Data collection, multidisciplinary communication help unit consolidations run smoothly, consultants say

Berkeley Research Group's healthcare consultants offer pointers to hospitals and health systems responding to inpatient volume disruptions. (Getty/SDI Productions)

Unit consolidation can be an attractive tactic for hospitals and health systems looking to cut costs and offset shrinking inpatient volumes, but successful reorganization demands a data-driven game plan and buy-in from stakeholders across the board, healthcare consultants with Berkeley Research Group advise.

The financial case for consolidating underused units has become more and more clear in recent months, Bill Orrell, managing director of healthcare performance improvement at BRG, told Fierce Healthcare.

Particularly for specialties like orthopedics, surgical procedures have gradually shifted from one-night stays to same-day discharges—or, if patients are being kept overnight, providers no longer receive the same level of reimbursement that they may have in the past, he said.

More immediately, the pandemic has rewritten the playbook on seasonal demand. Hospitals “can’t really afford to staff every bed 365 days a year,” Orrell said, and uncertainty regarding potential new COVID-19 variants or other infectious disease outbreaks has given them a new reason to plan for rapid upward or downward scaling of inpatient capacity.

Providers now need to be “nimble enough to be able to constrict their patient footprint during low-census times or low season times, and then expand again when they need to in the wintertime when, typically, we see an influx of flu patients that cause a lot of respiratory issues and high-acuity patients,” he said.

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The appeal of unit consolidation to financially strained organizations is at least somewhat tempered by its complexity. Overhauling entire units is a major organizational commitment, the consultants said, and decision-makers need to be sure that it’s the right move for their hospital or health system before moving things forward.

With that in mind, the first step for any potential consolidation effort should be a thorough review of all available performance, volume and demographic data, Lauren Phillips, managing consultant at BRG, said.

After reviewing whether less costly adjustments to the existing structure could suffice, she said organizations must be able to characterize the communities they’re serving to understand the types and volumes of services that will be needed down the line.

“Ask if you’re in a rural area versus an urban area,” Phillips said. “Are you in a growing community with a lot of births, are you in a community with a lot of retirees, are you looking to grow a particular service line or [do] you want to get into behavioral health? Really look at those pods of patients, what your community needs and how many patient types are coming into your organization.”

Collecting data on communities’ potential demand is the only way organizations will be able to determine what level of consolidation is the most efficient for each facility, Orrell said. These can range between permanent closures with an overall reduction in beds, seasonal closures that are defined by census and disease trends or even weekend closures based on predictable utilization patterns.

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“The one thing to hammer home … is you’ve got to use the data. Let the data and historical trends guide what the plan is,” he said.

Putting this information together is by no means a one-person job, Phillips noted. From early on in the data collection and planning processes, engage stakeholders from the clinical staff, finance and any other relevant disciplines that could lend insight on issues that might otherwise be overlooked.

For example, “if you’re not thinking about all the beds you need for a unit, you could have the best plan and then realize you can’t put any of those patients into the beds you have, and you might have to buy new beds and that makes it financially undoable,” she said. “We put in a lot of time in with clients thinking through a lot of those questions and bringing those pieces to the table to make sure these kinds of undertakings are done smoothly.”

Having these supporting data and plans in place early on not only improves a reorganization’s chance of success, it also helps sell the initiative to leadership and other major stakeholders. The story of why a consolidation makes sense is in the data, the consultants said, and mocking up a tentative work plan that stresses the potential benefits goes a long way toward winning over C-suites, provider groups and even patient liaisons.

“Know your audience, make that message to that audience and really talk about the why—why this approach, why that recommendation or why look at consolidation at all,” Kimberly Vance, associate director at BRG, said. “Allow the data to do the talking … and then tailor your message specifically to your audience.”

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Beyond planning and pitching, communication remains a key component of successful unit consolidation, the consultants said. Taking the time to plan how and when consolidation plans should be shared with front-line workers, for example, can reduce bumps along the transition and ensure stronger culture among the merging teams.

“In previous partnerships, we went into how the unit will be communicated to,” Phillips said. “What will that look like—will it be town hall? Will it be email? How will the community be notified of something? How will the docs be notified, the ones inside the system and outside the system? Having all those pieces lined up is tremendously helpful.”

Finally, plan to continue data collection and organizationwide communication well past the consolidation itself, Vance said. Leadership should continue to monitor quality, safety, volume and other key metrics surrounding the consolidated unit and be ready to support staff as they adjust to their new surroundings.

“This is a change. You brought people on board, but not everyone might buy into this,” Vance said. “Have that support to make it successful and have your key indicators that you’re going to measure to make sure that quality is not impacted and that it’s sustainable.”