Community Needs Analysis Is Of Critical Importance

“Wishing and Hoping May Not Get us Where We Want to Go”

1

Thur., Oct. 22nd, 2015

Presentation Team and Introductions

• The Owner’s Perspective: Jeff Prochazka, Director of Strategic Planning, Methodist Health System

“Why Did We Do Our CHNA And What Are Our Needs?”

• The Architect’s Perspective: Patrick Leahy, Director of Planning, Research and Innovation for Holland Basham Architects (HBA)

“Do Architects Support CHNA’s and CON’s and FGI Efforts/”

• The Planner’s Perspective: Jim Easter, Principal, Easter Healthcare Consulting (Ehc)

“Isn’t Planning Changing to Asset Management and Dollars?”

• The IT/IS/Systems Perspective: Alan Dash, Principal, The Sextant Group

“How Will IT/Medical Communications Change our Vision for The Future?”2

Learning Objectives• O1: Some Historical Perspectives, Good or Bad, Here They Are

And Many Are Money Related.

• O2: Population Health Management Should Support Needs

Based Efforts, How Does that Work?

• 03: Who Benefits In This World of Needs Based Planning?

• 04: We Are Changing The Focus of Planning to Strategy and

Finance:• Why CHNA?

• Why CON?

• Why FMP?

• Who Wins?

• What Works Best? 3

Just A Little Background

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We’ve Seen So Much

Planning + In America, Why Is That The Case?

Needs Wants and Wishes Competitive Dynamics Cost and Economic Development Process Change and Consumer

Awareness Technology

TheCONProgram

TheDeficit ReductionAct And COBRAPlus Medicare

ThePPS for MDsAndHIPAA

TheBalancedBudget ActPlus CMS Reforms

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The Recent SupremeCourt Ruling

AndThe 2016

November Elections.

?

Sharing Ideas and Impressions(The Future Is Not Here Yet…Hard To Predict, Trends Are Easier To Manage)

• Regulatory Impact (ACA and Private Pay – ACO a little too fast…move toward Co-Management with MDs).

• Mergers, Acquisitions and Network Partnerships.

• Community Health Needs Assessment (CHNA).

• Certificate of Need (CON).

• Guidelines and Standards of Practice.

• Research and Regional Implications.

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Summary of Todays Discussion

A Basic Trend Of Doing“More With Less”

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1. Different Types of Beds and More Ambulatory Care2. Improved Access, New Processes and Better Design3. Enhanced Efficiency and Cost Reductions

What Are The Consumer Benefits?

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1. Shorter Waiting Times.2. Convenient Access Through Better Pre-Arrival Work

Up and Preparation Efforts.3. Better Wayfinding Less Waste.4. Improved and Safer Access plus Handicap and HIPAA.5. Right Sizing and Right Treatments = Less Costs.6. Best Services Not Always Most Revenue (Emergency)

Summary of Today’s Discussion

Key Elements of a CHNA ProcessIntegrated Strategy and Master Plan(Market Share, Capital Budget, Space Needs, Master Plan, Process Change)

Partnership Effort On Strategy and Process

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Process Change and New Technology(We Are Learning Together)

Teamwork Is MandatoryHow The CAH/CHNA Links Providers With Overlapping Objectives Into the Service Area (Why Do We Need This Intensity of Effort?):

• FQHC and Primary Care Patnerships

• Acute Care Partner

• Fulfilling the Hospital’s Mission and Vision Via Partnership With Care Receivers And Other Providers (City, County, Federal, Public and Private)

• County Health Department

• Local Nursing Care Centers

• Mental Health Association

• Correctional System

• Pharmacy

• Local Practitioners

• Public School System

• Business Community

Our Responsibility.

Who Involved? Why?

Incentives?10

CHNA – An Overview

• New (2010) Requirements for most Tax Exempt

Hospitals (2,894 of total 4,999)

• Dual eligible (federal NFP) not required to provide

• While required, should be viewed as a useful tool to

determine vulnerable populations and health disparities in

the community

• Most hospitals haven’t utilized the information other than

to meet requirements

• Next wave of assessments to be conducted in 2016 (for

2015) 11

Key Elements of a CHNA Process

1. Data Assessment

- Service Area

Defined

- External and

Internal Sources

- Local Studies

- Community

Inventory

2. Community Input

- Public Health

- Underserved

Populations

- Chronic Disease

Populations

- Others

3. Implementation Strategy

- Summary of Data and

Community Input

- Prioritizing

- Implementation

Strategy for Each

- What is NOT included

and Why?

4. Reporting

- CHNA Summary

Report

- Implementation

Strategy Board

Approval

- Posted on Website

- 990 Reporting

5. Monitoring

- Measurements

- Annual Data

Updates

- Prepare for the

Next CHNA

What do we know? How do we package the

final material?

What are the priorities and

how do we implement?

What are we hearing?

What are we doing to track

results?IRS AuditOf Gaps!

Community Planning – CHNA

Partnership Effort On Finance, Needs and Strategy

Must ShareThe DataTo Work

Effectively!12

ACO Timeline

2007

Elliott Fisher of Dartmouth Medical School publishes “Creating Accountable Care Organizations: The Extended Hospital Medical Staff.” He is generally credited with coining the phrase “Accountable Care Organization.”

2011

• 3/31/11: CMS releases its proposed rules for the “Shared Savings Program,” inviting commentary before rules are finalized.

• 6/6/11 Comment period closes.

• Final rule will be released after all comments have been reviewed.

• CMS will accept applications for ACOs and will approve or reject by 12/31/11.

2014

All first year ACOs will have reached the shared risk stage, if they have continued with the Shared Savings Program.

Beyond2010

PPACA signed into

law

• Outlines a “Shared Savings Program.”

• CMS will determine how this program is to be implemented.

32 Around USA But 1/3 Dropped Out 13Supreme Court Ruling Has Impacted Many Service Delivery Programs.

Keys to Success

Successful Co-

Management Agreement

Transparency

The Necessary

Tools

A Clearly Defined Plan

Service Line Expert

Established Expectations

Physician Leadership

Active Participation

Future Physician RelationshipsEmployment + Co-Management

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Assessing “Common Good” In Society• Understanding the Basic Business Planning Principles That

Have Common Value Across The Board:• Access, Linkages and Referrals – Time Is Life Saving and Expensive

When Wasted. No • Nebraska Map of distances between hospitals.

• Longer Term Implications for access and connection.

• Partners with Federal Agencies

• Partnership With City/County Leadership

• Collaboration With Utility Providers (Water, Sewer, Electrical)

• Collaboration With Real Estate and Urban Planning

• Selecting key Consultants to Support CAH15

Nebraska Systems Are Working

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93 Counties90 Hospitals

64 CAHs6 FQHCs

2 Investor Owned 2 Medical Schools

Strategy + $ + Architecture

• Strategic Planning, Facility Master Planning and Detailed Functional Programming

• Staffing, Quality and Change Management (Hospitalists, Intensivists, Robots, Scribes, Technology, Extenders)

• Step-by-Step Process Following Basic Needs Analysis• Part of a Justifiable Business Plan• Road Map With Options And Detours• Vision

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Opportunity +

• Innovation and Creative Considerations:• Ambulatory Care Options For Small and Rural Communities• Shifting to Free Standing Emergency Centers, Ambulatory

Surgery Center and Primary / Visiting Specialist.• Creative HealthParks• Greenhouse Design for Senior Care• Memory Care and Assisted Living• Congregate Care Via The Full Continuum

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Key Questions• How Will Population Based Health and Integrated

Delivery Systems Impact Technology?

• Why Would “Needs Based Efforts” Apply In The Technology Arena?

• What Are The Asset Implications Of An Integrated Healthcare Delivery System?

• How Will Rural Health Services Change Over Time?

• Will IT Programs For the Future Show An ROI and What Are The Potential Savings?

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A Planning Perspective From Need, to Region, to Rural, to

The Front Door.

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Shift From Building Master Planning (MP) to Integrated System-wide Master Planning:

Consolidation Efforts (Impact of MD Employment and Extender Efforts)

Demolition (Combined With Preservation In Some Cases)Community Linkages and Continuity of Care (Needs Based and

Population Health)Real Estate (Re-Alignment of Assets Using Technology and Creative

A/E Design plus Energy is Expensive)Process Improvements (Modular Design, Waste Reduction, Efficiency

Metrics – HCA FacilitiGroup and Ascension Medexcel+ Trimedx Biomedical Support Program)

Technology (EMR, Digital, Remote Telemedicine and Robotics)

Why: More Effective Care With Better Access/Consolidate. GPS,

Onuma, Trelligence and Revit for A/E and IPD applications.

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Rural Health and Shifting Service Delivery DynamicsCAH Transition (25 + 10 Utilization Shifts). ADC = 8+/-CAH Move to Free Standing ED and Post Acute ModelHealthPark Applications With Modular and Flexible

Components (Re-Alignments and Re-Purposing for Efficiency Purposes)

Rural Health Linkages to Post Acute, Rehab, Nursing Home, Assisted Living, Memory Care, etc.

CAH Partnerships and FQHCs, Medical Home Models,TeleMedicine, Robotics, Centralized Clinical Support

Centers (Clinical and Asset Implications)Leveraging Regional Partnerships and Economic Development (City, County, State, Public Health,

Industry and Family)

Why: Rural Areas Are Changing, It Is Time To Change.

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Emergency Medicine (Industry-wide Trends)No Waiting Emergenuity ModelFree Standing EDs (Trend Driven) Free Standing ED + HealthPark Support ServicesRetail Medicine (Jury Still Out0Process Change and Training plus Performance Focused Clinical Pathways (SA, Children, Seniors, Cardiac)Enhancement of Efficiency + IncentivesRural and CAH Partnerships (Impact of FQHC Programs)

Why: Advanced, Less Expensive, Higher Quality Service Delivery Plus ED’s Need To Be BetterTeam Members. Stronger Data Interface.

3

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• Understanding The Dynamics and The Situation

• Changing Systems, Processes and Methods

• Community Linkages plus Demands

• Cost Reduction, Waste Reduction and Change

• Real Estate Re-Alignment and Savings (Energy, Rent, etc)

Integrated System-wide Master Plan(Full Continuum, Multiple Sites, 30,000 Foot Perspective)

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Integrated Systems and NetworksWith Implications For The Provider

IntegratedCollaboration

Clinical IntegrationWork Flow Mapping

(Process)

Master Planning Strategy

Architecture EngineeringConstruction

EPICCompliance

Follow Through

With Facility Linkages

TelemedicineePharmeImageeUrgent

Long Distance – Video Conference/Consult

Master Planning Process

Integrated System-Wide Planning

• Strategic Re-Alignment• Location and Needs• Highest and Best Use• Convenience• Efficiency

Clinics In The Right Location For TheRight Reason, the Right Cost, Right Sequence

and Appropriate Need.

NewTower

Specialists

ClusterServices

ClusterServices

ClusterServices

ClusterServices

ClusterServices

4-94-9

4-9

4-9

4-9

4-9

4-9

4-9

4-9

4-9

4-9

4-9

4-9

H4-9

Integrated System-wide Master Plan(Full Continuum, Multiple Sites, 30,000 Foot Perspective)

1. Situation, Mission, Vision, Goals and Objectives

2. Cultural Work Up + Data Collection

3. Asset Work Up, Inventory + Image + Updated Plans

4. System Work Up, Capacity + Conditions

5. User Perspectives, Daily Situation, Concerns

6. Consumer Perspectives, Patient and Family

7. Clinical Perspectives + Needs plus Physician Input

8. Size, Time, Money and Priorities + Phases of Change

9. Debt Capacity

10.Decisions + Action 27

Operations + Assets + People(Strategy, Buildings, Systems, Access, Process and Economics)

OldFragmentedObsoleteLow TechPoor EnvironmentNon – CompliantInefficientWrong LocationImageSafety

PartnershipsResource Re-Alignment

System UpgradesSmaller

Higher CapacityLess Maintenance Dollars

Shorter StaysFriendlier Staff

Safer + Modular + FlexibleSMARTER ARCHITECTURE

Program + Master Plan = Design

Excellence

The Architectural Program should be a key

aspect of the hospital campus master plan (MP).

The precursors to programming include: Owner and User Orientation to Process

Establish a Planning and Programming Leadership Committee

Completion of a Strategic Plan (Usually by Staff or Consultant)

Completion of a Campus Master Plan (MP) By Healthcare Consultant/Architect

Completion of Building Gross Program (All Departments Sized Using Various Methods)

Formal Approval of the MP and the First Phase Projects to be Programmed

Ideally, the Departments Are Programmed

Simultaneous With the MP

Process…Better Results! (Often a Fee Issue With Owners) 29

What is Programming in a Traditional Sense?

A PROGRAMMING MATRIX FOR HOSPITAL PLANNING

GOALS FACTS CONCEPTS NEEDS ISSUES

FUNCTIONMission Statistical Data Service Groups Space Requirements Unique and important

Maximum Number Area Parameters Departmental Groups Room By Room Performance standards

Individual Identity Manpower/Workloads People Groups Equipment that will ultimately

People Interaction/Privacy Utilization Trends Special Activities Systems/Services shape/drive function and

Hierarchy Of Values User Characteristics Priority Parking Building design.

Activity Security Community Security Outdoor Spaces

Progression Value of Loss Sequential Flow Building Efficiency

Relationships Segregation Time/Motion Studies Separated Flow Functional Alternatives The existing building is

Encounters Behavioral Patterns Linkages/Networks obsolete...should be

Efficiency Space Adequacy Separated Flow replaced.

Mixed Flow

Relationships Can't recruit physicians

FORMSite Elements Site Analysis Enhancement/QA Quality (Cost/SF) Major considerations that

Site Land Use Climate Conditions Climate Control Environment and Site will ultimately impact

Property Ownership Code Survey New Image/Character Influences On Cost building function and

Environment Neighbors Engineering Survey Safety design quality.

Individuality Soils Analysis Special Foundations

Quality Direction FAR/GAC Density

Access/Egress Surroundings Interdependence The building is in the wrong

Image Physiological/Psychol. Home Base Location

Quality Level Cost/SF Network

Efficiency Orientation/Access No land available nearby.

ECONOMYAmount Of Funds Cost Parameters Cost Controls Project Budget What is the general attitude?

Return on Investment Maximum Budget Allocation Of Resources Operational Costs related to the initial budget

Cost Effectiveness Time-Use Factors Multi-Functional Debt Capacity expectations and real project

Initial Budget Operational Cost Market Analysis Merchandising Life Cycle Costs cost and that relationship

Capital Costs Income/Reimbursement JV/Investment Energy Costs to project quality standards?

Operating Costs Maintenance Energy Source/Costs Energy Conservation Loan Capacity

Capital Expenses Economic Data Cost/Benefit Reserves

Life Cycle Life Cycle Reductions Competition

Equipment Activities/Climate Design Related Groups

Systems/Energy Historical Position Capital Cost Pass Through

Automation Credit Rating

TIME Preservation Significance Adaptability Escalation Implications Of Change, Growth

Master Plan Behind/Ahead Phased/Staged Phasing Plan on the overall long-range

Past Static/Dynamic Space Parameters Tailored/Loose Fit Workplan performance of service

Change Activities Convertibility

Present Growth Projections Expandability

Controls/Limits Linear Schedule Concurrent Schedules Leadership is key

Future Occupancy Date Progress Interchangeability

Revenue Streams Limiting Factors Fast Track Conservative leadership today.

What Is The Statement Of The Problem....Opportunity?

To create a more

efficient hospital

Zoning requires a 50’ set back with

a 5 story max. height

The budget is $50 M total project cost.

Funding?

Use a CM and prepare early

release packages will help us open

quicker

What does LEED gain our

community, building users

and staff?

Doesn’t it Cost more to achieve the LEED status?

We’ve converted

to CAH, now we

must down-size

We prefer the

PlanetreeConcept

Is

GreenhouseDesignMore

Expensive?

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Integrated ProjectDelivery (IPD)

Is On The Horizon

For The Future.

Beginning Our

Capital Campaign

$

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Other Site Plan

Studies For

Campus Plan…

Location

Access

Growth

Image

Value

ROI

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Simply Stated “Rural Health Will Be About Doing More

With Less And More Creatively”What Does This Mean Architecturally and More Importantly,How Do We Plan for The Changes?

What Will the Buildings Look Like and How Are They StructuredTo Be Cost Effective, Efficient and Less Wasteful?

Who Are The Primary Stakeholders and What Must They Do to Survive?

Are There Trade Off’s?(Yes, There Are A Few)

Partner Or Co-Manage Or New ManagementAdd + Expand Services

(Geriatric Psych, Memory Care,LTC, Senior Care, Post Acute Rehab Care)

Consider Linkages RegionallyProcess Improvement

Expert Coaching and DirectionExtenders, NPA’s, IT Leadership

Master Plan AssetsStrategic Shift In Direction

The Rural Health Situation(CAH, Step Down, Post Acute, ED, Free Standing ED orPossibly Innovative HealthPark Model; Less Costly and No Waste)

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B Model – M odest Reductions

M ASTER ZON IN G (M Z)

Conceptua l Design Our MP studies have illustrated the OPTIMUM HEALTHPARK but not a “precise application” on behalf

of the TRHMG smaller versions that may be more applicable to suburban and rural areas. In order to

prepare the prototype models, one must make some “gross assumptions” . In this case, we will TEST OUR

concepts with staff early in 2013 (scheduled for February briefings at this time).

Prototype M odels Plus Smaller Components

The development of these models is actually a reasonable way to begin a “prescriptive and iterative

process” which provides both CASE STUDIES and illustrative models that may be creatively adapted to the

TRHMG/ TRHMC regional services. Changes will occur as the MP process evolves due to the system-wide

adjustments in staffing, IT system enhancements and process improvements. These models will combine all

the existing services and “ test” as mentioned previously, new linkages that may not be readily apparent at

the onset. Briefly, each model; the A Model -- Full Scope, B Model -- Modest Reductions and C -- smaller

model all move toward the preferred groupings identified at the start of the MP process. (see representation

at left).

Each illustration decreases in size from 82,547 GSF to 49,586 GSF and finally, 33,988 GSF. The Excel

back up programs have been designed to permit a “careful and methodical selection” of rooms and

services that ultimately build the “preferred prototype” project. Smaller versions of these models can drill

down to the very basic services for example, the following:

A 9 E/ T Physician Clinica l Practice (No Diagnostic Support) New Construction:

o 10,070 BGSF (1,119 per MD)

o $2.0 to $3.0 M Total Project Cost Including All New Equipment

A Free Standing 6-Room Urgent Care Center Only:

o 5,710 BGSF for 6 Rooms plus Support

1. $1 - $1.5 M Total Project Cost Including All New Equipment

C Model – smaller model

Scope

A Model – Full Scope

A Model – Full Scope

Scope

A Model – Full Scope

Models Developed By Function and

ProportionalTo Need, Scope and

Situation.

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Imaging

ASCSurgery

Pre/Post Recovery

Lab

Women’sService

FSED or Urgent

Care

Pharm

PhysicalRehab/Fitne

ssCompMed

InfantCare

Co

nco

urs

e o

r M

all

MO

BC

afet

eria

CommunityEducation

Eng

SleepCenter

“A Clinically drivenAnd ACO FriendlyCenter”

“Outpatient = Instant Referral”

Spa

ALot of

Parking +ADA

spaces

ConvenienceOptimumVision + GrowthDirectionImpressionsHealthPlace FitnessAlready An IssueRegional ImpactClinical Pathways:

-Seniors-Women-Infants-SA/Pain/Addicition-Education -Prevention

Spiritual

WellnessCtr

CommunityOutreach

ALot of

Parking +ADA spaces

An IDS Friendly HealthPark With ED Hub

Retail:

PharmacyDME

CosmeticApparelPodiatricWellness

Other

An Important Rural Opportunity!Less Expensive + More Appropriate.It’s About The Outpatient Package.

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The ED Is The WindowTo The Community

(Demand, Exchanges, Convenience, Portal of Entry, Poor PC Support)

LastingImpressions!

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Key Drivers Of Change

• No Wait ED (Never The Patient)

• Bedside Triage/Registration

• Immediate Care In Rapid Assessment Unit (RAU)

• Tests/Treatment/Disposition Within An Hour

• Internal Disposition Area For Vertical Patients

• Functional Roles For Clinical Staff

• Performance Metrics Driven Model

Emergency Department Process Change.

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High Capacity Unit

Fewer Filters - Patients Go Directly To ED Bed Immediate Nursing Assessment

Immediate Physician Assessment

Bedside Registration

Registration

Triage

Waiting Room

Main EDFewer ED FiltersNo WaitingNo LWOBS

Decreased Time Provider

Greeter

Rau

IDA

Holding Patients

Improved Process Changes

Decision Made On Need For “Stretcher Time”

Patients That Do Not Need Stretcher To IDA

Patients Requiring Complete Work-ups To Main ER

Super Track Process Map – Split Flow State

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Traditional Capacity / Demand Analysis

Recommendation:29 Beds Currently40 Regular Beds Recommended

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RME Model – Results Waiting

Recommendation:29 Beds Currently32 Beds-9 Chairs Recommended(Less Space Required Based on Function)

Re-design staff work spaces to support activities

Concentration

Consultation

Collaboration

Standardization & Innovation

• Standardized modules support efficient throughput• Modules support patient care pods / zones

images: Herman Miller Healthcare

Adaptive Environments & Innovation

• Design total work environment based on activities, needs & technology

Standing/TouchdownSeated SpacesVirtual Collaboration SpacePACS StationCopy / Fax StationSpecialty Carts

Adaptive Environments & Innovation

• Configuration supports efficiencies & reduces steps

• Lower support core enhances visibility

• Adaptive environments support process change & reconfiguration

• Medications, digital images & supplies easily accessed

• Partial height panels support ‘on-stage / off-stage’ activities

Business Performance Enhancements

LEAVE WITHOUT BEING SEEN (LWOBS)REGAINED PATIENT VOLUME

ADMISSIONS INCREASED ED ADMISSIONS &

REDUCTION IN DIVERSIONS

ANCILLARY TESTING INCREASED OP DIAGNOSTICS

OBSERVATION STAYS/RE-ADMISSIONSAVOID PENALTIES/2 MIDNIGHT RULE

.26% $1.87 M GAIN

157

PAT.PER DAY $2.63 M GAIN

MORE TESTING REVENUE

REVENUE

OPERATIONAL IMPROVEMENTS

TRADITIONAL

MODEL

HIGH

PERFORMANCE

MODEL

2.6%

149

PAT.PER DAY

LESS TESTING REVENUE

REVENUE

Case Study

Economic Impact

FACILITY PERFORMANCE ENHANCEMENTS

CAPITAL IMPROVEMENTS LESS OVERALL AREA REQUIRED

MEDICAL EQUIPMENT SAVING FEWER ROOMS BEING EQUIPPED

FURNISHINGS/EQUIP. SAVINGS PERMANENT BUILT VS. ADAPTABLE

FURNISHINGS DEPRECIATION LONG TERM VS. SHORT TERM

FACILITY IMPROVEMENTS

$8 MIL

MORE REQUIRED

MORE REQUIRED

30 YEAR

$6 MIL

LESS REQUIRED

LESS REQUIRED

7 YEAR

TRADITIONAL

MODEL

HIGH

PERFORMANCE

MODEL

CASE STUDY

Economic Impact

OPERATIONAL PERFORMANCE ENHANCEMENTS

OVERAL SATISFACTION

DOOR TO DOC TIMES

WAITING ROOM USAGE

CAPACITY DIVERSIONS DECREASED

40th PERCENTILE

60 MIN

ON AVERAGE

90% OF TIME IS FULL

700 HRS/YR

90th PERCENTILE

< 20 MIN

ON AVERAGE

90% OF TIME IS EMPTY

200 HRS/YR

( 0 HRS IN YEAR #2 )

FUNCTIONAL IMPROVEMENTS

TRADITIONAL

MODEL

HIGH

PERFORMANCE

MODEL

CASE STUDY

Economic Impact

STAFFING PERFORMANCE ENHANCEMENTS

NURSE PRODUCTIVITY EXTENDERS/MIDLEVELS/RECRUITMENT

STAFF SATISFACTION RETENTION & RECRUITMENT

ROLES AND RESPONSIBILITIESREALIGNMENT IMPROVEMENTS

PRODUCTIVITYSCRIBES /RESIDENTS/INTERNS

THRU-PUT BARRIERS

FRUSTRATION

RATIO NURSING

MULTIPLE RESPONSIBILITY

LEAN PROCESS

SATISFACTION

PRIDE

FUNCTIONAL NURSING

LEVERAGED RESPONSIBILITY

STAFFING IMPROVEMENTS

TRADITIONAL

MODEL

HIGH

PERFORMANCE

MODEL

CASE STUDY

Economic Impact

Economic Impact

LEAN OVERALL PERFORMANCE

STAFFING BURDEN

BUILDING AREA26,800 ED+

23,400 ED ONLY

24,000 ED+

20,600 ED ONLY

10% REDUCTION IN ED +

12% REDUCTION IN ED ONLY

16% INCREASE IN CAPACITY

EMERGENCY

DEPARTMENTINCLUDING: DIAGNOSTICS, OBSERVATION &BEHAVIORAL

HEALTH

TRADITIONAL

MODEL

HIGH

PERFORMANCE

MODEL

LARGER DEPT.

= MORE STAFF

SMALLER DEPT.

= LESS STAFF/

LESS STEPS

CASE STUDY

PERFORMANCE MODELKEY BENEFITS

OPERATIONAL• THROUGHPUT/EFFICIENCY/FLEXIBILITY• VOLUME/GROWTH• COMPETTION/MARKET SHARE

FINANCIAL• ROI/REDUCED OPERATING COSTS/VALUE BASED• MARKET SHARE• REIMBURSEMENT

CAPITAL INVESTMENT

• MEASURED INVESTMENT• VALUE BASED VS VOLUME BASED• REDUCED CAPITAL EXPENSE/OUTCOME DIRECTED

DELIVERY

• EFFICIENT/FRIENDLY/SAFE/SECURE• RESPONSIVE• PATIENT RESULTS ORIENTED

The Patient 1st.

Thank YouQuestions, Thoughts and Suggestions

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