Achieving the Highest and Best Use of Space

By Krisianna Bock, MPH, FACHE, EDAC and Shawna Langworthy DNP, MBA, RN, NEA-BC, EDAC

Today’s capacity constraints and cost escalation require that everything is optimized to greater degrees than in the past. As hospitals, clinics, and healthcare systems explore ways to optimize their existing assets, these are some recommended strategies.

Balance Data and Alternative Agendas

Alternative agendas (aka “politics”) and emotions can overshadow objective decision-making. The aim is to enable resource stewardship and decisions based on data and community and organizational needs. Leveraging objective, historical visit volume data is pivotal to cutting through the noise to see the current state reality. Forecasting data and capacity with a variety of scenarios based on population growth, use rates, and strategic initiatives can illuminate capacity constraints and opportunities. These findings can enable future efforts that may involve level-setting, volume transfers, partnerships, staffing refinements, etc. to meet visit volume demands.

"Dig In" on Operating Room (OR) and Procedure Room Block Schedules and Turnaround Times

Conducting a deep dive on OR and Procedure Room block schedules can highlight opportunities for efficiency and mitigate capacity constraints. Researching key metrics such as room utilization, block time utilization, and cancellations as well as other key performance indicators (KPIs) can provide clarity for improvement initiatives.

Leverage a Culture of Planning Discharge Upon Admission

There is value to imbuing a culture of preparing a patient for discharge upon admission. Discharge moments between the healthcare providers and patients and caregivers are a critical moment for a warm handoff of knowledge, medication, equipment, and logistics. Careful, advanced planning for these moments enable an efficient discharge, positive patient care experience, and reduced re-admissions. Enhancing predictability in care coordination and patient discharge times facilitates reliable patient transportation to the home or the next care setting.

Examine Hospital Throughput Processes

Organizational culture can impact a variety of hospital throughput processes. Establishing expectations and policies for subprocesses can enable greater efficiencies. Subprocesses to examine can include (but not be limited to) 1) decision criteria to admit a patient versus discharge, 2) decision criteria regarding the appropriate inpatient nursing unit and requirements for specialty care, 3) new patient admission times to inpatient units to ensure a safe nursing handoff of patients during shift change, 4) inpatient room cleaning turnaround times to create an open bed or room for a new admission, and 5) imaging and lab orders and result turnaround times, patient prioritization, and hours of operation to enable patient discharge.

Conduct Detailed, Visual Inventories of Offices and Workstations

Within a given floor, building, and campus, there can be a tendency for people to find unoccupied workstations and offices. Overtime, these “squatters” can occupy (unknowingly) a significant amount of space and sometimes even duplicate spaces. There is value in conducting an annual visual walk-through of all offices and workstations. Using a data-driven, occupancy tracking tool can be very effective in measuring, monitoring, and managing space. This information can provide regular reports to leadership and stakeholders for enhanced space and resource stewardship. Lastly, ensuring there is a clear definition and process to assign workstations and offices that align with organizational roles and responsibilities furthers efficiency within the building spaces.

Implement Round-the-Clock Rounding

Rounding at various times and days provides outstanding opportunities to build teamwork and trust. Rounding reveals complexities that may not always surface in committee meetings. Similarly, these real-time engagements provide ways to address issues and celebrate successes in the moment. Maintaining a tracking log of successes and issues encountered during the rounding efforts helps illuminate best practices and trouble-points that need a deeper dive.

We collaborate closely with our clients to help them achieve their organizational visions through operational and asset optimization.

For more information about Advisory Services, please contact Neil Alexander ([email protected]) and Michelle Jutt ([email protected]).

HKS' Advisory Services team includes strategists, nurses, architects, planners, financial analysts and industrial engineers. Each are subject matter experts who follow a data-driven approach with a business focus to facilitate the decision-making process. Learn more about our firm's Advisory Services.