Affordability

When the Anaheim Medical Center Admitting department unit-based team set out to increase its collection of inpatient hospital copayments, it had several hurdles to overcome.

Some staff members had to get comfortable with asking for money from patients. Others had to learn how to calculate copayments. They also needed to notify Admitting of a patient’s pending discharge so copayments could be collected at the point of service.

And since the team goal of collecting copayments didn’t always dovetail nicely with individualized goals, that put some staff members at odds.

“We had created this unhealthy competition,” admitting supervisor/manager and union co-lead David Jarvis says.

They also had the problem of convincing staff members in other departments that collecting copayments from hospitalized patients was not a bad thing.

"They used to think of me as Public Enemy No. 1," says Patti Hinds, a financial counselor and member of SEIU UHW.

To educate and motivate staff members about the importance of collecting copayments, the unit-based team held a kickoff meeting in January 2010.

Staff members who were good at collecting and calculating copayments were deemed “master users” and received training so they could help their peers learn to correctly calculate amounts due. They also got pointers on speaking with patients about the money they owed.

"We wrote scripts, we role-played and, as people did it more, they became more comfortable with asking for money and with knowing when it is appropriate to do so," admitting clerk, SEIU UHW Patricia Hartwig says.

The team also had to teach staff members in other departments about the benefits of copayment collection.

"We showed them the bottom-line connection between revenue collection and their paychecks," Hartwig says.

Better working relationships developed between admitting department staff and the nursing units, prompting nurses to contact admitting staff more consistently before patients are discharged.

"They came to realize we’re not the 'bad guys,' " says financial counselor Marcela Perez, an SEIU-UHW member.

Getting patients where they need to go is essential to the operation of a hospital.

But the process of moving them around for tests, X-rays and other services can be a major source of delay, congestion and patient dissatisfaction.

Members of the Inpatient Transport team at the San Jose Medical Center were assigned to specific departments and different floors. Some locations were busier than others, and some transporters were tasked with more work.

And the waits for patients were at best unpredictable. Nurses and technicians often resorted to pushing occupied beds themselves, rather than waiting for a transporter. Workplace injuries rose and attendance became problematic.

San Jose transporter Dharmesh Patel lobbied for a centralized dispatch system, where calls would come into one place and transporters would wait for assignments. The unit-based team agreed to the project, and it worked.

After the change, transporters completed 68 percent more patient trips per day. Timing also improved. Transporters reached the patient’s location within five minutes of the call 90 percent of the time, as the average response time went from about four minutes to 2.46 minutes.

Savings were found in both reduced overtime and sick days.

With fewer nurses and technicians chipping in to transport patients, the team shaved an estimated $200,000 in annual costs for less overtime. In two years, workplace injuries dropped from seven to one, and sick days decreased from a rate of more than 11 days per employee to save another $15,000.

“Overtime is down, sick time is down and the patients are happy,” Patel says.

The medical/surgical staff at Fontana Medical Center had a problem with pressure ulcers. The 59-bed unit averaged about 10 of these hospital-acquired bed sores a quarter.

It's painful for the patient and costly for the hospital, which can average about $43,000 per incident. But pressure ulcers are also preventable, and that can lead to shorter hospital stays and improved patient satisfaction scores. Reducing the rate of pressure ulcers can also eliminate inquiries from the California Department of Health Services.

Based on recommendations from the UBT, the staff implemented an education program and provided one-on-one training on how to spot, rate and reduce bed sores.

The team established a strict regimen that included rating patients on the Braden Scale, which helps identify those at risk for pressure ulcers. They performed morning assessments, and used waffle mattresses and moisture-protective barriers for at-risk patients.

They also rounded hourly for turning and got patients out of bed three or four times a day to decrease their risks. This allowed patients to use the restroom and to keep them clean.

“It’s pretty much a collaborative effort among nurses, nutritionists and wound specialists,” says charge nurse and UBT co-lead Toni Leonen. “The nurses are receptive to implementing the various methods we use to prevent pressure ulcers.”

In a span of two years, the new process helped the team reduce the number of bed sores to 0.

“We’ve created this environment where the staff thinks safety and thinks patient comfort,” Kathy Smith, RN, assistant department administrator says. “It’s automatic. They just come in and make sure patients are turned. Nobody has to remind them.”

Coming up with a new process to combat pressure ulcers helped the team build a sense of unity and staff satisfaction, but they also know the work continues.

“Sustaining our success is the biggest challenge because you can revert back to old practices,” Smith says. “You have to keep emphasizing what we’re doing and what the reasons are. Make sure they know you appreciate them so they continue to do well.”