Hospital Management: Realising the Benefits of Going Digital



Bryan Camoens
09/27/2010

Joe Hau, Head of Operations & Administration University Surgical Cluster, National University Health System, speaks exclusively to Pharma IQ's Bryan Camoens, on customer behaviour as well as Lean methodology of Value Stream Mapping.

Pharma IQ:  What are some of the key issues that need to be overcome when attempting to effectively manage influx and share patient load to ease and improve surge capacity?

J Hau:
It is crucial for the hospital to try to manage the inflow and outflow of patients. There are 2 key inflows of patients to the hospital 1) elective admission and 2) emergency admission.  While elective admission is within the control of the hospital, emergency admission is not.  Hence, there is a need to plan the elective list based on projections of emergency load throughout the year.  As for emergency inflow,  definitive treatment for the patients should start at Emergency Department (Emergency Department should ideally be equipped with the relevant diagnostic equipments eg. ultrasound, CT scan etc.).  Having a patient clinical observation unit at Emergency Department to house patients for 24hours will also help to alleviate the backlog of patients at Emergency Department waiting for inpatient beds.

As for outflow, it is vital for the hospital to build a good working relationship with stepdown care facilities (eg. nursing home and community hospital), as they play a vital role in ensuring seamless transition of care for the patients, and relieve beds from being taken up by patients waiting for stepdown care facilities.



Pharma IQ: What are some of the key challenges when trying to understand the behaviour and values of customers?

J Hau:
The customers(patients) demands are getting higher every year. While we strive to meet the demands of the customers, we also need to ensure that clinical quality and timely access to care is not sacrificed in the process. 

In this information era, patients ‘learn’ from a growing number of sources with varying validity. In addition to hearing from family, friends, and others who have experienced the surgery or treatment, patients can be influenced by conventional news sources and Internet sites with information of variable quality and potential bias or sensationalism.

Therefore, clinicians and caregivers need to be more comprehensive and holistic in their answer to patient’s queries.

One way to overcome this is to have a comprehensive patient education program. Patient understanding and involvement are central to optimal treatment selection and active patient role in treatment and recovery. This maximises patient benefit and safety. We should carefully communicate realistic expectations for the treatment plan and outcome.

Pharma IQ: In your opinion what needs to be done to when re-organising workflow processes to ensure timely patient transport and response times?

J Hau: I felt that the Lean methodology of Value Stream Mapping is a very good platform to base on for re-organising of workflow.  Sometimes in our haste to introduce new revamped workflow, we lose sight of the big picture –what is the value and benefit of this re-organising to the patients?

It is also critical that the hospital management has an overall strategic masterplan for its facilities, as many a time,  localised improvement and re-org in workflow may result in extra processes for other departments.

Pharma IQ: Please could you tell us the challenges faced when streamlining workflow processes and realising the benefits of going digital? 

J Hau: Each department has standard, fixed way of doing things, and most times, all these have been established a long time back.  As such, whenever changes and streamlining of work process are done, the department staff are resistant and skeptical of the changes. Therefore it will be wise that even before any changes are done, efforts are carried out to explain the benefits of the changes and get the buy-in from the ground.

By going digital, electronic medical record(EMR) helps with the standardisation of forms, terminology and abbreviations, and data input.  It also solved the issue of sharing of information, as when paper-based records are required in multiple locations, copying, faxing, and transporting costs are significant compared to duplication and transfer of digital records.

It is also critical to ensure that the development of standards for EMR interoperability between hospitals is considered at initial design stage.  By enabling the sharing of patient information across different hospitals, this will be another step towards health services that are timely, patient-centered and portable-care.