Physicians can benefit from a patient-focused hospital.
Fundamentally, patient-focused care hospitals restructure operations by creating "minihospitals" structured around the needs of patients and physicians. These minihospitals are developed for patients with similar clinical needs. Services are brought closer to the patient (figure 1, page 37), and a team approach is created. Personnel are crosstrained to increase staffing flexibility and improve continuity of care.
For example, ancillary services such as x-ray, laboratory, pharmacy, and rehabilitation are placed on the patient floor, significantly reducing travel time from the patient room to the service area. As a result, x-ray technicians, medical technologists, pharmacists, and therapists are integrated on care teams. Testing and treatment results are received in less time, enhancing the care process. One hospital streamlined its diagnostic radiology process by 32 steps, reducing the average procedure time from almost two and one-half hours to 28 minutes. Skill mixing and crosstraining also reduce the scheduling and coordination time, because caregivers are integrated on the care team and communication is direct.
To maximize utilization of ancillary services on the floors, patients with similar clinical needs are grouped into a focused care center. Because these patients require similar types of exams, ancillary services generally cover 90 percent of the procedures required by the patient mix. The personnel skill mix is developed on the basis of clinical needs of the patient mix. A pulmonary group requires greater respiratory therapy skills than a psychiatric group. On the other hand, phlebotomy and pharmacy are needed by virtually all focused-care centers.
Benefits to Physicians The PFC Model increases:
* Patient satisfaction and quality of care
* Physician productivity
* Physician satisfaction
Better Care for Patients
Studies have shown that nurses spend a considerable amount of their time in activities other than caring for patients. At Hinsdale (Ill.) Hospital, nurses spend 40 percent of their time on patient care; the rest is spent on communication, coordination, hotel services, documentation, transportation, and administrative issues (figure 2, left). By implementing the PFC model, the hospital intends to greatly minimize the time spent by nurses on these nonpatient care functions. Increased support personnel will join nurses on the floor of a PFC hospital, shifting nonpatient care functions to lower-paid staff. Hinsdale Hospital has a goal of 75 percent direct patient time for its caregivers (figure 3, left).
PFC also increases continuity of care. In a PFC hospital, the number of caregivers who interact with a patient in a three-day stay drops from up to 55 to fewer than 15.2 The principal caregiver (case manager), usually a registered nurse, monitors the patient from admission to discharge, developing a closer relationship with the patient.
Efficiency is improved through clustering ancillary services on the floor with the patient. This approach decreases transportation, coordination, and scheduling time. When a patient needs an x-ray, the case manager talks directly to the x-ray technician, who, in turn, makes all necessary arrangements for the procedure. Because scheduling and coordination are minimized, chances for errors are reduced and patient waiting time is virtually eliminated.
Turnaround time declines significantly for services that are decentralized and brought to the floor. For example, a phlebotomist does not need to travel back to the central laboratory to process a STAT exam. Laboratory STAT turnaround time can decrease as much as 75 percent, providing timely information to the physician.
By creating focused care centers, which span traditional nursing units and admit patients with similar clinical and service needs, there is a substantial reduction in the number of units that care for patients with similar DRGs. A study showed that up to 11 distinct units were discharging patients with the same DRG (figure 4, below). Similar patients located closely to each other reduces travel time for physicians, especially specialists.
Physicians indicate that units experimenting with PFC meet their needs about half again more frequently than do traditional units. If the traditional unit meets physicians' needs 60 percent of the time, the PFC would meet their needs about 90 percent of the time. One hospital indicates an almost fourfold increase in the number of physicians who are very satisfied with the patient care given on the PFC units compared to the traditional units (figure 5, fight).
Physician Participation and Input
Physicians can play key roles when hospitals plan to evaluate the PFC model. Despite the newness of the concept, some authors have addressed it, and several hospitals are in advanced stages of implementation. Researching what these hospitals have done will equip physicians with the knowledge base to discuss the concept intelligently with hospital administration and medical staff leaders. Attendance at relevant seminars provides physicians the opportunity to ask questions.
If a hospital decides to embark on this journey, physicians should give suggestions throughout the process. The physician's focus should include evaluating the benefits to customers -- physicians, patients, and hospital employees. Traditional "turf' barriers should be minimized. This unbiased, realistic look at the potential benefits and drawbacks of this model will maximize the benefits to customers. There is a tremendous opportunity to improve patient care through patient-focused care, and physicians can join hospital administrators to lead the charge.
1. Weber, D. "Six Models of Patient-Focused Care." Healthcare Forum Journal, 34(4):23-31, July-Aug. 1991.
2. Lathrop, J. "The Patient-Focused Hospital." Healthcare Forum Journal, 34(4):17-9,21 July-Aug. 1991.
"Million Dollar Cost Saving Ideas: Eighteen Tactics for Reducing Labor Costs." Health Care Advisory Board: The CEO sERIES, vOL. 1,18989
Perry, L. "Staff Cross-Training Caught in Cross Fire," Modern Healthcare 21(18):26-9, May 6, 1991
Eubanks, P. "Nursing Restructuring Renews Focus on Patient-Centered Care." Hospitals 64(8):60,62, April 20, 1990.
Teschke, D. "Nebraska Hospital Brings Services Closer to Patients." Healthcare Financial Management. 45(10):118, Oct. 1991.
James G. Lee, MHA, MPH, is Assistant Directory of Operational Improvement, Hinsdale [Ill.] Hospital and Project Coordinator of the Patient-Centered Care Study.
Robert W. Clarke, CPA, MBA, is a Partner in the Health Care Operational Consulting Division of Arthur Andersen, Chicago, Ill.
G.H. Glassfor, MD, FACS, is Director of Medical Affairs, Hinsdale Hospital.
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|Title Annotation:||Medical Quality Management|
|Date:||Jan 1, 1993|
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