Advocate Lutheran Breaks Down Silos with Commonsense Solutions

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As healthcare reform continues to impact the provision of care across the United States, it has become increasingly evident that hospitals and other healthcare organizations can no longer afford to operate in silos.

However, silos are often constructed among departments within the same healthcare organization.

Recent initiatives at Advocate Lutheran General Hospital in Park Ridge, Ill., have successfully broken down these interdepartmental silos and in so doing, have led to reforms that have improved the hospital’s finances and safety procedures.

Engaging front-line staff for change

Advocate Lutheran is a 645-bed non-profit teaching hospital serving the north and northwestern suburbs of Chicago. The hospital has more than 4,500 employees who are referred to as associates. By proactively engaging these associates, Advocate Lutheran’s leadership team has forged a pathway to cost reductions and better care.

“We need to always focus on safety, quality, and service first,” said Chief Operating Officer Barbara Weber. “We needed to involve our front-line associates with the leadership team to be proactive in our cost-management efforts. We never want to be in a position where we have to make drastic decisions because we are not meeting our operating budget.”

Advocate Lutheran has implemented several projects that seek out waste and strive to remove unnecessary delays in each service line. A few years ago, for example, the emergency department developed a process to expedite patient admissions.

“In the emergency department, you have waste when people are waiting or when there are preventable delays in service,” Weber said. “We have reduced the time for getting a patient in a bed once requested from 90 minutes to 20 and lowered our walkout rates.”

To reduce those times, management and front-line associates explored ways to enhance throughput efficiency while sustaining excellent care. The leadership team, Weber said, made a point of engaging with every stakeholder as these changes were being implemented.

“You cannot make assumptions when you’re trying to redesign a process,” she said. “We need to be transparent in how we make decisions and examine who’s impacted and the downstream effects before making a change. This involves executives working with department leaders and those leaders working with their associates.”

Bringing all departments together

Recently, the hospital began holding a daily 8:30 am safety-huddle call. The call is led by the executive team and includes an update from every manager across 60 departments. It lasts only 20 minutes.

Managers are provided with an agenda in advance so they know what to report. Most reports are based on safety issues–prevention, close calls, safety events that happened and lessons learned, and any other safety or operational issues.

Weber said the call has raised awareness throughout the hospital, increased the timeliness of response for issues, and improved collaboration.

For example, on the morning call, if a bed alarm isn’t working, the manager can address it and maintenance is able to respond that day. If the pharmacy has a medication on backorder, the department can tell every manager the process for limiting distribution.

“We are able to address important concerns during and immediately after this call rather than waiting for someone to read an email,” Weber said. “It allows the chance for everyone to be proactive. Managers can learn from safety events or near misses and implement those lessons on their units.”

The overarching goal of this increased emphasis on collaboration and communication is reducing all serious safety events to zero in 2015.

In the beginning, the call required some culture change, Weber said. People were used to holding other meetings first thing in the morning, but now, no meetings can be scheduled between 8:30 and 9 am for those involved in the huddle.

The call has influenced departments to hold their own huddles with associates to receive insight and hear their concerns.

“All of our meetings now begin with a win and a safety story. The safety story details what happened and how it was addressed,” Weber said. “We are able to bring closure to issues in our executive meetings, to put measures in place when we begin to note trends.”

Weber said based on the safety-huddle calls, the hospital maintains a Top 10 Safety Concerns list. The list includes items such as falls or mislabeled specimens. The executive team assigns people to resolve the problem and implement a solution. Once addressed, that problem is taken off the list and the next concern is added.

“Our focus is to provide the safest environment for patients, associates, and physicians,” Weber said.

Promoting quality and safety for financial stability

Advocate Lutheran is a member of the larger Advocate Health system and continues to implement principles of the Advocate Experience. The experience comprises patient, associate, and physician satisfaction.

Upcoming initiatives center on efforts to improve population health and transition from fee-for-service to value-based payment models.

“It’s a journey,” she said. “We are always looking at ways to be more efficient. It takes the entire hospital to be involved, with high levels of engagement among leaders, physicians, and associates.”

by Patricia Chaney

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