Volume 7 (2022-23)

Each volume of Management in Healthcare consists of four quarterly 100-page issues. Articles scheduled for Volume 7 are available to view 'Forthcoming content' page.

The Articles published in Volume 7 include:

Volume 7 Number 2

Editorial
Simon Beckett
Papers
Advancing change agility in healthcare
Wei (Sophia) Chen, Senior Health Systems Engineer, Strategy Department, Christa Y. Leung, Senior Principal Health Systems Engineer, Strategy Department and Janine R. (Coelho) Kamath, Executive Director, Mayo Clinic International, Mayo Clinic

Agility has been adopted in the software development industry for decades and has been used in the business world for the past 10 years. In healthcare, however, agility has not been widely adopted or studied but is emerging as imperative for competitive advantage in a rapidly changing environment. Human-centred agility and change in the wake of the COVID-19 pandemic has become especially important. Change agility is composed of two aspects. While the first aspect is a mindset that embraces change, resiliency, flexibility and responsiveness to consumer needs, the second is an approach using collaborative efforts through self-organising teams. Healthcare organisations must adopt both aspects to leverage the collective value of change agility. To help staff embrace and develop a change agility mindset, healthcare organisations need to offer relevant educational courses and coaching; teach change agility principles and values by using case studies and real-life applications; and promote the right culture by building flexible systems, providing a safe learning environment and encouraging risk-taking. To grow and sustain change agility, healthcare organisations can benefit by using a continuous seven-step quest: examining the current state, defining the future state, assessing the gaps, developing strategies, executing the strategies, measuring progress and maintaining success. This paper addresses the strategy and iterative interventions developed by the Department of Management Engineering and Consulting (renamed the Strategy Department) at Mayo Clinic to prepare its professional staff to drive a business-focused, change agility mindset through benchmarking, education and experiential learning. The early experiences and lessons learned at Mayo Clinic in change agility are likely broadly transferable to other healthcare organisations.
Keywords: agility; change; diverse; healthcare; iterative; mindset
Strategic adoption trends for automation across the revenue cycle
Amy Raymond, Vice President of Revenue Cycle Operations, AKASA

This paper analyses how, while many healthcare organisations are automating portions of the revenue cycle today, there is significant variation in the breadth and depth of automation technology deployed. While robotic process automation (RPA) is helpful, it also has limitations that are easily addressed by more advanced technology, namely artificial intelligence (AI) and machine learning (ML). Identifying best practices for the strategic adoption of advanced revenue cycle automation can help organisations leverage lean processes that reduce the cost to collect, promote strategic customer service tactics and redeploy employees to higher-value tasks that improve the overall patient financial experience.
Keywords: revenue cycle management; RCM; revenue cycle automation; artificial intelligence; machine learning; robotic process automation; patient financial experience
Adaptive strategy for high-acuity home-based healthcare delivery
Phil Mitchell, Chief Medical Officer, DispatchHealth and Christi McCarren, Senior Vice President, MultiCare Health System

Patient care is rapidly shifting into the home. Based on a survey of physicians who serve predominantly Medicare fee-for-service (FFS) and Medicare Advantage (MA) patients, the global management consulting firm McKinsey and Company estimates that approximately 25 per cent (or US$265 billion) [Bestsennyy, O., Chmielewski, M., Koffel, A., Shah, A. and McKinsey and Company, (2022), ‘From facility to home: How healthcare could shift by 2025’, 1st February, available at: https://www.mckinsey.com/industries/healthcare-systems-and-services/our-... (accessed 5th August, 2022)] of the total cost of patient care could shift to the home. This shift is being propelled by payers, an ageing population, consumer preference and technological innovation. Payers have realised the cost savings opportunity of treating patients in the home. This is evidenced by large payer organisations investing in resources internally and externally in organisations that are elevating the acuity of care in the home. With approximately 10,000 Americans [United States Census Bureau, (2019), ‘By 2030, all Baby Boomers will be age 65 or older’, 10th December, available at: https://www.census.gov/library/stories/2019/12/by-2030-all-baby-boomers-... (accessed 5th August, 2022)] ageing into Medicare every day and seniors preferring to receive care in the home, the market will continue to grow for years to come. Improvements in both the capability and cost of technology are helping to enable higher acuity care to be performed in the home. The pandemic accelerated the movement by compelling CMS to institute the hospital at home waiver, spurring significant investment in high-acuity home care platforms, increasing payer openness to reimburse for high-acuity home care services, and increasing provider and patient comfort with these care options and associated technology, as patients avoided traditional healthcare facilities early in the pandemic. This paper discusses how healthcare systems such as MultiCare are looking to innovate and improve health outcomes for patients in the location where they want it most.
Keywords: value-based care; healthcare at home; patient satisfaction; hospital level care at home
Look to the past to improve our future: Improving quality, safety and equity through community and patient engagement
Knitasha V. Washington, President and CEO, ATW Health Solutions, et al.

Healthcare administrators must ensure delivery of care that is high quality, safe and produces equitable outcomes while balancing business, workforce and community needs. To meet these challenges while guiding their organisations through COVID-19 recovery, administrators can look to a strategy with a strong track record for success: engaging patients, families and communities. This paper focuses on evidence, experience and best practices for improving quality, safety and equity by engaging people, patients, families and communities. Effective patient and family engagement (PFE) and community engagement strategies draw on research and experience across a wide variety of efforts, from nationwide federal programmes such as the Centers for Medicare and Medicaid Services Partnership for Patients initiative to health system- and neighbourhood-level programmes. Research demonstrates that commitment to PFE leads to measurable improvements in quality and safety. Experience shows that engagement, when practiced with attention to diversity, equity and inclusion, can reduce health disparities. Engagement best practices include: making engagement a strategic priority, embedding patients and families with diverse perspectives into improvement efforts, supporting continuous learning by adapting engagement efforts over time, benchmarking progress and measuring disparities. To continue the advances begun before the pandemic, healthcare administrators and leaders must redouble engagement efforts and implement best practices. Administrators can meet the many challenges of the moment by returning to the proven strategy of engaging patients, families and communities to drive integrated quality, safety and equity efforts.
Keywords: quality; safety; equity; patient and family engagement; community engagement; improvement; high-reliability organisation; HRO
A framework for successfully navigating a series of unfortunate events
Myra W. Norton, President and CEO, Arena and William G. ‘Bill’ Robertson, Chief Executive Officer, MultiCare Health System

The effects of the ongoing COVID-19 pandemic, coupled with a staffing crisis and looming macroeconomic shifts, have created a climate of fear, uncertainty and doubt among healthcare professionals, the likes of which we have not seen in generations. In order to navigate these troubled waters while still providing the highest levels of patient care, healthcare organisations must take a diligent, thoughtful and multifaceted approach that balances short-term needs with long-term strategic goals. The strategic steps taken by MultiCare Health System and Arena Analytics amid the COVID strain and labour shortages provide an instructive example of how companies can respond proactively to economic uncertainty by affirming their core mission, vision and values, focusing relentlessly on win–win outcomes and exercising a ‘now, near and far thinking’ approach.
Keywords: COVID-19; pandemic; staffing crisis; macroeconomic shifts; climate of fear; patient care; MultiCare Health System; Arena Analytics; labour shortages economic uncertainty; core mission
Organising social care initiatives within an urban academic medical centre
Walter Rosenberg, Director of Social Work and Community Health, Rush University Medical Center and Associate Professor, Rush University College of Health Sciences, et al.

Meaningfully addressing social risk factors that impact health outcomes is a complex and expensive endeavour. As healthcare systems across the USA pivot their operations to include upstream and downstream social care elements, they struggle with the operationalising screenings, intervention, staffing and sustainability. This paper shares the nearly decade-long experience of Rush Medical Center in Chicago in creating an infrastructure that identifies social needs, escalates patient cases to an interdisciplinary team intervening at different levels of intensity and simultaneously engages local community and medical entities to develop an enduring partnership to support these efforts.
Keywords: social care; care coordination; integrated care; cross-sector collaboration; health equity
Patient-centred medication management: How to enhance patient safety and reduce the work burden for medical staff by digitalised closed-loop cabinets
Maximilian C. von Eiff, Assistant Physician Urology, St. Josef Hospital, Clinic for Urology and Uro-Gynaecology, Wilfried von Eiff, Professor of Health Care Management and Regulation, HHL Leipzig Graduate School of Management and Director of the Center for Hospital Management and Mohamed Ghanem, Senior Consultant of Orthopaedic Surgery, Department for Orthopaedics, Traumatology and Plastic Surgery, University Hospital Leipzig

Medication management is both an economic challenge and a patient safety issue. In German hospitals between 19 per cent and 35 per cent of all failures causing harm to patients are attributable to medication errors. As a consequence, an estimated 15,000 patients die each year. In addition, about 14 per cent of the average length of stay is assignable to unplanned drug interactions. Independent of patient risks, health impairments and outcome deficits, every non-fatal medication error leads to additional costs totalling €3,000 on average. Nurses, in particular, who typically suffer from work overload, are affected by error-prone medication logistics. Between 26 per cent and 44 per cent of all failures occurring in the medication administration process result from activities in which nurses are substantially involved. International best-in-class hospitals like the Mayo Clinic (Phoenix), Scripps (San Diego), OLVG (Amsterdam) and Guy’s and St. Thomas’ (London) have been using automated dispensing systems (smart cabinets) for medication safety reasons for many years. Moreover, in the USA, automated medication dispensing cabinets are ubiquitous in various types of hospitals and have an implementation rate of 89 per cent. But in German hospitals, this technology is still nowhere to be seen. In 2020, the German government, via legal act, decided that all hospitals must implement a closed-loop medication administration system in combination with a unit dose drug delivery by January 2025 in order to minimise medication errors. Otherwise, a penalty of 2 per cent of the total hospital revenue would have to be paid. Derived from best-practice reports in the literature, this paper explores the benefits of smart cabinets in terms of economic efficiency, patient safety, reduced work burden and employee acceptance. Furthermore, the reasons why many German hospital decision makers refuse to implement smart cabinets are presented and analysed. Finally, based on all this information, a generic medication administration process has been developed to provide a blueprint for a successful implementation of smart cabinets as an electronically based backbone in a closed-loop medication administration system.
Keywords: adverse drug events; automated dispensing cabinets; closed-loop medication administration; medication errors; medication logistics; patient safety; smart cabinets
An evidence-based approach to virtual workforce programmes
Ekta Vyas, Chief Human Resources Officer, Keck Medicine of USC, Adam Higman, Partner, Dragana Gough, Director and Dean Vanderhoof, Senior Associate, Press Ganey Associates

Healthcare organisations across the country have or are currently exploring the potential for continued telework/flexible work environments for both staff and leaders. In this paper the authors share their experiences beginning with harnessing the employee voice to engage leaders and staff and better understand important infrastructural factors for successful telework. A focus of this listening strategy was in developing an inventory of best practices, technology needs and policies and processes to support digital telework for both leaders, medical, clinical and support staff. Space planning utilised these learnings to organise optimal work environments, understand efficiency and cost savings on leased space. The pandemic subsequently encouraged a wider adoption of remote practices by more groups, many of whom have since learned that remote work can be not only effective but also a talent recruitment and retention strategy for employees.
Keywords: employee engagement; employee satisfaction; hybrid work; remote work

Volume 7 Number 1

Editorial
Simon Beckett
Papers
Applying data, analytics and technology to improve patient outcomes in value-based care
Ashok Roy, Chief Medical Officer, Value-Based Care Solutions, Signify Health

The U.S. healthcare system is undergone a paradigm shift. Spiralling healthcare spending is not translating into improved patient outcomes and longer life expectancy. Patients demand, and deserve, value for their healthcare dollars. Value-based care provides the opportunity to improve patient outcomes and quality while decreasing total medical spend. Succeeding in value based care requires leveraging data, analytics and technology to best utilise limited resources and target the right patients with the right interventions at the right time.
Keywords: Patient health care data and analytics, Patient outcomes, Value-based care data and analytics, Healthcare quality and outcomes, Practice transformation analytics, Accountable Care Organization, ACO healthcare data, ACO patient data analysis, Population health management, Data and analytics for patient
Mitigating potential morale and revenue disruption during new provider onboarding
Leslie Jebson, Executive Director — Clinical Strategy & Initiatives, Texas A&M Health and Jeanne Goche, CEO/President, Solutions in Health Care Management

While the COVID-19 pandemic caused a pause in some provider recruitment, the fundamental growth in physician demand will continue to outpace supply for the near future. Thus, it is more important than ever for a healthcare organisation to excel in provider recruitment, onboarding and retention. Establishing a positive relationship with a provider during the onboarding phase is an investment in provider morale and retention as well as in reduced revenue disruption caused by provider turnover. After presenting an overview of provider recruitment and retention trends, this paper provides a comprehensive picture of effective new provider onboarding. It then provides several options for streamlining processes and adopting technology to support onboarding. These ideas can contribute to an excellent learning experience, making the new provider more effective and productive earlier in practice establishment. Successful onboarding is not only beneficial to the overall organisation but also creates a positive relationship with the new provider that is foundational to long-term provider satisfaction and retention.
Keywords: provider onboarding, provider retention, provider recruitment, provider relationship-building, provider new practice
Two years into the COVID-19 pandemic: The five lessons learned
Lily Jung Henson, Chief Executive Officer, Piedmont Henry Hospital, et al.

Over a year ago, we published a paper on the lessons that we as a healthcare system in Georgia learned from the first wave of the COVID-19 pandemic. These lessons included the following: (1) Take a deep breath; this is a marathon, not a sprint. (2) There is no ‘right’ way to do things. (3) Be kind to yourself and to others. (4) Teamwork. (5) Be flexible. At the time the paper was published, there was hope that with the rapid development and approval of vaccines, we would soon be looking at the end of the pandemic with a return to life as we knew it before its onset. Sadly, the slow adoption of vaccines has led to the emergence of variants like Delta and Omicron, and almost two years into the pandemic, the light at the end of the tunnel seems much dimmer than it had been a year ago. At the time of this writing, we are beginning our fifth surge. This paper describes the journey that we have been on for the past year and a half and shows that the five lessons previously learned remained relevant as we continue in the second year of the COVID-19 pandemic. Our focus as we managed the impact of the pandemic remained consistent with the values of Piedmont Healthcare: (1) Focus on patient-centred care; (2) Exemplify teamwork and connections; (3) Be an owner; (4) Embrace the future. We maintained our pursuit of the Piedmont Promise as we made a positive difference to the lives we touched.
Keywords: COVID-19, pandemic, values, lessons, teamwork, healthcare, incident command
Analysis of refilling late appointment cancellations in an outpatient practice at a community-based health system
Pawan Bhandari, Principal Health Systems Engineer, Mayo Clinic Health System, et al.

Mayo Clinic Health System — Southwest Minnesota Region, one of four practice regions in the Midwest, provides primary and speciality care in ambulatory, procedural and hospital settings. Clinic appointment fill rates, no-show rates and late cancellation rates are closely monitored operational metrics, but at the time this study began, less was known about the refill rates of late appointment cancellations. This metric is of importance because these unfilled appointment times contribute to increased expenses for healthcare organisations, unnecessary delays in care and decreases in revenue. The main objectives of this study were to understand the current state and potential opportunities for refilling late cancellations. Qualitative and quantitative methods were used, including variance analysis, the Tukey post hoc test, Pareto analysis, the completion of interviews with important stakeholders and data extraction from the institution’s electronic health record. Findings showed that late cancellation rates remained steady in 2021 and that late cancellations were not being refilled consistently across departments and regions. Appointment refill rates were higher in departments with few or no requirements for preparatory evaluation, whereas in specialties that did require preparatory evaluations, refill rates were lower across the four regions of the Mayo Clinic Health System. Even in departments with high demand, the refill rates were lower, resulting in missed opportunities for patient visits. Mapping the workflow for late cancellations indicated inconsistent methods for refilling late cancellation openings and the lack of a defined process for refilling them that was understood by the entire care team. The logistics of optimising refill rates for late cancellations were affected by provider preference, self-scheduling functionality and appointment requirements. This study identified opportunities for optimising workflows to use the waiting list proactively to refill late cancellations.
Keywords: appointment refill, health system, late cancellation, speciality practice
Retaining patients and maintaining volumes in a consumer-driven world
Adrin Mammen, AVP & Patient Access Transformation Officer, Montefiore Health System

Patient retention is essential for healthcare organisations’ survival. Now that patients have become healthcare consumers, they expect their interactions — from finding a physician to scheduling and attending their appointment — to be fast and convenient. To meet these expectations, healthcare professionals need to provide digital strategies for patient engagement. The patient access team at Montefiore Health System launched a digital transformation initiative to improve patient access to care, attract new patients and maintain patient loyalty. This paper discusses the evolution of the patient engagement landscape and describes how Montefiore implemented digital strategies for continuous patient engagement that improve patients’ health and the organisation’s bottom line.
Keywords: Patient retention, healthcare organisations, healthcare consumers, digital strategies for patient engagement, patient access team, Montefiore Health System, patient loyalty
Maximising a remote Revenue Cycle Management (RCM) workforce through technology and transparency
Michele Zimmerman, Senior Solutions Consultant, Finvi

The onset of COVID-19 in 2020 forced revenue cycle management organisations to ride the work-from-home trend. As the pandemic’s ‘stay-at-home’ mandates continued, these organisations began to experience the benefits of a remote workforce — improved work-life balance, employee satisfaction and productivity among others. When the restrictions of the pandemic lessened, the desire to maintain a flexible work environment remained strong. Organisations must now find ways to optimise their remote workforce without the comfort of walking the floors for real-time observation and feedback. They must now replace previous best practices of an in-person work environment with technology that provides real-time visibility into day-to-day activities, performance improvement opportunities, centralised workflow, advanced account segmentation strategies and modern payment options. By implementing technologies to amplify their workforce from within flexible workplace environments, organisations will reap the benefits of improved productivity performance. They will also create a work environment that boosts morale and reduces staff turnover by setting up their staff for success and investing in tools that remove barriers to achieving their goals and enhancing their experience.
Keywords: revenue cycle management (RCM), remote workforce, technology, productivity, employee satisfaction, quality assurance
Creating more value from hospital labs: Partnership models for the modern area
Michael Lukas, Vice President and General Manager, Professional Lab Services and Donna Cooper, Director, Product Solutions, Quest Diagnostics

American health systems — and the clinical laboratories they run — have for years experienced financial, labour, data and other pressures as a result of internal and external factors such as decreases in reimbursements, consolidation and policy changes. While these challenges existed before the COVID-19 pandemic, the pandemic has introduced added volatility in lab staffing, supply chains and profitability while building new inroads into remote lab administration. Amid these trends, many hospitals are shifting their lab management strategy towards partnership models and stewardship programmes that optimise resources, cut waste and promote business and patient outcomes. Buoyed by annual savings of up to 15 per cent and improvements in guideline-aligned lab formularies, such models scale from independently managed operations to shared ownership structures, with many options in between. This paper explores these emerging structures and looks at how health systems can identify the right model — if any — for them to create more value from lab operations while overcoming the many strains of the modern healthcare environment.
Keywords: lab management, staffing, lab stewardship, efficiency, supply chain, shared ownership, third-party lab
Outcomes of transitioning from in-person to virtual appointments in a child psychiatry practice
Bipinchandra Hirisave Krishna, Regional Vice Chair, Clinical Practice and Regional Chair, Mayo Clinic Health System, et al.

The COVID-19 pandemic caused a transformation in healthcare delivery at a pace never before experienced, including by the child psychiatry practice at Mayo Clinic Health System in Mankato, Minnesota. The aim of this study was to describe the outcomes of that practice’s transition from in-person to virtual care. This retrospective study comprised two groups of patients who received care in the child psychiatry practice at our institution: before COVID-19, 1 March 2019 to 28 February 2020; and after COVID-19, 1 March 2020 to 28 February 2021. We extracted data related to patient visits from the electronic health record and satisfaction data from a Medical Practice Survey given to patients after visits. Virtual visits increased by 306 per cent within a month of transitioning to virtual care and remain the main visit type for established patients. Findings from patient surveys showed substantial overall improvements in patient experiences with virtual visits,and no-show appointments decreased substantially (from up to 23 per cent to 1 per cent). This study provided data for an overview of how the COVID-19 pandemic affected a child psychiatry practice and of the positive outcomes of transitioning from 100 per cent in-person visits before the pandemic to more than 80 per cent virtual visits. The quick transition to virtual care delivery in the child psychiatry practice was a positive change for patients, families and the care team. We believe that other healthcare systems can learn from our experience.
Keywords: behavioural health, paediatrics, telemedicine, telepsychiatry