Hospital Impact: 4 ways health systems can make a big issue small

Hospital sign and view of building

headshot of the authorOur CEO, Jim Nathan, often uses the phrase, "How do we make big, small?" when dealing with complex issues that may seem overwhelming and thus may never be achieved. That phrase is now spreading.

As easy as it sounds, it is a major challenge to execute and ensure you are following a plan every day--making big into small.

Some examples of complex issues include patient flow, readmissions, hospital-acquired conditions and patient experience.

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So how do you take any of these "big" and help make them "small"?

Start with understanding the position of "one," as this promotes the need for a more focused and disciplined approach. Let's take an example with a patient (n=1) at risk of readmission. She has congestive heart failure (n=1) which is one of the subset diagnoses with a higher risk of readmission.

Try this four-step approach to focus on the "n of 1" to see if you have a solid plan in place that can be managed every day:

  1. Awareness: Ensure systems are in place to provide early identification that there is a patient you have to manage who has congestive heart failure. Do you know where all these patients are in your health system today?
  2. Collaboration: Who do you need to work with to coordinate the care of this patient while he or she is in your care and where will you transition this patient post-hospital stay? Do those post-acute locations know what they should be doing to continue the care you provided? How do you ensure you are all in sync with your efforts?
  3. Intervention: How will you manage this patient while in the hospital, and what are the key care needs such as better nutrition, awareness of medications and potential side effects, and clear and understandable discharge plans?
  4. Measured results and follow-up: Was this patient readmitted 30 days post hospital stay? If yes, why and how could it have been managed differently? If no, how was it managed so you could replicate with other similar patients and apply the same approach toward other "big" situations?

I look forward to your organizational examples of making big into small.

Scott Kashman is the chief administrative officer of Cape Coral Hospital, which is part of the Lee Memorial Health System in southwest Florida.

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