The Texas Children's Hospital's 2014 Leadership Conference focused on improving operational efficiency through value-based care by addressing care management, patient placement, and care variation. The strategic initiatives recognized the need for better integration of health care services, leading to significant operational improvements, patient satisfaction, and financial outcomes. Key strategies included enhancing interdisciplinary collaboration, utilizing data-driven approaches, and sustaining improvements through ongoing partnerships.

1. ANNUAL LEADERSHIP CONFERENCE
October 12-14, 2014 • Palm Desert, California

2. Texas Children’s Hospital
Transforming Operational Throughput –
The Journey Toward Value-Based Care

3. Agenda
• Learning Objectives
• Background: A Changing Industry, About TCH
• Opportunities and Challenges at TCH
• Where We Began
• Work to Date/Results: Care Management, Care
Progression, Patient Placement, and Care Variation
• Strategies for Improvement
• Lessons Learned
• Next Steps
• A Sustainable Approach/Conclusion
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4. Learning Objectives
• Identify strategies to enhance integrated care
across the delivery system
• Learn specific initiatives to drive improvement in
throughput efficiencies
• Understand outcomes from a financial, clinical,
and operational perspective
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5. Background: A Changing Industry
Dynamics in health care are driving unprecedented
change:
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Bottom Line:
A Challenging
Fiscal
Environment
• Shifting from volume-based to
value-based purchasing
• Shifting from experience-based to
evidence-based care delivery
• Focusing on eliminating waste

6. Background: About Texas Children’s Hospital
• 503-bed not-for-profit hospital and
academic medical center in
Houston, TX
• Part of a 650-bed system
• Mission to create a healthier
future for children and women
throughout the global community by
leading in patient care, education
and research
• Consistently ranked among the top
children’s hospitals in the nation
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7. Opportunities and Challenges at TCH
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Care Management
Patient Placement
Care Progression
Care Variation

8. Where We Began
• Transactional approach to care management
– Operational inefficiencies in utilization management
– Lack of integration of care management functions
– Under-resourced, both in terms of people and tools
• Need for care progression
– Above average severity-adjusted Length of Stay (LOS), compared to
risk-adjusted benchmarks
– Lack of consistent, coordinated interdisciplinary rounds
– Spending significant hours on census alerts and unable to
accommodate outside transfers
• Inadequate or insufficient tools to support patient placement
– Inefficient bed turnaround, including environmental services support
– Delays in placing patients from the ED and PACU
• Challenges in care variation
– Payers shifting to DRG-based payment structure
– Lack of consistency in utilization of evidence-based standards
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9. Work to Date: Care Management
• Restructured Care Management department and recommended case
loads in line with national Care Management standard
• Engaged over 20 Care Managers in weekly Clinical High Risk meetings
to collaboratively resolve barriers to efficient patient flow, efficient care,
transitions to the next level of care and hospital reimbursement
• Redefined roles and responsibilities of department personnel, including
utilization review, discharge/transition planning, avoidable day
documentation, interaction with multidisciplinary team and utilization
management
• Initiated a Care Management Medical Director to provide physician
leadership and expertise related to Care Management practice
• Initiated an Access Care Manager role to increase the number of patients
who are screened for appropriate status and level of care at the time of
admission
• Implemented Morrisey, a Care Management software tool for
discharge planning, utilization review and other work flow
management
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10. Results: Care Management
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• Prioritizing patient load
• Proactively anticipating and planning for discharge
• Facilitating interdepartmental communication
• Managing high-risk patients
• Improving utilization management
• Engaging physicians

11. Work to Date: Care Progression
• Established 11 daily multidisciplinary Care Progression Rounds (CPR)
across 35 services to proactively plan for patient’s discharge with the care
team and the patient/family
• Conducted over 1,500 CPRs (and counting) since project start with
participation by over 500 physicians, nurses, and supporting care team
members
• Created Epic Care Progression Rounds flow sheet to facilitate timely
and efficient documentation of anticipated discharge dates and barriers to
discharge (i.e., education, prescriptions, transportation)
• Increased effectiveness of Care Progression Rounds by leveraging a
new Quality Review process and garnering timely feedback from
participants
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12. Results: Care Progression
• Improving interdisciplinary communication and
collaboration
• Improving patient and family involvement
• Improving ability to proactively anticipate and
communicate discharge dates
• Increasing patient, staff and physician satisfaction
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13. Work to Date: Patient Placement
• Redesigned patient placement department and recommended caseloads to
support responsibilities that include bed assignment, level of care assessment
prior to admission, and timely interaction with nursing units, nursing supervisors
and physician advisors
• Centralized patient placement process, which allows resource nurses to
spend more time assisting with patient care, reduces avoidable patient delays,
and maximizes the space/beds available – including a process for nursing units
to provide placement input to inform placement decisions
• Created a patient placement matrix to assist in identifying the appropriate unit
for each patient based on services required
• Initiated Level of Care Reviews at admission, reducing denials and ensuring
beds are available for the patients that need them most
• Upgraded to TeleTracking XT™ platform, which streamlines communication
between the nursing units, Bed Management, EVS, and Patient Escort and
improves our ability to proactively place patients in the right bed
• Trained over 600 TCH nurses, unit clerks, EVS, and Patient Escort staff on
the TeleTracking system
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14. Results: Patient Placement
• Improved ability to ensure patients are placed
into the right bed at the right time
• Instituted new process for census management
• Consistent “Bed Turnaround Time” below 50 min
– Efficient housekeeping responses to high priority requests
• Use of PatientONTRAC Summary and Detail reports
by clinical leadership to:
– Drive staff performance
– Share successes
– Review areas of opportunity
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15. Work to Date: Care Variation
• Worked with physicians, nurses, and ancillary providers in
select DRGs to:
– Streamline care
– Reduce variation
– Enhance existing evidence-based standards of care
• Used lean methodology and processes as the structure to
perform this work
• Developed future state vision of care processes for Diabetes and
Pneumonia patients at TCH that align care with IOM dimensions of
quality and safety
• Developed Pneumonia multidisciplinary care pathway to be
integrated into Care Progression Rounds
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16. Results: Care Variation
• Developed interdisciplinary Care
Pathway for patient care
• Implemented vision for Diabetes Center
of Excellence
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17. Organizational Results
⬇ 38% reduction in acute care red census alert
hours
⬇ 8% reduction in hospital readmissions
⬇ Reduction in capacity-related transfer denials
⬆ Significant improvement in admission, transfer
and discharge physician and nursing metrics
• Significant improvements in Length of Stay (LOS)
⬇ 18 hour decrease in average LOS
⬇ 13% decrease in severity-adjusted patient LOS
• Capacity to serve + 2,296 more inpatients per year
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18. Results: Severity Adjusted LOS
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19. Strategies for Improvement
• TCH partnered with Huron to expand solutions that
ensure care is:
✔ Clinically appropriate
✔Delivered efficiently
✔According to evidence-based standards
• Focused on throughput initiatives to:
⬆ Improve efficiency of patient flow
⬆ Improve care delivery
⬆ Change satisfaction system-wide
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20. Lessons Learned
• Key to driving results:
– Utilizing a team-oriented, process-and data-driven
approach, supplemented by enabling technologies
– Bringing all team members together to work on necessary
components
• Key to driving successful change:
– Proper structure and methodology
– Leadership, data, devoted resources, communication and
implementation
• Key to integrated care delivery:
– Physician/nurse partnership
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21. Next Steps
– Formal Patient Flow meetings
– Clinical High Risk meetings, focusing
on patients with outlier LOS
– Focus on specific patient populations
where variation is high
– Extending the Care Management
model beyond hospital walls
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Continuing to build upon Huron engagement:

22. A Sustainable Approach
• Huron’s tools and processes have enabled
TCH to build on recent improvements
• TCH and Huron worked to create a
sustainable solution
- TCH has seen additional improvements since
the engagement and continues on a positive
trajectory
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23. Contact Information
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Presentations
www.childrenshospitals.net
Larry Burnett, RN, MSN
Managing Director, Huron Healthcare
Phone: (480) 892-2511
Email: lburnett@huronconsultinggroup.com
Tabitha Rice, MBA
Senior Vice President, Texas Children’s Hospital
Email: tlrice@texaschildrens.org
Jackie Ward, MSN, RN
Assistant Vice President of Nursing, Texas Children’s Hospital
Email: jaward@txch.org