George Bischalaney, President and CEO, Eden Medical Center
By George Bischalaney, President & CEO, Eden Medical Center
This past year was another busy year for our elected representatives, passing another bevy of bills that will impact hospitals and other health care providers. In every case, I have no doubt, each bill was written with some positive motive; to provide better access to health care services, to help control or reduce costs, to protect confidentiality or a patient’s right of choice, or in some cases mandating policies or practices that are costly to implement and monitor and may have a questionable cost benefit to patients.
But will more legislative remedies to the extremely complex and already cumbersome system of health services in California actually improve the patient care experience? One has to wonder.
In most service industries, the consumer helps direct change by withholding use of a service that doesn’t meet his/her needs. This is not as easily done when someone needs medical care. Yet the consumers, our patients, speak to us through direct communication and through their responses to the surveys we send. What we need to do is listen more attentively and respond more appropriately.
At Eden Medical Center we randomly send out surveys to patients who have been hospitalized, patients who use our mental health services, patients who have surgery and leave the same day, and patients who use the Emergency Department. We ask about every aspect of their experience, from the time they are registered through their discharge from the hospital. This includes physician and nursing interactions, quality of food and housekeeping, and the staff that drew blood or took an x-ray. Patients or family members are also invited to write comments, good or bad, and tell us anything else they think we should know about our services.
Hospitals are for the most part, stops of last resort for all. People come here already laden with apprehension, uncertainty and even a certain amount of fear. They have seemingly little or no control over what is about to happen to them or their loved ones. It is our job, our responsibility, to care for them as we would members of our own family.
If more legislation is needed to encourage us or force us to care for patients as we would our own family members, then we deserve what is given us. However, if we truly listen to our patients, our customers, and respond as a service industry that needs to be attentive to the needs of its customers, the industry would be vastly improved in terms of quality care and the patient’s experience. What more is really needed?
As always, we want to hear what you have to say. Please feel free to comment or ask questions in the comment box beneath each post, including this one. We will respond as quickly as possible.
Bryan Daylor
By Bryan Daylor, Vice President of Ancillary and Support Services at Eden Medical Center
Technology is critical to convenience & efficiency…
As I mentioned in my previous post, our collaborative team has been very focused on how we would use technology, innovation and design to improve work flow and increase efficiency. You may also want to read the previous post by Andrew Flanigan, Senior Planner/Designer with Devenney Group, the architecture firm for Sutter Medical Center Castro Valley.
For example, in our clinical lab today, we have clinical space that is not fully utilized. The lab was originally designed when equipment was much larger and therefore required more space. The current lab was designed as a “decentralized” service, meaning that different sections of the lab, i.e., blood bank, hematology, chemistry, microbiology, pathology were divided into separate areas. We have learned over the years that this concept is outdated, as well as inefficient to operate and impractical to rebuild.
The new “best practice” is to create a centralized service where the work flow is organized and instruments are closely aligned. In this type of design the work flow is much more efficient, and staff has fewer steps between tasks and can be much more expedient in processing specimens. Ultimately this increases turnaround times of critical test results for physicians and patients, and results in a better work environment for the staff. With the advances in technology, one person can do multiple tasks in one area using state-of-the-art instrumentation.
Another mechanism to provide efficiency and convenience for the patient is the new Control Center, located on the first floor close to high activity areas. The Control Center functions similar to an “air traffic control” room. It is staffed with a variety of people representing key functions within the hospital. The area is designed for maximum communication and collaboration among the teams.
There will be multiple computer screens that will provide large visual displays of the various activities and flow of resources—patients, staff and key equipment. Bottlenecks in processing and movement of patients through the care continuum will be readily apparent and the Control Center staff will be able to quickly resolve issues. This will allow us to be much more efficient as we’ll see problems before they occur. The computer monitors will show us bed status: full, vacant, ready for cleaning; patients scheduled and waiting for discharge; expected completion times for surgical procedures; ER patient flow status, etc.
What does this mean for patients? It means less waiting time, more convenience and more time for personal care. For example, the Control Center can monitor patient wait status to ensure no one waits too long for testing. The necessary alerts will be displayed to the staff so they can provide efficient service. If surgical cases are running late, staff will be able to more effectively plan so resources of the OR and other support areas will be efficiently utilized, including communication to other affected physicians, patients and families. We’ll know on a real-time basis if we’re not performing at optimum levels and what the barriers might be. This knowledge will allow us to take the necessary action—e.g., deploy additional resources such as staff or equipment, and return the hospital to optimum performance levels.
Patient-focused clinical flow…
We also looked at clinical flow, from the patient’s perspective. One of our major goals from the beginning has been patient-focused care, creating convenience and comfort for our patients. We have effectively eliminated unnecessary trips within the new hospital for both patients and staff, starting with pre-op registration and diagnostic testing before surgery.
In the new hospital once the patient is registered and accompanied to their suite, clinical staff will come to the room for laboratory and other portable diagnostic testing. The goal is to minimize the amount of travel and disruption for the patient. We are also putting more services at the bedside. Due to the new hospital design of all private inpatient rooms, which are larger than our current rooms, we will be able to deliver more therapies at the bedside. This is an improvement for both patients and staff.
Please email me if you have any questions about the internal layout of the new medical center, or feel free to leave a comment here. We welcome your input!
My name is Bryan Daylor, and I am Vice President of Ancillary and Support Services at Eden Medical Center. I’m also on the “user” team that has had significant input on the design of the new Sutter Medical Center Castro Valley. Those of us who head up different functional areas at Eden worked collaboratively with our respective teams (consisting of managers, supervisors, staff and physicians) to determine the best way to improve the delivery of patient care in the new hospital by implementing industry “Best Practices.”
Our focus is on patient safety and quality of care, efficient patient flow and effective use of skilled resources. This work was an important opportunity to design a building that supports the process of care and enhances the experience for patients and caregivers. We were challenged with the puzzle of creating work space and flow in a new building, but in the end we feel we have achieved an excellent design for the new hospital.
It’s noteworthy that the replacement hospital for Eden will serve as a prototype for “best practices” operating models to be deployed to other Sutter Health affiliates that are building new hospitals of similar size and scope.
In the beginning…
When our user teams initially convened, the project size and scope had already been defined. We were challenged to look at how we do things today, and then be creative in how we could design this building to improve they way we provide care in the future. Some of the key goals of these teams were to look at quality and safety of care, efficiency for providers and an enhanced experience for the patient. All of these concepts had to be balanced with ways to drive down the operational cost of the hospital—hence efficiency! We looked at things like distances traveled by providers, adjacency of departments and services that work together, etc.
Acting as stewards of already-scarce resources, we decided that the hospital building would be designed for predominately clinical and direct patient care services, while almost all administrative functions would be housed in the adjoining medical office building. Hospital space costs more than twice that of regular medical office space to build and operate. So, our goal was to maximize clinical areas within the hospital and minimize the administrative functions. With the convenience of the connecting medical office building, placing the administrative services there helped us meet our budget goals without compromising the project or the future operations of the organization.
We deployed twelve different teams representing the various functional areas of the hospital, each looking at their role along the patient continuum of care and planning the layout of the hospital to support the care process. The user group contributed a wealth of knowledge that was invaluable to the development of the design of functional spaces for patient care.
Staff from all functional areas, including nursing, interventional services (surgery), sterile processing, radiology and imaging, women’s health, emergency and trauma, cardio-diagnostic testing, therapeutics, pharmacy, laboratory, and support services such as plant operations, facilities, food service, housekeeping and shipping & receiving, worked on the design of their respective units and then determined which services fit together. Efficient processing, and patient flow and experience, were key factors considered in these collaborative design sessions. Physicians from the emergency department, surgery, medicine, obstetrics and radiology also participated in the design discussions to ensure the efficiency of their part of the care process.
We worked with architects from The Devenney Group on the rough design of these areas, examining the most effective alternatives for organizing these services with consideration of services that are complementary to one another. The teams worked through several iterations of plans, building on the previous ideas and concepts from team members. The architects revised these layouts several times in draft form before a final schematic design was reached. This collaborative approach brought together years of healthcare delivery experience, as well as years of hospital and operational design experience to result in an efficient and aesthetically pleasing design that met Sutter Health’s project and budget goals.
The management team and physicians are proud of the work they have done and are excited to be a part of building the health care services of the future. Please feel free to comment here, or email me if you have any questions about the internal layout of the new medical center.
George Bischalaney, President and CEO, Eden Medical Center
Q & A with George Bischalaney, President & CEO, Eden Medical Center
We recently had an opportunity to talk with George Bischalaney, President and CEO of Eden Medical Center, about some questions that have been raised in the local community about the number of beds that will be available for patients in the new Sutter Medical Center Castro Valley. This is part of a series of Straight Talk with the CEO blog posts we plan to publish, that began with Mr. Bischalaney’s first post.
The questions from the community are in bold, with George Bischalaney’s responses below:
Why will the new Eden Hospital have fewer beds than the current hospital?
The current hospital was built in the early 1950s, more than 50 years ago. At that time, rooms housing more than one patient were the then current design. Since then, we’ve learned that it’s much more efficient to have private rooms for everyone. It’s better for patients, since they are not exposed to the illnesses of others, and it’s better for families, allowing more space and time with their loved ones, and better for hospital staff in caring for patients effectively.
The new hospital will have 130 private rooms, each designed in way that brings as much care to the bedside as possible. The hospital overall will be more patient-centric, and the patient rooms will reflect this philosophy in their design and in the future delivery of nursing care.
Will 130 beds be enough for our future needs?
We believe 130 beds are sufficient to care for patients as we envision hospital services in the near future. Concerns I have heard generally compare the current bed count to the proposed bed count in the new hospital. The fact is that there is not the significant change that most people perceive.
The current Eden Hospital building has 178 licensed beds. However, many of these beds are apportioned into specialty services. There are patient rooms, or beds, dedicated to obstetric patients, psychiatric services and three distinct critical care units.
The new hospital will continue to have a dedicated obstetrics service, but will not have beds dedicated to inpatient psychiatric services. There is a greater demand for outpatient service, which we also provide and will continue to provide in the future. We will dedicate one complete floor to critical care in the new hospital. This change will allow us to concentrate our critical care clinical providers more effectively and they will work more efficiently as a result. This will not only help reduce cost but will also improve the quality of care for our sickest patients.
We will have 90 general medical/surgical beds, all in private rooms in the new hospital, compared to 111 beds in the existing building, of which the vast majority are in two bed and four bed patient rooms. Multi-patient rooms are much less flexible, in that we cannot mix genders, patients with infections, nor do we want to put patients in end of life situations with other patients due to the greater needs of these patients and their families. None of these factors come into play with private rooms, making them much more efficiently used and reducing the overall need.
Today, patients spend less time in the hospital than they did even a few years ago. Patients now have surgery and go home the same day. Patients have babies and go home in two days. In both these examples, it was not unusual for patients to spend five or more days in the hospital in the past. Our single patient rooms will be utilized much more efficiently and therefore, fewer are needed.
What if there is a natural disaster—will you be able to take care of the community?
Any natural disaster could overwhelm our ability to meet the community needs. This is true of any public service, be it fire, police or hospitals. However, we feel that we are still positioned to respond appropriately if needed. One reason we believe this is the addition of something entirely new to our community, a 34 bed Universal Care Unit. While these are not licensed hospital beds, and therefore, are not included in the count of 130 beds, they are single patient accommodations that can be used to care for injured patients in a disaster situation. For every day use, they are meant to care for patients who stay less than 24 hours in the hospital, or who need a period of observation following treatment in the Emergency or Trauma Services. Therefore in a disaster response, we would have 174 patient stations available, in addition to the standard capacity in the Emergency and Trauma Services.
But wouldn’t it be better to have more than we need, knowing this area is overdue for a major earthquake along the Hayward Fault line?
No, that would be wasteful. Consider this—it will cost $2.5 million in total project costs for each new bed built in the new hospital. We also know that an unused bed, or room, has ongoing costs in maintenance and upkeep. It is estimated by industry experts that unused beds in hospitals have an average annual cost of $322,000. This is expensive space to have, “just in case.” Let’s not forget that ultimately, it is you and I who pay for this. Whether it’s through direct charges from the hospital when we use it, or in health insurance premiums, the costs are passed through to the buyers of health care services. We have an obligation to the community to build what the community needs, but in an efficient and cost effective manner for today and tomorrow. Remember, you don’t build a church just for Easter Sunday.
Additional questions and comments are welcome, in line with our comment policy. We will make every effort to respond within a few days.
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