01, 2010 - 20:10

    I.C. CLEARLY. YOU OBVIOUSLY NEED TO GO AND GET NEW GLASSES. WHEN YOU HAVE SPENT 50 YEARS AS A PHYSICIAN IN HEALTH CARE YOU PERHAPS COULD UNDERSTAND BETTER WHAT IS GOING ON.

  • I C Clearly
    July 01, 2010 - 20:09

    Nate and Abacus - you focus on your nose and not the path ahead. Eastern Health has not been able to sort out their problems for years and continue to throw good money after bad on poor practices. br The current practices are costing a lot more than $450,000 - each and every year. They need to change, and they need guidance on how to do so. br I'd rather see 1/2 million spent on doing this than say, donating it to Rolls Royce to set up shop in Mount Pearl.

  • I C Clearly
    July 01, 2010 - 20:08

    50 years as a physician in health care Abacus? What else would you be a physician in - bowling? br Why the xenophobic attitude? The problems exist - they have not been fixed. Local resources obviously do not have the answers - otherwise, the would not have hired the consultants and the problems would have been fixed long ago. Most docs with 50 years of experience can't use a computer properly. br BTW (that's computer speak for 'by the way')- the caps lock key is the one on the left - right next to the letter 'A'.

  • I C Clearly
    July 01, 2010 - 20:06

    GLO - you prove my point.
    You complain of health care staff doing everything but delivering healthcare. Inadequate systems due to too much manual work for process that could be automated. Sub-optimal utilization of resources available. Overworked staff because they have too much to do.
    Yes, systems wil take years to implement - and the process has already started. You cannot progress without taking steps. If you do not know where you need to be, how do you expect to find your way there? The consultants are giving you the map. You should appreciate it.

  • GLO
    July 01, 2010 - 20:02

    WOW, EASTERN HEALTH MAKES THE HEADLINES AGAIN. AND THIS TIME IT COST A WHOPPING $450,000?? br br THAT'S AT LEAST 7 NURSES EASTERN HEALTH COULD HAVE EMPLOYED FOR A WHOLE YEAR IN THE ER, WHICH WAS RECOMMENDATION #3, BY THE WAY... br br IF EASTERN HEALTH WANTS TO CONSTANTLY AND CONSISTENTLY CUT CORNERS BY REDUCING COSTS AND STAFFING NUMBERS, HOW CAN PATIENT FLOW EVER INCREASE?! br br I DO HOPE THESE NEW AND EXPENSIVE CORPORATE OFFICES WILL ENCOURAGE EH'S EXECUTIVES TO MAKE BETTER AND MORE TIMELY DECISIONS, HOWEVER I HIGHLY DOUBT MONEY CAN CREATE GOOD LEADERSHIP...

  • g-man
    July 01, 2010 - 19:54

    i feel that eastern health is too dominated by women.i never see a mans face when it comes to eastern health.health care is definatly a womens world.

  • Nasty
    July 01, 2010 - 19:44

    Eastern Health released a $450,000 consultant's report on patient flow problems.

    $450,000!!! No wonder we are in debt again.

    Williams, Kennedy and Kamikaze are fools. They have no trouble tossing cash around to friends and family, but not to the people that need it most.

  • GLO
    July 01, 2010 - 19:43

    I C Clearly: Don't be so concerned about the CAPS lock issue. CLEARLY you do not work on the frontlines for EH, and especially at the HSC. If so you would know the inadequacy of how the system actually works. What you speak of are idealistic scenarios that will take years to implement. We're talking about how to move patients in and out efficiently and proper availability of treatment and care, This is CLEARLY not about pushing an electronic documentation system, or increasing productivity with staffing numbers as they are; staff are overworked, too few in numbers and generally underpaid for expectations in work performance. Please spend a day on the front to see for yourself...

  • Steve
    July 01, 2010 - 19:43

    Eastern Health needs good leadership, something which they do not have at this moment. Those two children, Kennedy and Kaminsky MUST step aside and high quality leaders NEED to be put into place at Eastern Health.