Denise Hargrove is a Manager at Ernst & Young with over 20 years of healthcare experience who specializes in clinical transformation and cost reduction projects. She has led numerous projects focused on improving processes, increasing productivity and reducing costs across various clinical areas for many healthcare clients. Her experience includes initiatives in emergency services, perioperative services, nursing, hospital operations and more.
3 Strategies for Maximizing Service Line Efficiency, Quality and ProfitabilityWellbe
Maximizing service line efficiency, quality and profitability is a hot topic, particularly with rising patient care demands, changing reimbursement models, and estimated physician shortfalls. This webinar takes a look at three solutions beginning in the operating room and expanding to the entire patient care journey.
1st solution: A unique clinical and operational service model focused on the specialization of qualified, reimbursable clinical labor to optimize surgeon involvement and reduce OR costs.
2nd solution: Taking a holistic view of the service line through the patient care journey to produce a value stream map to understand the current state. Assisting staff with comparing this current state to the ideal future state, comparing national benchmarks and clinical best practices helps your staff innovate and co-create an individualized plan to get your service line to a higher level.
3rd solution: Utilizing dashboard metrics of the critical to success factors, to sustain and improve your service line.
As a participant, you will be able to:
• Identify key operational and clinical indicators of orthopedic service line efficiency
• Describe how Surgical First Assists can add value in the OR
• List the steps in developing and/or evaluating or building an orthopedic service line
• Describe how metrics/dashboards assist in sustaining change and improvement of orthopedic service line
About the Speaker:
Miki Patterson, PHD ONP, Senior Director of Orthopedics in Intelligent CareDesign at Intralign
Dr. Patterson is a certified orthopedic nurse practitioner and brings over 25 years of clinical experience in healthcare, consulting, direct advanced orthopedic patient care, teaching, NIH level, qualitative and quantitative research and publishing. She is a past president of the National Association of Orthopedic Nurses (NAON) and continues to be nationally recognized for leadership and advancing orthopedic care.
Presentation describing the DMA INSIGHT programme and its use in collaboration with St Andrews Hospital Charity to develop person centred integrated care pathways - presented at International Forensic Conference - UCLAN
3 Strategies for Maximizing Service Line Efficiency, Quality and ProfitabilityWellbe
Maximizing service line efficiency, quality and profitability is a hot topic, particularly with rising patient care demands, changing reimbursement models, and estimated physician shortfalls. This webinar takes a look at three solutions beginning in the operating room and expanding to the entire patient care journey.
1st solution: A unique clinical and operational service model focused on the specialization of qualified, reimbursable clinical labor to optimize surgeon involvement and reduce OR costs.
2nd solution: Taking a holistic view of the service line through the patient care journey to produce a value stream map to understand the current state. Assisting staff with comparing this current state to the ideal future state, comparing national benchmarks and clinical best practices helps your staff innovate and co-create an individualized plan to get your service line to a higher level.
3rd solution: Utilizing dashboard metrics of the critical to success factors, to sustain and improve your service line.
As a participant, you will be able to:
• Identify key operational and clinical indicators of orthopedic service line efficiency
• Describe how Surgical First Assists can add value in the OR
• List the steps in developing and/or evaluating or building an orthopedic service line
• Describe how metrics/dashboards assist in sustaining change and improvement of orthopedic service line
About the Speaker:
Miki Patterson, PHD ONP, Senior Director of Orthopedics in Intelligent CareDesign at Intralign
Dr. Patterson is a certified orthopedic nurse practitioner and brings over 25 years of clinical experience in healthcare, consulting, direct advanced orthopedic patient care, teaching, NIH level, qualitative and quantitative research and publishing. She is a past president of the National Association of Orthopedic Nurses (NAON) and continues to be nationally recognized for leadership and advancing orthopedic care.
Presentation describing the DMA INSIGHT programme and its use in collaboration with St Andrews Hospital Charity to develop person centred integrated care pathways - presented at International Forensic Conference - UCLAN
Total Joint Replacement- Improving Day of Surgery Efficiency and ThroughputWellbe
Organic growth of total joint replacement volume is growing at 3-4% per year as the number of physicians entering orthopedic residency programs is in decline. Cuts in Medicare reimbursement for total joints is forecast every year producing stressors for the surgeon to perform more surgery just to tread water financially. Increasing surgical volume without increasing time in the day requires a team approach to process improvements. By taking a fresh look at operating room processes, it’s possible to accomplish this goal.
Discussion points include:
• Pre-op patient preparedness
• Resolving inherent conflicts
• Surgical case order
• Tracking case efficiency
• Surgical tray streamlining
About the Speaker:
Sandy Nettrour has specialized in orthopedics for 30 years. She is the Neurosurgery and Orthopedic Service Line Coordinator for Butler Health System, providing oversight of the business aspects of Neurosurgery and Orthopedics, while continuing to first assist in the operating room and provide patient care at the bedside.
Sandy graduated from Alderson Broaddus College in 1980 with a Physician Assistant degree. She has been awarded the Distinguished Fellow Recognition by the American Academy of Physician Assistants, the Hu C. Myers Award for lifetime professional achievement and community service, and the Pennsylvania Society of Physician Assistants Humanitarian of the Year 2013. She was a Round Table Participant in Orthopedics Today June 2012′s “Effective and Efficient Joint Replacement Programs Need Constant Review and Renewal of Processes.”
The best of clinical pathway redesign - practical examples of delivering bene...NHS Improvement
The examples here showcase just some of the innovations that have enabled thousands of patients to enjoy better health and well-being thanks to practicalservice improvements implemented on various clinical pathways
A presentation given by Sonya Preston at The Journey, CHA Conference 2012, in the 'Delivering Safety & Quality: Innovations in Clinical Governance' stream.
Total Joint Replacement- Improving Day of Surgery Efficiency and ThroughputWellbe
Organic growth of total joint replacement volume is growing at 3-4% per year as the number of physicians entering orthopedic residency programs is in decline. Cuts in Medicare reimbursement for total joints is forecast every year producing stressors for the surgeon to perform more surgery just to tread water financially. Increasing surgical volume without increasing time in the day requires a team approach to process improvements. By taking a fresh look at operating room processes, it’s possible to accomplish this goal.
Discussion points include:
• Pre-op patient preparedness
• Resolving inherent conflicts
• Surgical case order
• Tracking case efficiency
• Surgical tray streamlining
About the Speaker:
Sandy Nettrour has specialized in orthopedics for 30 years. She is the Neurosurgery and Orthopedic Service Line Coordinator for Butler Health System, providing oversight of the business aspects of Neurosurgery and Orthopedics, while continuing to first assist in the operating room and provide patient care at the bedside.
Sandy graduated from Alderson Broaddus College in 1980 with a Physician Assistant degree. She has been awarded the Distinguished Fellow Recognition by the American Academy of Physician Assistants, the Hu C. Myers Award for lifetime professional achievement and community service, and the Pennsylvania Society of Physician Assistants Humanitarian of the Year 2013. She was a Round Table Participant in Orthopedics Today June 2012′s “Effective and Efficient Joint Replacement Programs Need Constant Review and Renewal of Processes.”
The best of clinical pathway redesign - practical examples of delivering bene...NHS Improvement
The examples here showcase just some of the innovations that have enabled thousands of patients to enjoy better health and well-being thanks to practicalservice improvements implemented on various clinical pathways
A presentation given by Sonya Preston at The Journey, CHA Conference 2012, in the 'Delivering Safety & Quality: Innovations in Clinical Governance' stream.
1. A member of Ernst & Young Global Limited
Professional experience summary
Denise Hargrove is a Manager in the Advisory Services practice of Ernst & Young LLP. Ms.
Hargrove has over 20 years of health care consulting, clinical and administrative experience.
She is recognized as a skilled leader with a demonstrated aptitude for increasing productivity
and instituting cost saving initiatives. She has exceptional team building and team
management skills and has a proven track record of increasing revenue, initiating process
improvements and restructuring operations to increase client effectiveness in the increasingly
competitive healthcare industry. She serves as a clinical expert for reviewing quality,
throughput, costs and patient experience. Strengths include:
► Large-scale and complex redesign across Perioperative Services, Emergency Services, Nursing
Services and Hospital Operations
► Clinical and Operational Transformation efforts that have spanned the healthcare continuum in the
US and Australia including, Public, Private, Academic Medical Centers, and Military Health.
► Assessment, Design/Implementation across the following areas: Productivity/Labor workforce,
Perioperative Services, Emergency Services, Care Management, Bed Management, Patient
Throughput, and Ancillary Services
► Operating Model design and organization structure design and implementation
► Clinical Information System Design and Implementation
Engagement experience
► Clinical Transformation and Process Improvement: Developed short, medium and long term
strategies to optimize South Australian Health Services Transforming Health program; facilitated
the development of enhanced models of care at selected sites; identified key strategic initiatives to
improve access and to increase productivity across Emergency, Medical and Surgical Services;
identified and prioritized options to improve the financial viability of the system. These changes
have enabled the South Australian Healthcare System to increase access in outpatient services,
decrease and decommission inpatient beds and open a new 800 bed hospital.
► Clinical Transformation and Process Improvement: Provided operational planning support for
process analysis and design to Veterans Administration Hospital replacement facility for their activation
and clinical transformation by assisting with development of service delivery plans of clinical and
nonclinical teams; providing prescribed direction and oversight to the identified teams and workgroups in
the completion of task list items; and evaluating new facility spaces in the context of determining
workflow, staff flow and patient flow processes. This enabled the VA not only to prepare for changes for
their new facility, but also to make significant work flow and process changes for current state issues.
► Cost Reduction and Process Improvement: Facilitated the Design Phase of a large Health
Network Value Creation Project by reviewing quality, throughput, costs and patient experience; and
developing recommendations for opportunities for improvement and cost reduction for Emergency
Services and Radiology. Facilitated the Implementation Phase of Emergency Department and
Perioperative Services Initiatives enabling both areas to realize combined financial targets of $6.2M, in
addition to identifying an additional savings opportunity of $5M in Air and Ground Medical Transportation
area. In Emergency Services, developed and implemented new staffing grids and flexing models; new
Denise Anne Hargrove
Manager
Advisory Services
Contact information
Ernst& Young LLP
1101 New York Avenue,NW
Washington, DC 20005-4213
Mobile: +1-918-269-6052
Office: +1-202-327-7018
Email: Denise.Hargrove@ey.com
Industry lines
Healthcare
Clients
South Australia Health
(Adelaide, AU)
Denver VA(Denver, CO)
Hoag MemorialHospital
(Newport Beach, CA)
Novant Health (Charlotte, NC)
Yale-New Haven Hospital
(New Haven, CT)
JacksonMemorialHospital
(Miami, FL)
Carilion Clinic (Roanoke, VA)
Allegheny Health Network
(Pittsburgh, PA
Orlando Health(Orlando,
Florida)
Lahey Clinics (Boston, MA)
Military Health (Washington
D.C.)
Center for Medicare and
MedicaidServices (Ownings
Mills, MD)
Education
B.S. University of Maryland
M.S. University of Maryland
Graduate School
2. A member of Ernst & Young Global Limited
models for Triage and Fast Track; and a new ED Tech job category to better facilitate the workflow of the ED. The
primary emphasis with Perioperative Services was developing a Network Level Governance Council; policies to guide
Block Utilization; reallocating Block for all six of the Network hospitals; and working with flagship hospital to implement
identified recommendations.
► Cost Reduction and Process Improvement: Provided support to a Value Creation Project for Emergency Services,
Physician (Hospitalist) Services, Pharmacy Services, Laboratory Services, Rehabilitation Services, Respiratory
Therapy, Home Health, and Bed Management. Responsible for reviewing quality, throughput, costs and patient
experience; developing recommendations for opportunities for improvement. Facilitated the design of new processes,
and facilitated the implementation of the Bed Management and Emergency Department initiatives, to include developing
a new care model for staffing and patient care and throughput. This resulted in a $4.8M saving in Emergency Services
and enabled the System to realize it’s first positive cash flow year after becoming a seven hospital system; and resulted
in significantly shorter length of stay in both the Emergency Departments and Inpatient Services.
► Advisory: As a Subject Matter Expert, supported the development and design of a learning system and curriculum that
met the needs of the Centers for Medicaid and Medicare’s “Million Hearts” program. We established a learning model
for the use of the data collection model and risk calculator, and supplied the leading practice literature for reducing and
treating cardiovascular diseases and strokes for the participants in the program.
► Advisory, Cost Reduction and Process Improvement: Identified and validated the stated rules of the negotiated
Nursing Collective Bargaining Agreement by determining alignment and where conflicts may exist amongst contract
terms and identified components of the contract that would benefit from modification. Developed recommendations and
work plan which allowed Nursing Services to schedule and staff within contract rules; facilitated the implementation of
newly developed staffing grids and workflow practices; developed tools and an education program which assisted the
organization to function within the contract guidelines, coached nursing leadership throughout the implementation
process and assisted with monitoring compliance. These interventions resulted in a $1.2M yearly payroll savings for
Nursing Services by just complying to the rules of the negotiated contract.
► Project Management and Advisory: Provided guidance to IT Project Management Team for clinical transformation for
the implementation of the Epic Implementation; and provided clinical SME support to the inpatient clinical build teams,
resulting in a successful EHR implementation in all seven hospitals in the System
► Advisory: Led Emergency Department ECIS Implementation Initiative for large Healthcare System; assisted with
developing the role and job description for a permanent clinical ECIS manager; and provided support to clinical services
for ECIS Implementation for Emergency Services throughout Healthcare System. Assisted in the development of the
design and implementation effort, of the Healthcare System to incorporate clinical and business process transformation
activities to ensure the new Centricity Enterprise suite of applications would bring additional benefits to the patients,
physicians and other staff. Assisted with the development and implementation of Internal Emergency Department EMR
System; and was clinical resource to ensure EMR system build incorporated all necessary components of the clinical
workflow
► Project Management and Advisory: Directed the clinical support and coaching at County Hospital for implementation
of Siemens Soarian Clinicals, Soarian Scheduling, Siemens/MAK to include developing project work plans, coaching the
assigned clinical and IT staff through design, development, and the building phases of Implementation; coached the
clinical leads and staff PMO skills to ensure the hospital staff had the capability to succeed post implementation; and
acted as a clinical resource for the project.
► Process Improvement, Advisory and Cost Reduction: Provided expert industry input for the Phase I Assessment
and facilitated the implementation of process improvement changes for Department of Emergency Services.
Determined gaps in services in the Emergency Department which prevented it from providing quality efficient patient
care. Developed recommendations and an Implementation Plan which allowed the Emergency Department to meet the
identified financial targets, and improve efficiencies. Assisted ED nursing and medical staff with developing standards
and clinical care plans for patient care resulting in decreased average LOS of ED patients of two hours. Redesigned
Urgent Care staffing and workflow which resulted in increased efficiencies and decreased turnaround times and average
LOS. Collaborated with laboratory and pharmacy services to decrease the turnaround times for requested services.
Gave significant expertise in clinical and operational management of the Emergency Department which was used
3. A member of Ernst & Young Global Limited
effectively to create a solid Performance Improvement Plan. Identified approximately $700K of financial improvements
and several process improvements that would provide for better quality and effectiveness in the Emergency
Department.
► Process Improvement and Cost Reduction: Facilitated project of Perioperative Services to increase patient
throughput and to decrease cost. Worked with surgical committee, Nursing and Medical Directors to develop Block
Scheduling which resulted in fewer case delays, and more efficient use of staff, and decreased use of overtime;
developed new role and job description for Perioperative Services Medical Director; assisted Perioperative Services
Director with redefining roles of staff; reorganized Cardiovascular Surgery staff and schedule, and workflows; and
developed a plan to cross train all Perioperative nursing staff.
► Process Improvement and Advisory: Developed a two tiered triage system which allowed for a higher level of
observation at the door; a continuous move forward, and as many initial tests completed prior to the MD encounter.
Increased the efficiency of internal and external patient flow in the Emergency Department by eliminating Boarders and
moving the admitted and observation patients outside of the Department. Integrated and aligned the Emergency
Department performance improvement activities with the organization’s PI plan, mission, vision, and values. Developed
an Emergency Department care delivery model that focused on effective, efficient use of all patient care team members.
Workflow redesign of Laboratory, Radiology, and Pharmacy processes for Emergency Services. Developed new
workflow process for Triage and Urgent Care and mentored Emergency Department managers and charge nurses.
► Process Improvement and Project management: Implemented a Throughput Initiative which allowed the hospital to
realize increased capacity and decreased LOS by 1.5 days. Facilitated a process improvement project in the
Emergency Department, Nursing Services, OT, and PT which involved: work redesign for the clinical and nursing staff,
and charge nurses; implementation multidisciplinary discharge planning rounds; development of a new staff and patient
scheduling process to allow for a more efficient use of staff; and coached managers and directors through the
implementation process.
► Project Management, Process Improvement and Cost Savings: Provided project management for the three offices
of a National Disability Management Firm. Provided oversight for standardizing workflow processes across all the
offices; defining the roles of clinical and support staff; developed quality standards and developed tools for ongoing
measurement for the call centers. As a result of the changes the organization had the opportunity to realize a cost
savings of $2.4 million.
► Process Improvement and Advisory: Facilitated the development of improved management tools and skills in order
to enhance work processes, and quality and service. The primary focus included:
Management development
Developing new clinical pathways to facilitate TOT of Emergency Department patients
Facilitation of new workflow process for the management of Radiology and Lab requests to decrease the TOT
Facilitation of Emergency Department workgroups charged to increase staff morale, new staff scheduling process,
decrease patient LOS and increase patient satisfaction
► Interim Management and Process Improvement: Co-managed a process improvement and patient throughput
project in nursing and outpatient cardiovascular services; and Interim management of telemetry unit. Process
improvement initiatives included: restructuring the flow and care of post op Cardiac Cath patients; designing new care
plans for the Cardiac Cath patients; implementation of new patient flow management position; implementation of Bed
Management rounds; and creation of a more efficient process which facilitated the use of clinical pharmacists on the
inpatient units