This is relatively speaking, the largest hospital turnaround performed in Sweden. The hospital, which had been bleeding financially for almost a decade, achieved to stay within its yearly budget for the first time in ten years, after the project was performed.
Background
The hospital, a general (ER) hospital, which covers a population of 60,000 with 8,600 inpatients per year, had a significant problem with cost control. One of the main reasons for this was a continuing increase in ER flow and outpatient treatment in university hospitals (outpatient treatment is billed to the local hospital).
The hospital turned to Mantec for help, and a pre-study of the surgical specialists, followed by the rest of the hospital, identified potential cost-saving through improvements in patient flow, resource utilization and better management information systems.
Implementation
Based on the results of the pre-study, Mantec made a proposal for a full project to the management of the hospital. Following a thorough internal quality control process, hospital management made a successful proposal to the political leadership. Negotiations on staff reductions and the practical implementation of the main project were undertaken over the next three months and included the following:
Patient flow was developed with the use of a method of joint clinical care ways with clearly divided work between local government and hospital. The axiom being that the hospital’s resources are only for those patients who really need specialised care. The care pathways were developed jointly between leading physicians and nurses in local government and the hospital. This was done both on the traditional diagnostic level, but also based on flow of for example elderly patients that had fallen.
Outpatient treatment and pre-triage system was developed jointly between hospital and the municipality leading to a clearer understanding of the clinical pathways in the hospital. Inpatient treatment was developed with a jointly created intermediate care unit at the hospital, run by nurses from the municipalities and physicians from the hospital.
ER flow was developed in the hospital based on fast track and lean health methodology, based on the newly designed patient flow system with the municipality. These changes had significant impact on a number of ER flows in the hospital: The ER room was equipped with an internal medicine polyclinic for patients primarily with heart diseases. They were channeled through the ER polyclinic rather than ER admission and treatment in the hospital or in the elective polyclinic. Earlier these ER patients had been sent to the ward for diagnostics and treatment. A significant number of these ER patients could be checked within a period of 24 hours, leading to a semi elective flow of medical patients. Thus, the hospital could utilize capacities they had in the ER room before noon. (ER flow peak was after noon).
Furthermore, the flow of ER patients was developed with active use of medical guidelines for the treatment of patients with short stays (fast track principles) and higher-level competence at an earlier stage of out-patient treatment and in the emergency room. To fast track patient flow we developed a clinical decision unit integrated into the emergency room, which increased efficiency of the patient flow.
The elective flow of patients was developed with reduced pre-hospital days through better steering processes in the surgical polyclinics, as well as a significant productivity increase in the operation theatre.
Fundamentally, the implementation of a new planning and steering methods for the operational leaders, based on activities, was paramount for the success in the change process. A comprehensive system for measuring patient safety was developed to monitor all changes in patient treatment and patient satisfaction, throughout the change process.
Results
The headline benefits to the hospital of following through on the change program proposed by Mantec have been:
- total cost reduction of approximately EUR 10 million, including a reduction in staff numbers by 29 % resulting in budgetary balance one year after the proposal was delivered
- 20% reduction in the average length of patient stay; and
- a reduction in the number of beds per 1,000 patients from 2.3 to 1.9 but due to the intermediate care unit an increase of beds totally within the overall communal care system;
- exceedingly good cooperation between local government and hospital;
- a shift in focus from employee to patient, with focus on process and patient flow;
- increased patient safety awareness with significantly above average results on infections, fall injuries (Global trigger Tool) etc;
- planning and steering systems is implemented throughout the organization.
