1. Be Intentional
There is no shortage of demand for the quality of Stanford’s providers and services, said SHC CEO Entwistle. But the hospital’s limited capacity mandates that Stanford be more deliberate about its program growth, said McKenna. Rather than continuing to “allow a thousand flowers to bloom,” the organization is now engaging in thoughtful discussions amongst School of Medicine and SHC leaders to determine where and how to apply limited resources. These joint SHC and School of Medicine decisions, said McKenna, are being driven by community need. “Without this intentionality, hospital beds fill, patients are turned away, elective surgeries are canceled and financial strength is impacted.”
2. Be Creative
Clinical redesign is another strategic focus of the new administration. Employees are being asked to rethink the work they do, and to benchmark their practices against similar institutions. Many of these new clinical redesign projects are employee-inspired and employee-driven such as optimizing the use of clinical laboratory equipment. Others are organization-driven efforts to improve length of stay and the medication formulary.
The Drug Utilization Management Guidance Team (MGT), which oversees the use of 600 medications on the physician formulary, is looking at how to reduce rising pharmaceutical expenses without negatively impacting patient care. When the team identifies a medication that is exorbitantly more expensive than an equivalent drug, or one that Stanford physicians use more frequently than their counterparts at similar institutions, the MGT conducts an investigation. First it reviews current literature, and then compares Stanford’s prescribing patterns to those at other centers. Using this approach, the committee has successfully reduced costs for targeted drugs such as dexmedetomidine and inhaled nitric oxide, for which a lot of dollars are spent at Stanford, said committee member Stan Deresinski, MD. “We focus on rationalizing the use of these drugs so that they are only used when they provide value.”
In a separate effort, the Length of Stay committee is looking at how to increase capacity by freeing up beds. One strategy is to find potential inpatient populations who can be safely treated as outpatients, said Ning Tang, MD, Senior Medical Director, Clinical Effectiveness and High-Value Care. For example, new protocols for low-risk patients with chest pain or symptoms of transient ischemic attack (TIA) will have them receiving follow-up care as outpatients after their initial diagnosis and treatment in the ED. Another initiative focuses on reducing patients’ post-surgical recovery time. “In many of our elective procedures, there’s good scientific evidence that if we follow a specific set of practices, we can reduce length of stay, improve patient outcomes, improve patient functioning and improve patient satisfaction,” said Tang. A newly piloted care path for pancreatic resection patients reduced average length of stay from 10.9 days to seven days.
3. Be More Efficient
Building on the strength of Stanford’s ongoing process improvement work, McKenna encourages employees to focus on outcomes as they simplify their jobs and increase productivity. “Pay attention to areas where the quality and outcomes are less than what you would expect from a Stanford experience,” said McKenna. “Those are the areas ripe for improvement.”
A team in Facilities Management did just that. By re-sequencing work and coordinating hand-offs between multiple crews, the team achieved a 99 percent improvement in room maintenance turnaround times.
4. Be Resourceful
“As we think about cost reduction, I don’t want us to lose sight of the reality that we are better off growing,” said Entwistle. “There are tremendous opportunities on the revenue side.”
At the top of the list is documentation. Stanford has an opportunity to more accurately document the clinical complexity of the care it delivers, which will improve our ability to see more clearly where we need to focus quality improvement efforts as well as improve our overall financial performance, said McKenna. A second area for revenue growth is retaining patients within the Stanford system. “What patients do we already have touching us in one part of our system who we are sending out of our system for other services?” asked Sri Seshadri, Vice President of the Cancer Center. A team from the Cancer Center has redesigned its processes to make medical oncology and radiation oncology appointments more accessible to surgical patients. And the Cancer Center will be capturing lost pharmaceutical revenues by opening its own specialty pharmacy this summer.
“All of these efforts are needed to restore a sustainable balance between revenues and expenses,” said Entwistle, “and to strengthen our ability to meet patients’ needs.”