In 2009, Sherman Hospital (now Advocate Sherman Hospital) in Elgin, Ill. chose Vituity as its new ED management partner, and I came aboard as the new Medical Director.
For the past few years, the ED had been battling efficiency issues. Wait times were long, too many patients were leaving without being seen (LWBS), and a growing number were going elsewhere for their care.
The Advocate Sherman administration hoped that Vituity could improve the ED's reputation and draw patients back to the hospital.
Our new ED team got to work quickly, partnering with the nurses, introducing Rapid Medical Evaluation (RME)®, and recruiting new providers. And in the process, we introduced an even more fundamental change: we changed the way the hospital approached emergency care.
Put another way: we changed the culture.
Breaking Down the Silos
At Vituity, we foster a “culture of caring.” It’s based on our belief that patients should be at the center of every decision we make. While that may sound obvious, putting into practice a culture of caring can be surprisingly difficult.
One of the biggest barriers is the disjointed care that often exists within medicine. Disciplines can operate in silos, with each solely focused on its piece of the puzzle. No one's thinking about what happened before that patient entered the ED or what will happen after that patient leaves.
A culture of caring asks each group to consider the entire care spectrum, from the three to five days before the patient presents to urgent care through the crucial 60 days after they are discharged from the hospital.
It means that even in the ED, the staff is thinking about things they can do to make that patient’s hospital stay shorter.
The hospitalists who later care for that patient constantly ask, “What can we do to ensure that this person has their best outcome and is safe to leave the hospital so that they don't have to come back? What resources are we going to put in place? What follow-up care can we help to coordinate?”
By integrating the practice that way, the silos are broken down and a true culture of caring can emerge.
Putting Patients First
That’s exactly what happened at Advocate Sherman.
Through leadership and collaboration, we developed a team of nurses and providers who were committed to change. They wanted to improve the department not only to comply with regulations or please the higher-ups but because they wanted to do the right thing for patients. (You can read more about this transformation in my previous post.)
Thanks to their energy and engagement, time-to-provider plummeted from 85 minutes to 15. Turnaround time at discharge dropped from 200 minutes to 117. The LWBS rate dwindled to nearly zero. And as we'd all hoped, our volume soared from 40,000 to 60,000 visits per year.
Now some of that growth might have been due to the fact that we'd just moved into a shiny new building. But a building alone can't explain the great feedback our team received from patients or the growth in our satisfaction scores. As it turned out, we took market share from four competitor hospitals in our immediate catchment area. Our patient-first culture allowed us to create new efficiencies — and basically cannibalize the competition around us.
A similar transformation took place at Saint Agnes Hospital in Baltimore, where my colleague Pascal Crosley, DO, became ED Chair in 2013.
By using Vituity’s culture to attract great providers and to foster collaboration among disciplines and departments, Dr. Crosley and his team transformed the department, boosting volumes by 10 percent in the first year.
Acute Care Happens
One of the most notable shifts in healthcare in recent years has been a focus on preventative care: delivery systems that keep people healthy and, by extension, out of the hospital. It’s a welcome change, and one that was long overdue.
But the fact of the matter is people are going to get sick. They're going to get injured. They're going to need a place where they feel as though they're going to get great care. And when you have high-functioning urgent care centers, when you have high-functioning EDs and hospitalists, you're able to retain those patients. They're not going to go other hospitals. They’re going to keep coming back to you.
Once you have those lives under your management, preventive care is a must. You’ve got to keep them healthy, to make sure they're getting their immunizations and checking their blood sugar and managing their congestive heart failure.
But first, you've got to have those patients. And one of the most effective ways of adding patients is by showcasing your health system’s expertise vis-à-vis the acute care continuum.
A New Approach
Aligning and integrating providers, reducing readmissions, and implementing new programs and service lines are just a few of the things a hospital can do to grow its market share.
But making your hospital the first choice of patients sometimes needs to start with actions that are somewhat less tangible, such as changing internal attitudes, approaches, and priorities.
Changing, in other words, the culture.