As Costs Spike, is Construction Best Option for Your Hospital?

Take a Long Walk before Spending Millions on New Space

PITTSBURGH -- Before deciding to build in the face of skyrocketing construction costs, hospital executives should go for a very long walk.

A walk around their own hospitals.

That walk could save them a fortune if they do five simple things, according to process redesign expert Lisa Romano:

* Make rounds to see if there are empty beds that were not reported

* Make sure that cleaning occurs immediately after discharge

* Make sure that bed assignments are made to the identified bed

* Make sure that the patient moves into the bed

* Make sure every bed is staffed.

If one or more of the above are amiss, Romano says, then there are probably several options short of building that are open to your institution.

With the average cost of a single new bed now above $1 million and square foot costs for new hospital space as high as $550, why are hospital leaders spending millions when they could spend just thousands?

Because the hospital building boom has been driven not only by overcrowded emergency departments, but the belief that an aging population will increase demand for in-patient care. Yet, America may not be getting older as fast as once thought. Between 2005 and 2015, the average age of U.S. citizens is expected to increase only from 36.5 to 37.9 years.

Too often, hospital executives overlook the least expensive solution, which is to make better use of the space they have. This costly oversight, which might yield 10 to 20 percent more capacity, could be fixed with a relatively small investment in process redesign and patient tracking technology.

Romano should know. She's a former nurse who helped lead a team which redesigned the patient flow process at Lehigh Valley Hospital and Health Network. Now she's providing her insights to other hospitals as director of Avanti Patient Flow Services, a division of TeleTracking Technologies.

WHAT HOSPITALS COULD LEARN FROM RESTAURANTS

Another simple analysis which she recommends is "The Restaurant Test."

At Restaurant "A," the hostess hands you a pager to wait for a table. You see the restaurant is packed, but the minute someone leaves, the bellboy is waiting with his tray to turn the table over. A few minutes later you are seated, the waitress takes a drink order and brings bread. You are content.

At Restaurant "B," you get the pager, but you notice that several tables are empty, and some still have dirty dishes on them. The hostess says the clean tables aren't covered by a waitress and the dirty ones are awaiting a busboy.

If your hospital is like Restaurant "A," it might make sense to add "tables, space and staff" because there would be opportunity for more revenue and more happy little customers. If your hospital is like Restaurant "B," adding capacity would be ridiculous. In fact, it would make the situation worse, because you are only expanding a problem, while incurring building costs, staffing costs and the wraith of disgruntled customers who tell their friends not to go to your place.

"Restaurants wouldn't tolerate the wasted capacity that occurs in hospitals," she said. "Yet many hospitals are going ahead with multi-million dollar construction projects while beds stand empty in their facilities."

Most hospitals do not use their fixed resources as efficiently as they think or would like to believe. The question is why not, and how can they improve the process. Some think the problem lies with the nursing staff.

"Saying that nurses are hiding beds is trite" according to Romano, an RN and MSN. Nurses and all personnel come to work each day with the intentions to the right things--good things, for their patients. "It is up to the hospital's leadership to be sure they have the processes and tools the work effectively. Top executives must assess the situation and create a culture where patient flow is a clear priority and understood to be everybody's business," she says.

"But don't forget to involve staff at all levels if you decide to redesign the patient flow process," she says. "When they are part of the planning, they have a pride of ownership that will make acceptance throughout the institution more likely."