by Dan O'Donnell

The Challenge 

When a 56-year-old man fell down at home after getting up and feeling dizzy in the middle of the night, he called 911 and was transported to the ER of a small nearby hospital. The next day, he learned that he’d need to be transferred to larger hospital for more complex care, including possible surgery on his fractured hip and follow-up on a suspected cardiac issue. Four days later, despite many conversations among patient transfer nurses, an orthopedic surgeon and a cardiologist, there was still no bed confirmed for him at the medical center. Behind the scenes, the medical center was wrestling with when a bed would be available, and whether the patient should be sent to Orthopedics or Cardiology for treatment.

These situations happen far too often, with patients and their doctors waiting days to hear when a critical transfer can happen. As medical advances lead to ever more specialized care, they require increasingly complicated decision-making to determine when and where to treat patients with complex needs. In such cases, a group such as a patient transfer center coordinates all decisions and logistics to accept a patient, understand their condition, receive their medical records, and arrange their transport.

We recently witnessed the complexities firsthand at a world-class quaternary healthcare system. Even before COVID-19, their Transfer Center team realized their processes had slowed due to the expanding types of care they provide. They were eager to streamline those processes in order to better coordinate patient transfers from hospitals across a multi-state area.

This work couldn’t wait for the pandemic to go away. Leadership engaged Point B to create a robust, standardized and streamlined system that would improve capacity management, bed utilization and all patient transfers to and from lower-complexity hospitals across the multi-state region. The goals were both immediate and long-term: to quickly stabilize existing Transfer Center operations while simultaneously redesigning the workflow of processes to improve patient transfer and admission.

Deeper, wider insight into the pain points

A lean Point B Healthcare team brought together the leadership and methodology to identify the Transfer Center’s pain points, facilitate a future-state vision, and build a roadmap of chartered projects to achieve it.

Knowing that hospital system leadership and staff were at max capacity due to the pandemic, Point B designed a project to get the work done with least impact to staff and leaders who were already strained.

Here’s how we did it:

  • We worked fully remotely, using human-centered collaboration methods to engage the team directly in the work.
  • We conducted a virtual, cross-system discovery process that made it easy for more than 70 high-level stakeholders to share valuable input on the current state.
  • Based on interviews with physicians, administrators, department heads and staff, we mapped out the impact of capacity issues and pain points across the entire workflow.

As we interviewed stakeholders, we developed and shared a visualization of the issues they raised. The visualization became richer with each conversation. Our iterative process gave everyone greater insight into common issues felt across the system—from communication and consistency issues around patient admission to problems managing capacity and patient discharges. This cross-system view built support for a broad set of improvements on a foundation of empathy and ownership among the diverse community of professionals who count on the Transfer Center 24 hours a day, 365 days a year.

Thinking “beyond the box” of best practices

Organizations are understandably eager to apply best practices as proven solutions to the problems at hand, but even best practices have their limits. There is no perfect, out-of-the-box solution to address the many complex and interrelated processes, relationships, and technologies unique to a regional acute-care system. We assessed best practices used by other complex health systems but dialed-in a solution that provided a more achievable path for this one. We moved “beyond the box” of best practices to consider:

  • The types of care in which this acute-care system excelled, so patients matching those care needs could be transferred more quickly.
  • How existing technology investments could be better leveraged to aid clinical decision-making and decision-tracking rather than suggesting new, big-ticket investments.
  • Specialty departments’ common goals and needs for patient information so they could easily have critical decision information at hand for conversations with outside hospitals.
  • Where there were gaps in the work and job responsibilities that, once filled, would make clinicians’ work easier and patient transfers smoother.

Leveraging existing resources

We also emphasized solutions that leveraged existing resources. By avoiding major new investments, we eliminated the time and budget impediments that often slow down transformation projects. When stakeholders understood the full scope of resources and IT capabilities already available to the Transfer Center, they realized they had what they needed to move forward.

Most important, we showed that tailoring practices to their own organization and leveraging existing resources would enable people to do this critical work even during the disruption of COVID-19. By making needed improvements now, the hospital network is positioned to come out of the pandemic with a more efficient workflow and a better transfer experience for everyone involved—hospital staff, referring physicians, patients and families.

A clear roadmap and ready-to-go projects

Based on our assessment of the Transfer Center’s current state and with input from stakeholders, we created a future-state vision and a detailed roadmap to reach it.

The roadmap identifies 45 projects, with milestones at 3 months, Year 1 and Year 2. Examples of projects include establishing a measurement framework to continuously improve response time for making patient transfer decisions, leveraging functionality embedded in their existing electronic medical record system to allow clinicians to more easily collaborate on patient transfers and projects to improve patient satisfaction and customer service to regional transferring hospitals. Each project is ready to go, with charters that make it easy for people to jump-start them.

The roadmap establishes three primary goals across the phases to build capability and maturity into the Transfer Center: 1) establish decision governance and a programmatic structure to the work in the first 3 months; 2) focus on building fundamental process capability and a measurement strategy in year 1; and 3) optimize improvements focused on patient, provider, and staff experience in year 2.

The key elements to success are a measurement strategy and tools that enable people across the system to gauge performance and outcomes. Shared visibility into relevant metrics will continue to build understanding and support by showing how and where gains in efficiency and experience are having impact. At any given time, leadership and staff can gauge where the Transfer Center is on its 24-month maturity curve.

This work has built confidence that even a pandemic won’t stop people from making the operational improvements when times are tough. Transforming the Transfer Center was a matter of tapping into existing talent and technology, connecting around a shared future-state vision, and positioning projects on a clear roadmap to reach it.  While COVID-19 is not yet in the rear-view mirror, it hasn’t stopped this leading healthcare organization from moving forward.