It's no secret that our nation's health care needs are on the rise. When the last of the boomers reach retirement age, it is estimated that almost 20 percent of our nation will be 65 or older, compared to just 13 percent today. Chronic conditions are also on the rise.

Undoubtedly, hospitals must accommodate this increasing demand for care. Until recently, expansion projects were the main method of coping. However, the credit crisis and recession has caused delays and cancellations of many construction plans.

Optimizing flow

Clearly, most hospitals can't add a new wing or even renovate an old one. Doing more with what already exists is the most viable option. But how can hospitals squeeze more capacity out of a seemingly maxed-out facility? The answer lies in optimizing patient flow‚ removing the delays, missteps and wasted time between patient care events. Brief delays from an extra 10 minutes a patient waits for transport to an extra half hour a bed remains dirty‚ can quickly accumulate and hinder a hospital's ability to treat more patients.

Optimizing patient flow is truly a hospitalwide project with room for improvement in nearly every department, but environmental services (ES) can have a particularly sizeable impact.

Flow strategies

As ES professionals optimize their bed turnover processes, they should keep nine strategies in mind.

1. Put best processes forward. Scrutinize current bed turnover processes from top to bottom. How do nurses submit a bed clean request? How does ES know if the bed was occupied by an isolation patient? Look for opportunities to create speed and consistency, facilitate communication and ensure an accurate flow of data.

A couple examples of process improvements conducted by Christiana Care Health System, Wilmington, Del., include the following:

• Nursing is the trigger for bed turnover. "In many hospitals, transport initiates bed turnover, but transport was only taking 60 percent of discharges," says Rick Olivere, director of environmental services at Christiana. "By making nursing the trigger, we created a best practice that enables us to capture all requests in a timely manner."

Christiana Care is an exception to most hospitals, where transport is the ideal trigger; however, their unique best practices show how valuable analysis and process mapping can be‚ and how important it is to have technology that fits your processes, rather than vice versa.

• Discharge requests are the top priority. "Formerly, when we received notice of a discharge our ES team wouldn't break its normal routine‚ we'd get to it when we had time," says Olivere. "Now, it's top priority. If you're beeped, you finish what you're doing and get to that room. This policy has definitely increased our capacity and reduced rework."

2. Create a lockstep relationship between technology and processes. Process improvements are crucial, but they must be accompanied by technology to achieve an environment of transparency, collaboration and awareness. Above all, processes should be supported by technology, not the other way around. "We put a lot of time and thought into developing our optimal bed turnover processes, so we wanted technology that would support our best practices," says Robert Mulrooney, Christiana's vice president of facilities and services. ES professionals shouldn't have to conform processes to technology‚ and it shouldn't pose even minor inconveniences for anyone.

3. Collaborate cross-functionally. Christiana Care's patient flow committee of clinicians and department representatives worked together to change processes and select technology. "We now have a real partnership between nursing and ES. Both parties work together to makes sure the turnover process goes smoothly," Mulrooney explains. "From the start, we realized we needed nursing buy-in; they had to see the benefit of making changes. And they have."

4. Set clear objectives and measure your way to success. It's a favorite adage among health care professionals: You can't manage what you don't measure. More importantly, you can't improve it. Set metrics for response time, cleaning time and other key performance indicators. Make sure everyone not just the ES team, but nurses and administrators, too, knows these objectives and whether they're being achieved. Make data such as time stamps, status updates and trend reports highly visible and easily accessible.

5. To centralize or decentralize? As zones are being arranged, conduct a workload study to determine whether a decentralized or centralized approach is better for the particular facility. If units can keep a housekeeper or ES team busy, a decentralized team might make sense. Most of the time, however, a centralized team divided into cleaning zones is more effective. For greater efficiency, additional teams can be assigned to work shifts when discharges are higher.

6. Get into the zone. Rearrange the team structure to ensure maximum efficiency throughout the turnover process. If someone isn't cleaning efficiently, he or she could be completely overloaded. Start by measuring workloads to determine the best way to load-balance and create a smooth, fair system.

7. Integrate clinical data. The obviously important data in the ES process is response time, room assignments and turnover time. But clinical indicators are important, too. As Olivere indicates, if a housekeeper doesn't realize it's an isolation room being cleaned, it may result in rework. Prevent wasted time and resources by ensuring the ES team members have the necessary information to do their jobs correctly the first time.

8. Establish rewards and consequences. Motivate the ES team to meet goals and comply with process changes. For example, hold a competition to see which zone can have the most discharges before 11 a.m. Award the winning team with a pizza party‚ make it fun and competitive. Also, as metrics related to turnover are tracked, it will facilitate an atmosphere of transparency. If people can't cover up bad behavior, they're less likely to engage in it. "Our ES team actually likes the transparency we now have with [bed turnover software]," says Olivere. "There's accountability with no finger-pointing or misplaced blame; it's all in the reports."

9. Keep it simple. Keep communication as easy and simple as possible. If the team doesn't use a keyboard as part of their daily activities, don't introduce it now. "Our new process is streamlined; there are no excessive steps involved in requesting, response or reporting," says Mulrooney.

Substantial rewards

Optimizing hospital patient flow isn't easy, but it has substantial rewards, including improved financial outcomes, greater efficiency and a more productive and proactive environment for clinicians, ES staff and patients.

As an added bonus, clinicians and ES personnel will enjoy a calmer and much more collaborative work environment that never feels like a "no vacancy" sign is necessary.

Sidebar - Christiana's flow improvement

One of the largest health care providers in the mid-Atlantic, Christiana Care, Wilmington, Del., has more than 1,100 licensed beds in two hospitals. It began a patient flow improvement project in 2006, redesigning processes and implementing Sunrise Patient Flow Solutions from Eclipsys Corp., Atlanta. Christiana Care addressed bed turnover first, implementing BedXpress at one hospital in November 2006, then at another hospital in February 2007. Next, the health system addressed bed management; they are currently implementing Sunrise Transport. Bed turnover goals included reducing turnaround time from patient discharge to bed turnover, improving patient throughput and monitoring and measuring success. Today, bed turnover averages 40 minutes, which,"with current resources, is about as fast as it could be," one vice president indicates. Moreover, Christiana Care has eliminated stat cleaning requests because environmental services (ES) responds so quickly that there's no need for stat orders. While they used to do 75 percent of bed turns on the evening shift, they now do the majority in the afternoon. Christiana Care's changes took time and work; efficient bed turnover is a collaborative effort that begins long before a bed clean request. Nurses and staff must be "in the know," have workable and consistent processes, and be able to easily communicate and access data. But it's a much more practical and cost-effective solution than adding beds.

For the post-lesson quiz for credit and information on obtaining continuing professional education credit click here .

Barbara Bryan is vice president of consulting services for Sunrise Patient Flow at Atlanta-based Eclipsys Corp. She can be reached via e-mail at barbara.bryan@eclipsys.com.

This article first appeared in the October 2009 issue of HFM.

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