Jefferson Hospital Uses an Agile Approach for Unassigned Patients

Jefferson Hospital in Jefferson Hills, PA, is utilizing an agile approach to their strategic decision making, which is proving to be highly effective. They are tackling critical issues with a one-two punch – speculate, then iterate.

Speculate means “to infer, theorize, or predict from incomplete or uncertain evidence,” according to Webster’s New World College Dictionary. Sounds reckless; however, in the complex and uncertain environment of healthcare, there is much we don’t know and have limited control over. So ignoring the ambiguity rarely leads to the best solution and often results in wasted time and effort.

Essentially, the Jefferson team “speculates” or creates a hypothesis about a situation. Then, using good scientific practice, they test their theory in quick, iterative steps. As a result, they quickly learn if they are heading for success or if they should pivot in a more fruitful direction.

“The analysis saved us both time and money because we avoided going down the wrong path for the wrong reasons.”

Mary Carol Limegrover, is an IT professional at Jefferson Hospital who focuses on enterprise reporting and analytics for operational improvement. She recently led an agile work group to identify ways to lower the Inpatient length of stay (LOS). They started by “speculating” on the top factors that contribute to longer stays.

One factor the group identified was unassigned patients, who are people who do not have a primary care physician and are admitted through the Emergency Department. This happens on a regular basis at Jefferson. The work group had a hunch that the unassigned patients had longer stays because their medical history was not readily available and they were not receiving regular care from a PCP. The team also had ideas on improvements. If this patient population was a driving force in a higher-than-expected LOS, they could make adjustments in the on-call physician assignment process. Or perhaps it was time for a hospitalist program. But these were substantial efforts to undertake.

So they tested their theory first. They wanted to see how the LOS differed between assigned and unassigned patients trended over the last two years so they turned to Polaris Strategic Solutions to extract and report the data. The results surprised them all – the unassigned patients actually had shorter stays consistently as shown in the chart below.

The work team was able to examine multiple iterations – drilling down into outliers, filtering out variations and comparing their results to CMS’ Geometric Mean LOS to normalize the inherent variability of their case mix. But the conclusion remained the same – unassigned patients were not the most important contributing factor to a higher LOS.

The work group reported their findings to the administration. As a result, the team has quickly adjusted their focus to the next hypothesis and is now examining service lines as a contributing factor to Inpatient LOS. Once again Polaris was able to show them the top 3 service lines with LOS greater than expected when compared to the Geometric Mean LOS.  This new direction is showing great promise.

“The agile approach gives us great speed-to-value in our decision-making” says Ms. Limegrover. “Of course, a flexible, responsive decision support capability is essential, too. We couldn’t have done this before we became customers of Polaris Strategic Solutions. We just didn’t have the capability. The Polaris team is great. They are fast and thorough – presenting the information with clarity for us. They really understand hospital operations and data so their advice is invaluable.”

Richard F. Collins, Jr., MD, Executive Vice President and Chief Medical Officer at Jefferson Hospital, agrees. “The analysis of unassigned patients was worthwhile. It saved us both time and money because we avoided going down the wrong path for the wrong reasons,” says Dr. Collins.

What’s next for Jefferson Hospital? Mary Carol is already tackling projects on observation patients and length of stay on weekends. “We are definitely using the agile approach with decision support from Polaris. It works,” she says.