NJ hospital turns structure upside-down
NJ hospital turns structure upside-down
Goal was to improve quality, continuum of care
It took Atlantic Health System of Florham Park, NJ, about 18 months to gain post-acute employees' trust after a switch from a traditional bureaucratic style to the new age of team management.
"We wanted to provide as much care as a patient needs in the most cost-effective way, in the most appropriate level, and the way to do that was to change our organizational structure," says Susan Brady, RN, MSN, director of post-acute services, including a rehabilitation facility, two nursing homes, and other Atlantic Health System services.
The health system eliminated post-acute departments and told employees that they no longer needed directors, supervisors, and managers. Some people chose to leave, but many gradually adjusted to the change, Brady says.
"I can't overemphasize how difficult it was for the staff," Brady says. "We really changed major philosophies to get people to understand the benefit of it."
However, the benefits of eliminating duplication and reducing costs outweighed any of the difficulties in implementing the new organizational structure, Brady says.
"This allows us to manage the care for people in the communities we serve so they are not fragmented, and that's a good position to be in for both managed care contracting and capitation," she adds.
Anytime an integrated delivery system or major health system makes an organizational change like this, it will require some extensive planning and staff training. Brady explains how Atlantic Health System made this transition and how other health systems might do the same:
· Form interdisciplinary teams.
In the old system, each department kept its own patient schedules and held its own meetings. "Our care was delivered in a way that met the needs of the department, so when we started this integrated system, that was the first thing we changed," Brady says.
Now, when someone needs therapy there is an interdisciplinary team providing the care. The team includes nurses, a physician, a social worker, and therapists. They work with patients and families, identifying what they need to do in order to go to outpatient rehabilitation or to home care, Brady explains.
"Traditionally, we would keep patients admitted until they were perfect, and now we focus on what we need to do to move them to the next level of care," Brady adds. "The interdisciplinary team makes the decision on who delivers that care."
· Train staff to be self-directed.
The health system eliminated positions for directors and supervisors and created positions for the manager of inpatient services and manager of continuum of care.
Some of the former supervisors and directors became new managers, and others returned to clinical work. Still others chose to leave the health system because they didn't agree with the new philosophy, Brady says.
Therapists, nurses, a physiatrist, and other employees formed into teams that work together to provide clinical management. Teams are involved in hiring and interviewing new employees, and they make schedules and provide peer review. Teams also help with managing budgets.
The health system's organizational development department met with employees to train the new teams.
"In the beginning they were not sure they really had permission to make those decisions," Brady says. "But it's been a tremendously positive experience, and when they started doing it, they saw how well it worked."
With practice, employees have become empowered through the teamwork and through not having supervisors making policy and patient care decisions for them, Brady says.
"It really has put the care in the hands of the people who deliver care," she says.
Both patient satisfaction and employee satisfaction surveys have been outstanding, Brady adds. The only negative aspect has been that the training process took longer than expected, Brady says.
· Move walls; eliminate offices.
Previously, the hospital had separate offices and separate work areas or gym treatment space for physical therapists, occupational therapists, and nurses.
Under the organizational change, those separate areas have been eliminated. Instead, Brady says, the hospital has a team work area where several disciplines may interact and work together with patients.
Also, physical therapists and occupational therapists work together in one patient treatment area, so the patient only has to go to one place instead of two different gym areas. This makes it patient-focused, and it meets the needs of the patient.
· Form partnerships with a continuum of providers.
"We saw health care moving away from acute care hospitals, so we identified early on that we needed to look at post-acute services as a major initiative of the system," Brady says.
First, health system administrators spent time defining post-acute services, including subacute care, home care, hospice, ambulatory rehabilitation services, long-term care, and skilled and assisted living.
"Then we said, 'We don't have all those pieces within Atlantic Health system, so do we need to own them all, buy them, or find partners?'" Brady explains.
They decided partnerships with other providers would be the most economical solution.
For example, the Atlantic Health System owns two nursing homes, but those are not enough to fill long-term bed needs of its patient population, Brady says.
The health system has formed a partnership with a company that provides post-acute services, including nursing home beds and adult day care. A patient may be discharged from an acute care bed to a nursing home bed owned by a partner, and ultimately to an outpatient facility or home care service owned by the health system, Brady explains. Atlantic Health System and its partners would work together to move patients through a seamless continuum of care.
"We don't want vendors, we want partners, someone committed to providing the level of care we want to provide," Brady says.
· Invest in information systems.
The other changes were fairly inexpensive. But the installation of an information systems program is a huge capital investment, Brady says.
Atlantic Health System is still working on this component, which is integral to the health system's new organizational structure and continuum of care, Brady says.
"You need information systems that let you track patients across different levels," Brady adds. "If I want to look at the whole patient care delivery, then I need to have all levels talk to each other and that's a monumental task."
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