Collaboratives are guided consensus building. You can’t tell a hospital how to do things, but you can get them together to share best practices. They’ll find something they didn’t have in their toolbox, and it will move the dial for them.
– Ian Butler, MD, Director of Quality and Performance, Vituity
Learning collaboratives are an increasingly popular method of bringing innovation to healthcare delivery.
Since 2013, collaboratives have been an essential feature of the Vituity landscape and a critical component of our success. As our practice has grown and diversified, we have found collaborative learning to be an excellent vehicle for promoting new and innovative process improvements across our organization.
In this post, we'll look at how Vituity's recent collaboratives have helped hospitals to improve efficiency, retain key providers, and provide a more satisfying patient experience.
About Vituity's Learning Collaboratives
A collaborative is a short-term learning experience that brings together healthcare teams seeking improvement in a specific area (for example, patient experience or emergency department throughput). Through shared learning, best practices, and support, a collaborative aims to create lasting change that ripples across the hospital and health system.
Vituity's learning collaboratives typically include 6 to 10 teams from hospitals around the country. Teams attend an in-person meeting to develop their action plans, which are carried out over the duration of the nine-month collaborative. Site teams also receive longitudinal coaching, resources, and tools to help them achieve success.
Between 2013 and 2017, 69 hospital departments sent teams to participate in Vituity collaboratives focused on topics such as patient flow, length of stay, team culture, and patient experience.
Here are some highlights from our most recent learning collaboratives.
2017 Emergency Department Throughput: Improved turnaround times by as much as 40 minutes
Six teams from high-volume emergency departments (EDs) participated in this collaborative, which focused on implementing or redesigning Rapid Medical Evaluation (RME).
RME involves placing a dedicated advanced provider, physician, and discharge nurse in the front end during peak arrival hours. Generally, the advanced provider focuses on low-acuity patients and starts workups on moderate- and higher-acuity patients, while the physician and discharge nurse focus on the disposition of moderate-acuity (ESI level 3) patients who require more complex management.
As a group, the collaborative teams reduced their time-to-provider by an average of 21 percent. In addition, length of stay for discharged patients dropped an average of 5 percent. One site reduced time-to-provider and time-to-discharge by 40 and 22 minutes, respectively.
The ED team from Swedish Medical Center Edmonds (Wash.) joined the collaborative after moving into a new building. As they adapted their processes to the new layout, their patient volumes began to rise. Soon they were seeing 30–40 additional patients per day above historical norms. Despite this, with the support of the collaborative, the ED was able to decrease its turnaround time to discharge by 12.5 percent, or 27 minutes.
Patient Experience: Reduced formal complaints by up to 90 percent
For this collaborative, 10 emergency medicine and urgent care teams came together to practice empathic communication techniques and learn about best practices for relationship-centered care.
At the start of the collaborative, teams developed initiatives focused on improving culture and provider and patient experience. Examples included:
- Callback programs
- Electronic quality improvement (to measure patient experience in real time)
- Leader rounding
- Whiteboard use and care card use
- Targeted service recovery
One site implemented a dedicated patient experience scribe program in which scribes round on patients, complete callbacks, and perform service recovery. This site reported a decrease in patient complaints due to the proactive service recovery program.
Another site that implemented a similar program reported that formal complaints decreased by 90 percent.
Overall, physicians and advanced providers who participated in the collaborative reported progress in integrating patient experience into their everyday practice. They also developed stronger partnerships with their nursing colleagues.
Advanced Provider Practice Collaborative: Decreased ED time-to-provider by up to 30 minutes
This collaborative included eight emergency and hospital medicine teams and targeted issues critical to the advanced provider experience, including:
- Site operations
- Team relations
- Advanced provider engagement
Participants also learned leadership and change management skills to help them proactively identify and implement improvement opportunities.
After nine months of applying these strategies, the participating teams reported many benefits:
- Higher levels of job satisfaction among advanced providers
- Improved patient satisfaction scores that appeared to ripple out to adjacent departments
- Positive adjustments to advanced provider staffing levels, which decreased unscheduled overtime and improved work-life balance
- Higher retention rates for advanced providers
- Greater respect among physicians, nurses, and advanced providers
The ED team at Bay Area Hospital (Ore.) focused its collaborative action plan on preparing to implement RME. By the time the process went live, the department had already decreased its time-to-provider by 30 minutes.
Vituity 2018 Integrated Collaborative
In 2018, Vituity reorganized its learning collaboratives into a single collaborative with multiple learning tracks. Participants attended integrated kick-off and wrap-up events before breaking out into their subject matter areas. This approach underscores Vituity's philosophy that providers across the health system are essentially on the same team.
The 2018 collaborative teams were divided into two tracks: Emergency Department Throughput and Emergency Department-Urgent Care Integration.
ED Throughput Track: Improved turnaround times by up to 39 minutes
Eight ED teams from three states participated in the 2018 throughput collaborative. Each team was chosen based on its readiness for change.
Overall, the collaborative EDs reduced their turnaround time to discharge by an average 18 minutes. When multiplied by the number of patients seen during the collaborative period, this adds up to 5.7 years of waiting saved. This is significant, because from the patient's point of view, waiting often equates with suffering, time away from work and family, and poorer outcomes.
The three most-improved EDs in the collaborative decreased their turnaround time by 39, 37, and 25 minutes. Interestingly, the most-improved ED was also the one with the highest patient volume.
By the end of the collaborative, Saint Alphonsus Medical Center in Boise, Idaho, had reduced its ED turnaround time to discharge to 140 minutes, which is excellent for a regional trauma center. The team had also eliminated 78 days of waiting for imaging and achieved the lowest turnaround times in Vituity for moderate-acuity (ESI Level 3) patients.
Urgent Care-Emergency Medicine Integration Track: Significant improvements in patient satisfaction scores
This collaborative involved 3 health systems working to integrate their ED and urgent care (UC) services. Team projects focused on improving efficiencies and care coordination between departments.
Advocate Sherman Hospital (Ill.) had historically transferred 2–3 percent of its UC patients to the ED. However, the team noticed that a disproportionate number of ED complaints came from these transferred patients. Among other initiatives, they changed their callback process to prioritize transfer patients.
By the end of the collaborative period, UC providers were connecting with 79 percent of the transferred patients. Because the number of transfer patients is small, the team couldn't draw firm conclusions based on satisfaction surveys. However, research suggests that high callback rates generally improve patient satisfaction.
Kaweah Delta Health District (Calif.) implemented a program in which ED providers can schedule discharged patients for follow-up at the urgent care center. This program was especially helpful for patients without a primary care provider. All of the patients who participated in this initiative scored their satisfaction level at a 9 or higher (out of 10).
Year after year, Vituity's collaboratives have created excellent value for our clients, partners, and patients. The collaborative model helps us to be worthwhile partners to health systems by providing support, education, and coaching that result in lasting change.
Interested in collaborative learning for your hospital? Vituity brings collaborative learning opportunities to like-minded health systems across the country. This is a unique opportunity to find support and innovation with your hospital leadership and clinical colleagues. If you’re interested in being part of Vituity’s 2019 Collaborative Series, please email firstname.lastname@example.org.
Originally published Jan. 15, 2019.