June 1, 2023

How Optimizing Care Coordination Improves Access to Care

In a recent Leader Dialogue Radio podcast, sponsored by ABOUT Healthcare in partnership with the Baldrige Foundation, co-hosts Dr. Charles (Chuck) Peck and Ben Sawyer, ABOUT’s vice president transformation engineering, sat down with Dr. Derek Feuquay and Jake Lansburg of Northern Arizona Healthcare (NAH) to discuss how care orchestration works for the health system providing care for nearly 800,000 lives across the state.


The episode, titled Optimizing Care Orchestration: Overcoming Challenges On Access, Throughput, and Capacity, explores how NAH implemented process design and organizational transformation to enable greater patient movement while providing patients with access to better care. Dr. Feuquay (NAH’s CMO) and Lansburg, NAH’s system vice president for care transformation and quality, discuss how NAH created cultural change to accelerate the transfer process and how it turns data into actionable information and insights.


NAH is the largest healthcare organization in Arizona, with a team of more than 3,000 doctors, nurses, and other experts providing care to people in an area covering more than 50,000 square miles. The sheer size of the area NAH serves with just two hospitals and a standalone emergency department (ED), along with the economic and transportation challenges faced by many residents of Northern Arizona, creates formidable barriers to care orchestration and patient throughput.


Recognizing barriers to access


“When we take people from so many places, one of the difficulties we face is returning them to those places after they stay with us, especially since some of the areas we care for are impoverished,” says Dr. Feuquay. “Getting people to pick up their family members, or finding rides, or even arranging air transport for people can be really difficult and can cause throughput issues all the way back to our ED.”


With only 270 beds at its Level 1 trauma center in Flagstaff and a 90-bed hospital in Cottonwood, poor patient throughput adds even more strain to bed capacity. NAH knew it had to make changes to improve access to care and to provide a better and safer experience for patients.


The health system launched a board-supported initiative this year to make patient throughput a focus across the entire organization, all within the context of the health system’s commitment to clinical excellence and patient-centered care. NAH analyzed its throughput composite score, which includes patient length of stay and the length of the discharge process. It was clear there was a lag in patient discharges, with only 35% of patients leaving a NAH hospital by the 1 p.m. targeted discharge time.


“We were starting every day at a disadvantage,” Lansburg says. “That small backlog compounds throughout the day, which leads to longer wait times for patients, excessive boarding in the ED, and threatens our ability to take patients from the community who need our care.”


Breaking down silos


NAH realized that the “secret sauce” to improving patient throughput and discharge management was aligning the entire care team around a plan, identifying barriers to effective treatment early on, and removal of those barriers “so we can get that patient home,” Lansburg says. The organization realized discharge planning must begin on Day Zero, or when the patient is admitted to an NAH facility.


Leadership development and teamwork are essential to breaking down silos and getting people across NAH to align, according to Dr. Feuquay. “One of the things you have to do when you’re taking on issues such as throughput and length of stay is to get the care coordinators, the nursing staff, the administration, and specialists all on the same page,” he says. “That’s a tough thing to do.”


One way for NAH to accomplish this was to provide not just data to team members for care orchestration, but actionable insights to provide better care for patients. The health system has dashboards containing hundreds of process and outcomes measures, so it was important to ensure NAH staff understood which were the most critical measures of success, such as geometric mean length of stay. Recognizing the most significant leading measures made it easier for NAH to establish and communicate goals and to determine which processes can be improved to meet those goals.


The podcast concluded with a discussion around changing culture at NAH to encourage “ownership” of throughput and discharge performance, the role of digital tools in orchestrating care access, and importance of alignment for optimizing care orchestration.


Hear more on this enlightening discussion by listening to the entire podcast here.