A Multidisciplinary Initiative to Increase Inpatient Discharges Before Noon.

OBJECTIVE: The aim of this study is to evaluate the effect of 2 hospital-wide interventions on achieving a discharge-before-noon rate of 40%. BACKGROUND: A multidisciplinary team led by administrative and physician leadership developed a plan to diminish capacity constraints by minimizing late afternoon hospital discharges using 2 patient flow management techniques. METHODS: The study was a preintervention/postintervention retrospective analysis observing all inpatients discharged across 19 inpatient units in a 484-bed, academic teaching hospital measuring calendar month discharge-before-noon percentage, patient satisfaction, and readmission rates. Patient satisfaction and readmission rates were used as baseline metrics. RESULTS: The discharge-before-noon percentage increased from 14% in the 11-month preintervention period to an average of 24% over the 11-month postintervention period, whereas patient satisfaction scores and readmission rates remained stable. CONCLUSIONS: Implementation of the 2 interventions successfully increased the percentage of discharges before noon yet did not achieve the goal of 40%. Patient satisfaction and readmission rates were not negatively impacted by the program.

Lean Manufacturing Improves Emergency Department Throughput and Patient Satisfaction.

A multidisciplinary team led by nursing leadership and physicians developed a plan to meet increasing demand and improve the patient experience in the ED without expanding the department's current resources. The approach included Lean tools and engaged frontline staff and physicians. Applying Lean management principles resulted in quicker service, improved patient satisfaction, increased capacity, and reduced resource utilization. Incorporating continuous daily management is necessary for sustainment of continuous improvement activities.

Effects of organizational and professional identification on the relationship between administrators' social influence and professional employees' adoption of new work behavior.

Administrative social influence is a principal tool for motivating employee behavior. The authors argue that the compliance of professional employees (e.g., doctors) with administrative social influence will depend on the degree to which these employees identify with their profession and organization. Professional employees were found to be most receptive to administrator social influence to adopt new work behavior when they strongly identified with the organization and weakly identified with the profession. In contrast, administrator social influence was counterproductive when professional employees strongly identified with the profession and weakly identified with the organization.

Lean-Based Redesign of Multidisciplinary Rounds on General Medicine Service.

BACKGROUND: Multidisciplinary rounds (MDR) facilitate timely communication amongst the care team and with patients. We used Lean techniques to redesign MDR on the teaching general medicine service. OBJECTIVE: To examine if our Lean-based new model of MDR was associated with change in the primary outcome of length of stay (LOS) and secondary outcomes of discharges before noon, documentation of estimated discharge date (EDD), and patient satisfaction. DESIGN, SETTING, PATIENTS: This is a pre-post study. The preperiod (in which the old model of MDR was followed) comprised 4000 patients discharged between September 1, 2013, and October 22, 2014. The postperiod (in which the new model of MDR was followed) comprised 2085 patients between October 23, 2014, and April 30, 2015. INTERVENTION: Lean-based redesign of MDR. MEASUREMENTS: LOS, discharges before noon, EDD, and patient satisfaction. RESULTS: There was no change in the mean LOS. Discharges before noon increased from 6.9% to 10.7% (P < .001). Recording of EDD increased from 31.4% to 41.3% (P < .001). There was no change in patient satisfaction. CONCLUSIONS: Lean-based redesign of MDR was associated with an increase in discharges before noon and in recording of EDD.

Patient web services integrated with a shared medical record: patient use and satisfaction.

OBJECTIVES: This study sought to describe the evolution, use, and user satisfaction of a patient Web site providing a shared medical record between patients and health professionals at Group Health Cooperative, a mixed-model health care financing and delivery organization based in Seattle, Washington. DESIGN: This study used a retrospective, serial, cross-sectional study from September 2002 through December 2005 and a mailed satisfaction survey of a random sampling of 2,002 patients. MEASUREMENTS: This study measured the adoption and use of a patient Web site (MyGroupHealth) from September 2002 through December 2005. RESULTS: As of December 2005, 25% (105,047) of all Group Health members had registered and completed an identification verification process enabling them to use all of the available services on MyGroupHealth. Identification verification was more common among patients receiving care in the Integrated Delivery System (33%) compared with patients receiving care in the network (7%). As of December 2005, unique monthly user rates per 1,000 adult members were the highest for review of medical test results (54 of 1,000), medication refills (44 of 1,000), after-visit-summaries (32 of 1,000), and patient-provider clinical messaging (31 of 1,000). The response rate for the patient satisfaction survey was 46% (n = 921); 94% of survey respondents were satisfied or very satisfied with MyGroupHealth overall. Patients reported highest satisfaction (satisfied or very satisfied) for medication refills (96%), patient-provider messaging (93%), and medical test results (86%). CONCLUSION: Use and satisfaction with MyGroupHealth were greatest for accessing services and information involving ongoing, active care and patient-provider communication. Tight integration of Web services with clinical information systems and patient-provider relationships may be important in meeting the needs of patients.

Patients, physicians, and the Internet.

Washington-based Group Health Cooperative has been providing personalized services to patients over the Internet for a year through the MyGroupHealth member portal. We continue to refine our communications to meet the needs of our patients online in the absence of experience comparable to that which we have gained in 54 years of in-person and telephone interactions.

Patient satisfaction with a Web-based patient-provider messaging system implemented across a statewide delivery system (Group Health Cooperative).

Since 1999, Group Health Cooperative has been developing and implementing Web services to improve patient access to health care. Among these services are a patient-provider secure messaging system and online pharmacy refills. A survey of patients using these services demonstrated the value of these tools in enhancing the patients' ability to manage their health care and the positive effects it could have on member retention.