Saint Luke’s Health System Creates Unified System of Care

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Kathy-Howell-thumbKatherine A. Howell, RN, Senior Vice President, Chief Nurse Executive

by Patricia Chaney

Silos of care based on specialty have long been a trademark of the healthcare world. As more hospitals are merging to form larger systems, however, new models of care are needed to break down these silos and develop methods of care delivery that provide a seamless experience to patients across multiple hospitals.

In Kansas City, Mo., Saint Luke’s Health System has an excellent reputation with more than a century of experience providing care to the region. With the latest changes in the healthcare industry, the organization re-evaluated its care-delivery structure in 2012.

As a result, Saint Luke’s has spent about two years developing a model of coordinated care, primarily within nursing, across its 10 hospitals.

Breaking down the silos of nursing care

“We were looking toward a new system design to ensure we delivered the highest value to our patients,” said Katherine A. Howell, RN, senior vice president, chief nurse executive. “We brought out key goals related to developing systems of coordinated care, rather than silos, to create an integrated clinical enterprise. We were good at leading vertically, but we needed to lead horizontally. That is what makes you patient-focused.”

This design change required a massive shift in the way the organization was structured, one that would steer Saint Luke’s away from a hospital-centric approach and toward a “level-of-care” approach. This involved creating consistent standards of care, competencies, education, staffing standards, and data management across all entities.

“We wanted to make sure that a patient who walks into any Saint Luke’s hospital will get the same high standard of care,” Howell said.

In her role as chief nurse executive, Howell oversees all of the nursing and many of the allied-health disciplines, and she led the majority of the structural changes to those departments. The first step was refocusing clinical-education specialists and nurse educators on pursuing a level-of-care accountability.

Now, two clinical-education specialists are dedicated to critical care to ensure nurses in every critical-care unit have the same competencies. This approach is taken across all services.

In addition to education, another change in management was to give the chief nursing officers of each hospital accountability for one specialty across the system. This was in addition to their hospital duties. For example, one CNO has accountability for critical care in all facilities, one for surgery, and one for neonatal care, allowing them to look at these service lines as providing one single standard of care that breaks down those aforementioned silos.

Howell said having the same competencies and training across all facilities allows the system to share resources. This strategy works well for Saint Luke’s, since it is not spread over a vast geographic area, even though it has numerous physician practices and other sites in addition to the hospitals.

Nurses also receive financial incentives in order to be considered a shared resource. They are assigned to a tier, so a tier-3 neonatal nurse can serve in any NICU in the system and will receive higher pay.

“Sharing resources through our Central Staffing Office allows us to be more flexible and avoid overstaffing for the ‘what-if,’” Howell said. “We have about 250 employees in the central work pool. This has brought down our agency costs and unit-staffing costs.”

To further improve collaboration, the system is implementing the Epic suite of products so it will have the same documentation platform across all facilities. Phase 1 of this implementation was completed on March 28 with seven hospitals going live. The next phases are now being planned for implementation and include the regional hospitals, ambulatory clinics, and revenue cycle. The final goal is to have an integrated, longitudinal EMR.

Expanding the redesign across the system

Restructuring an entire organization in this manner isn’t easy, and it’s not always immediately accepted by staff. It’s important, Howell said, that the project be driven by the CEO with a clear vision and open lines of communication.

Even though Saint Luke’s brought in consultants to help guide cost savings and provide structure, Howell said the leadership was key to helping everyone work through the disruption.

“We have to have leaders who can lead through tumultuous change,” she said. “You have to think through logically where you want to go. You can’t cause this kind of disruption without a clear end game.”

One of her frequent roles is to connect the dots for employees, reminding those whose role was drastically retooled why and what the big picture is for the organization.

“I make big requests to support departments or talk to individuals who have had their roles changed, and I have to remind them that we are doing this to allow our frontline staff to deliver care in a cost-effective manner so that we can continue to thrive as a health system,” she said.

In the first full year of implementing this clinical integration, Saint Luke’s has realized $25 million in cost savings.

Going forward, the system will continue to expand the integration, bringing on clinicians as well. Clinicians are rewarded for their work in helping to provide a more clinically integrated enterprise. Howell said the more they show improvements in clinical care at the bedside or help spearhead an effort that has a system-wide impact, the higher their pay will be.

“There is a lot of work to be done, and we will be working on our inpatient care model,” she said. “The inpatient care model has not changed a lot, and we need to look at how we can redesign it to be more effective and give patients a great experience.”

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