TeamHealth, one of the nation’s leading integrated physician practices with almost 16,000 clinicians in various specialties that include hospital medicine, emergency medicine and post-acute care, has undertaken a five-year initiative aimed at redesigning the approach to hospital medicine productivity. This effort is intended to ensure the sustainability of hospital medicine programs in the face of acute care revenue declines and reduced capacity for hospitals to subsidize HM programs in the face of their own declining revenue. Launched in 2019, this sweeping productivity initiative is committed to maintaining stellar quality and performance while providing services more efficiently and cost-effectively.
The value of broad engagement
The first year of the productivity redesign project was devoted to planning, including interviewing numerous leaders and front-line hospitalists to help shape the project design. The initiative deliberately set out to engage clinicians and clinician leaders in the effort and in fact is led by a group of senior hospitalists.
“It sounds incredibly simple, but it’s actually very hard to get broad engagement that allows physicians to feel part of the project,” says Amit Kachalia, MD, Senior Vice President at TeamHealth. “We achieved that by engaging an extensive group of clinical and administrative leaders. To increase productivity without a negative impact on quality or on clinician engagement and wellness, we’ve developed a plan aimed at improving their daily work flow.”
“We engaged people on the front lines to help us and teach us, and then teach their colleagues.” – Rohit Uppal, MD, Chief Clinical Officer for Hospitalist Services
Rohit Uppal, MD, Chief Clinical Officer for Hospitalist Services, agrees. “It’s been a very effective way to make sure we’re balancing the need for efficiency with our priorities of quality, safety, and clinician well-being. We engaged people on the front lines to help us and teach us, and then teach their colleagues. Achieving a productivity target by cutting hours is easy. But when you challenge a team to increase their productivity while still having a good work-life balance, and continuing to give our patients the best possible care, you need to involve everyone and capture the best ideas.”
The productivity initiative is governed by the Teamhealth Hospital Medicine Leadership Council, a team of senior hospital medicine leaders across the country who establish strategic direction for the service line. The productivity redesign project includes three major work groups, with each group having its own chairperson as well as both administrative and clinical leaders:
- Tools and Tactics- best practices from across the country are captured in a toolkit that is used for supporting and educating facility medical directors.
- Implementation – high-performing facility leaders act as change agents to implement new policies and procedures and to mentor colleagues through the process.
- Data Analytics – Ingenious Med’s capabilities were leveraged extensively to provide real-time data to our medical directors as well as trends and insites from retrospective data.
Dr. Uppal states, “The implementation team is made up of productivity super coaches — hospital medicine experts who help coach the productivity coaches. The productivity coaches are local medical directors who have distinguished themselves through their performance on both productivity and quality/performance of their programs. These productivity coaches are the actual change agents who interact with local medical directors across the country, assisting and supporting them with implementation of site-specific action plans and navigating challenges as they arise. This ‘mentored implementation’ model has been invaluable.”
Real-time productivity monitoring
While other specialties regularly use data to adjust their staffing levels, hospital medicine programs have traditionally staffed at constant levels despite variations in census and patient acuity across days of the week and seasons of the year. The productivity redesign project has changed that practice at TeamHealth. Using data from Ingenious Med and other sources, Dr. Kachalia and colleagues developed a productivity calculator with real-time analytics and historical trends to guide real-time staffing decisions.
Dr. Uppal says, “For that, Ingenious Med has been very helpful because we are able to track our encounters per day. We can track trends by day of the week, by month, etc., and use that information to understand and predict where we need to add or cut hours without overburdening clinicians or jeopardizing patient care.”
“We took the encounters from Ingenious Med every morning as our census, and then used historical seven-day trends to estimate what the staffing should be to meet ideal productivity levels,” Dr. Kachalia explains.
The Productivity Calculator enables site leaders to determine exactly how many hours they are over or under staffed compared to their productivity target. Ingenious Med encounter data is then used to compare actual to estimated productivity data each day, to track accuracy and make decisions in real time.
Dr. Kachalia notes, “As clinicians, we always remember the days where we’re understaffed, or we have too many patients and not enough people, but it turns out we have many days where we’re actually overstaffed. The data proved a real eye opener for local leaders who can now make decisions based on data rather than fear. They had already agreed on what a reasonable productivity level is. Now they know how many encounters they’re going to have tomorrow, so they know what staffing they need.”
Dr. Uppal contributes, “Our goal is not just increasing productivity, it’s really matching demand to capacity and being smarter about how we staff.”
“The data proved a real eye opener for local leaders who can now make decisions based on data rather than fear.” – Amit Kachalia, MD, Senior Vice President at TeamHealth
To avoid any unintended consequences to care quality, TeamHealth also closely tracks its quality metrics. “Two of those metrics are length of stay and readmission rates, which we get from Ingenious Med’s dashboards,” explains Dr. Kachalia. “We also review our patient experience scores and the number of discharges before 11 a.m. to ensure we are managing throughput effectively. Ingenious Med can attribute productivity metrics to individual clinicians to better evaluate individual performance.”
He adds, “Our productivity improved from 2019 to 2020 and we achieved our target for the year, which is significant considering the rise in acuity due to COVID. Importantly, we also maintained our levels of quality and clinician engagement.”
Customized dashboards
TeamHealth provides different levels of access to its dashboards for each level of the organization. Senior leadership and the project team generally have nationwide access, while super coaches can access the data for their own productivity coaches, and those coaches can access sites within their span of control. The dashboards enable leaders to quickly spot trends over days, weeks and months.
The initiative got an early test of its utility during the peak of the pandemic, enabling TeamHealth to help physicians on the front line flex up and down to meet fluctuating demands, improving clinician wellness and reducing the likelihood of burnout while also enabling them to work more efficiently.
With the first two years of the project under its belt, the Productivity Redesign team is positioned not just to meet its future yearly targets but also to continue building a new culture that can deliver greater efficiency while enhancing clinician work-life balance, clinical quality and throughput.