Bellin’s Model for Competency Improvement

 Bellin’s Health System, focus is health care delivery system

 is based upon the belief that outcomes are the results of processes that can be improved through:
 Identification of success metrics,
 Setting of goals and the Plan Do Study Act (PDSA) change process.
 Statistical process control charts are used to track identified processes for stability and response to
improvement efforts. Measurement is focused on:
 Growth
 Effectiveness
 Efficiency
 Engagement
 Innovation

Models of Health
1. 1. 3.2.1 Models of health and healthpromotion including: •Biomedical model of health •Social model of health •The
Ottawa Charter for Health PromotionKey Skills:The ability to• analyse the different approaches to health and
healthpromotion;
2. 2. Prevention: any action to reduce or eliminate the onset, causes, complications or recurrence of disease or
illness Intervention: any action to improve health or cure illness including the use of medication, hospitalisation or
surgery Diagnosis: identification of a disease or illness through medical observation of signs and symptoms, the
patient’s history and testsThe language of health: some key words
3. 3. Advantages and disadvantages Identify aspects of the models of health in case studies  Evaluate each
model with regards to likely success in various situations  Suggest ways that each model could be used to
address a particular health concern  Identify the major components of each model  Explain / outline / define the
models of health  Student must be able to: Assessment
4. 4. The Ottawa Charter for Health Promotion The Social Model of Health  The Biomedical Model of Health 
Three such models are:  Models of health are ‘conceptual frameworks’ or ways of thinking about healthWhat is
a health model?
5. 5. Focuses on the physical or biological aspects of disease and illness. It is a medical model of care practised by
doctors and/or health professional and is associated with the diagnosis, cure and treatment of disease. (VCAA
HHD Study Design)Definition –Biomedical Model of Health
6. 6. Receives the majority of government healthcare funding (over 90%) Tends to be the first thing people think of
when they think of health care Emphasis on diagnosis and treating individuals separately from their lifestyle/living
conditions – this model of health concentrates on the disease, illness, or disability and attempts to (cure) return the
physical health of the person to a pre-illness state. The reasons for the illness are not at the centre of the
biomedical model. Has been evolving for many years leading to improvements in medical science, technology,
increase in cures and treatments ie: increase in vaccinations /immunizationsBiomedical Model of Health
7. 7. Intervention: action taken to improve health e.g. via medical treatment, hospitalisation, prescriptions, surgery
etc. ****medical intervention with a fix it approach Diagnosis: identification of the disease or illness through Dr’s
observations of symptoms or through diagnostic tests e.g. X rays, Scans, blood tests  The 2 aspects of the
biomedical approach are:  In the biomedical approach Dr’s and hospitals are the real focus of medicine or health.
The expectation being that the Dr will be able to fix the condition and the patient will take on a passive role.
Medical- science of diagnosing-curing disease. Bio- living or living organism Dominant for many years and
played a large role in prolonging life expectancyBiomedical Model of Health
8. 8. Hospitalisation Surgery taken to improve health  Prescription Medicine refers to any action that is  Pap
smear tests Intervention/treatment –  Mammograms tests.  Ultrasound use of specific diagnostic  Blood Test
observation, or through the  Scans of a disease or illness through a doctor’s  X-rays Diagnosis – identification
Examples of the Biomedical Model
9. 9. Does the Biomedical model of health address this definition? Explain The WHO defines Health as “A complete
state of physical , social and mental wellbeing, and not merely the absence of disease of infirmity” (WHO 1946)
Biomedical Model of Health
10. 10. Can be successful in returning someone back to good health Improves quality of life  Extends life
expectancy Diseases that would otherwise develop and cause considerable illness or death can be stopped.
Many common problems can be effectively treated  Without this model of health there would be little known about
how to treat and diagnose illnesses It creates advances in technology and research Advantages
11. 11. Not all countries can afford the medical technologies and resources that are part of the biomedical model of
health - an important factor contributing to differences experienced in health status Affordability – not always
affordable  Cancer is an example – advances have been made, but treatment not always successful Not every
condition can be treated  Doesn’t encourage people to live healthy lives as they are treated to fix problems as
they arise. The focus is on the condition and not the determinants that caused it. Doesn’t promote good health /
narrow view of health  Technology, equipment and technological developments expensive Professionals with
specialist knowledge needed are expensive to train  Relies on professional health workers and technology and is
therefore costly Disadvantages
12. 12. Case Study- StephenStephen, aged eight, was born with a major kidneyproblem, which required surgery when
he was eightmonths old. His right kidney became badly scarred andmalformed as a result of several bad kidney
infectionswhich required hospitalisation.Throughout Stephens life his doctor has regularlymonitored the function of
Stephen’s kidneys through theuse of urine tests. The consequences of Stephens kidneyfailure to cope is
dangerously high blood pressure.Stephen makes regular visits to a renal specialist who usesan ultra sound to
check on his kidney growth andoccasionally Stephen requires nuclear testing with DSMAscan which involves an
injection of radioactive substanceinto his blood so doctors can view his kidneys and bladder.
13. 13. X-rays, blood tests , kidney surgery, ultra sound, nuclear testing DSMA scan, urine tests Reliance on
hospitals, medical professionsAnswers
14. 14. 2 marks
15. 15. Diagnosis, treatment Define the Biomedical model of health  TSSM Biomedical approach to healthPractise
Questions & ‘fix it’ model that focus on the biological/physical aspects of disease or illness Reliance on health
professions ie doctors and medial specialists cure
16. 16. It was developed in the late 1970’s 1980’s as some members of the community were not experiencing the
same levels as health as others despite the understanding of the impact of lifestyle and behaviours on health.
Focus is on policies, education and health promotion. The Social Model of Health goes beyond the focus of
lifestyles and behaviour and accepts the need for social change to provide prerequisites for health It is a
community approach to prevent diseases and illnesses. This approach attempts to address the broader
influences on health (social, cultural, environmental and economic factors) rather than disease and injury.Social
Model of Health
17. 17. Definition – Social Model of HealthA conceptual framework within whichimprovements in health and wellbeing
are achievedby directing effort towards addressing the social,economic and environmental determinants ofhealth.
The model is based on the understandingthat in order for health gains to occur, social,economic and
environmental determinants must beaddressed. (VCAA HHD Study Design)
18. 18. Inter-Sectorial collaboration Access to health care Empower individuals and communities Reduce social
inequities Addresses the broader determinants of health5 Key Principles (A.R.E.A.S.)
19. 19. Aims to promote equity for all people and to achieve this the social determinants which lead to inequality such
as gender, culture, socioeconomic status, location and the physical environment must be addressed.Empower
individuals and communities (empowers with skills, knowledge broader determinants such as gender, ethnicity,
socioeconomic state, location and physical environment influence behavioural determinants and have a strong
relationship with health and are becoming a focus of health promotion strategies.Reduce social inequities
(addresses equity of the social determinants of health)5 Key Principles (A.R.E.A.S.)Addresses the broader
determinants of health (all aspects of health are addressed) & Empowering individuals and communities with
health knowledge means they have the ability to make positive decisions about their health and participate in
healthy behaviours.confidence to make positive decisions re: their health)
20. 20. By involving all organisations and stakeholders (people with a shared interest) who have an influence over the
social and environmental determinants of health can all the social determinant be adequately addressed and affect
health status positively. Access to health care is a significant factor contributing to health status. This social
model of health acts to enable all people to have access to health care. Social factors that can impact on access to
health care include cultural and language barriers, economic and geographical factors and education level.Inter-
Sectorial collaboration (c0-ordinated approach health and government departments)Access to health care
(accessible and appropriate health information)
21. 21. Encourages individuals to take responsibility and lead healthier lifestyles = Less costly to prevent the disease
before it happens Govt support/strategies e.g. QUIT, TAC, immunization Education for people, so don’t get the
diseaseAdvantages – Social Model> Increase economic development of the country as the population is in good
health and lead productive lives Community approach involving all levels of government, non-government
organisationsimprove quality of life
22. 22. Results of this method of health are not evident until after a long period of time and difficult to measure its
effectiveness Not all diseases can be prevented Changing lifestyles is VERY hard Not believing it will happen
to them Population not motivated e.g. suntans, smoking, overweight. Lack of education for the whole population,
some people don’t get or understand the messageDisadvantages – Social Model
23. 23. Rural Retention Program (RRP) – federal government provide financial incentive for Doctors to work in
rural/remote areas Be a Man – Talk to your doctor about Prostate Cancer’ program – aims to break down cultural
beliefs about health held by men and encourage them to visit a doctor to discuss their health. Sun Smart Schools
Program – aims to reduce the exposure of children to harmful UV rays and educate them about the dangers of sun
exposure. Go For Your Life Strategy – made up of different government and non-government stakeholders,
targeted approach to education the whole community and encourages all people to adopt healthy dietary practises
and exercise.Examples of the social model of health:
24. 24. Inter-Sectorial collaboration Access to health care Empower individuals and communities Reduce social
inequities Addresses the broader determinants of health5 Key Principles (A.R.E.A.S.)
25. 25. Using the social model of healthPrinciple of the Addresses the Involves Acts to reduce Acts to enable
Empowerssocial model broader intersectorial social access to individuals determinants collaboration inequities
health care andIssue to be of health communitiesAddressedMental health Ensure mental Get workplaces Focus
on people Provide free Use men as theissues health to play a part. in indigenous access to promoters of education
and Like the communities or health care programs advice is workplace those of low assessments to targeting men
available in health checks. SES. those in low to educate men rural and SES groups, to identify remote areas.
provide symptoms of information at depression football Indigenous to matches, pubs develop and etc. promote
programs aimed at indigenous.Case studyYour Example
26. 26. Case Study – VicHealth’s Food For All Program(2011 exam q3)Section B3ci) Identify two principles of the
social model of health that are relevant tothe Food for All program ( 2 marks)3cii) Use examples from the Food for
All program to demonstrate how thesetwo principles are reflected in the VicHealth funded program (4 marks)
27. 27. Access all areas: arts program breaks down barrier Case study –  TSSM questions – social model of
health VCAA exam 2010 Q3Practise Questions
28. 28. VCAA prac exam 2010 q4 Address broad determinants of health; aim is to decrease social inequalities;
Increase access to health care for all people Involves intersectorial collaboration: developed by Peer Support
Program (the centre for Adolescent Health) funded by VicHealth, Victorian Department of Human Services,
Beyondblue
29. 29. Sectoral Collaboration – the PATS program was a result of integrated action between the Centre of
Adolescent health, funded by VicHealth, the Victoria Department of Human Services and Beyondblue.
Accessibility to healthcare – PATS program was facilitated by a health professional in 5 different locations in
Victoria providing young people in the programs with access to a service and information that was appropriated
and based on their need. Peer leaders involved in the PATS program played a role in education and advocacy in
the various locations the program was facilitated across Victoria. Empower individuals and the community – peer
leadership training was provided to the peer leader, adolescents in the program where provided with knowledge
and skills to cope with the challenges of a parent with mental illness. The PATS program focused on workers,
organisations and the broader community creating awareness of issues affecting young people with a parent with a
mental illness which enable community organisations to effectively develop resources to support the young people.
Seminars and professional development sessions also provided individuals and communities with information to
address factors affecting their health. Reduce social inequality – PATS program was a funded program involving
young people ) 12 – 18yrs) regardless of gender and SES. 5 programs were conducted across Victoria in various
locations making it available to adolescents in various locations. Address all determinants of health – PATS
program consisted of a Peer leader who was responsible for the social aspects of the groups including organising
activities and the socialisation of participants.
30. 30. Inter-Sectorial collaboration – education in schools, government and non-government organisations to provide
education on weight loss Access to health care – bulk builing doctors, public hospitals Empower individuals and
communities – community health centres, doctors/dietitians provide life skills education ie selection of low fat
foods Reduce social inequities – medicare, PBS Addresses the broader determinants of health – services
provided in local metro, rural/ remote areas, all genders ethnicity and socioeconomic groups has access
toAnswer:
31. 31. 5 Priority or action areas 8 Prerequisites (conditions or resources) for gains in health  3 Principles of health
promotion  Outcome of this conference was a document that provided organisations and key stakeholders
guidelines to help incorporate health promotion into their strategies, policies and campaigns with the aim of taking
action to achieve ‘health for all by the year 2000 and beyond’ through health promotion and reduce inequalities in
health.  In response to the Social model of health the WHO held its first International Conference on health
promotion in 1986 in Ottawa, Canada.  Charter – refers to the document that outlines the functions and principals
of health promotion  Ottawa – Canada hosted the first international conference on health promotion in 1986
Ottawa Charter for Health Promotion
32. 32. Study Design - DefinitionAn approach to health development by the World HealthOrganization which attempts
to reduce inequalities inhealth. The Ottawa Charter for Health Promotion wasdeveloped from the social model of
health and defineshealth promotion as ‘the process of enabling people toincrease control over, and to improve,
their health’ (WHO1998). The Ottawa Charter identifies three basic strategiesfor health promotion which are
enabling, mediating, andadvocacy. (VCAA HHD Study Design)
33. 33. Population focused Health promotion therefore focuses on prevention rather than cure and uses the causes
of disease as the starting point rather than diseases themselves Health promotion is the process of enabling
people to increase control over, and to improve, their health.Health promotion
34. 34. Advocate – supporting and making public health recommendations for health, getting the message out
Mediate – Professionals, social groups and health personnel have a major responsibility to mediate (negotiate)
between differing interests in society to achieve health. Co-ordinated action between all interested parties ie
government, NGO’s, media, health sectors, Enable – Health promotion aims to enable all people to achieve their
fullest health by closing the gaps in health inequalities by ensuring equal opportunities and resources for everyone.
Reducing differences in health status by ensuring equal opportunities and resources to make healthy
choicesThree basic Principle of HealthPromotion
35. 35. Social justice and equity- all people being valued and receiving fair treatment so all people share the benefits
of society Sustainable resources- the need to sustain the many resources needed for health (food, water, income
- funding, building supplies, oil) for future generations to benefit A stable ecosystem- a balance between plants
and animals in the environment which is important for many health resources such as food, water and air
Adequate income Safe and adequate food supply limited Education health. – Without these improvements in
health are Shelter underpin any improvements in Peace are the basic prerequisites that8 Prerequisites for
health These 8 conditions or resources
36. 36. 5 Priority or Action areas That should be taken into account when devising health promotion initiatives1. Build
healthy public policy2. Create Supportive Environments:3. Strengthen Community Action:4. Develop Personal
Skills:5. Reorient Health Services: (Bad Cats Smell Dead Rats)
37. 37. Build healthy public policy• Relates directly to the decisions made by the government and organisations in
relation to laws, regulations and policies that affect/improve health.• Examples, increasing taxes on certain
alcoholic drinks which makes participating in unhealthy behaviours more difficult thereby reducing exposure to
determinants that can cause ill health.• Some policies and laws are designed to make the environment healthier for
those who chose not to participate in unhealthy behaviours ie banning smoking in public places.• Some laws are
designed to directly influence behaviour ie wearing seat belts, safety restraints for children.• Some law aim to
deglamourise unhealthy behaviours – plain cigarette packaging
38. 38. Create Supportive Environments• A supportive environment is one that promotes health and assists people in
making healthy lifestyle choices. This priority recognises the impact that broader determinants have on health and
aim to promote a healthy physical and social environment for the community to allow people to live healthy lives.•
Examples – Quit line – a support service for people wanting to quit smoking, Providing shaded areas in schools –
reduces exposure to UV rays, Sustainable energy production – ensures future generations have access to a
healthy environment. Occupational Health and Safety Officers• Government childcare schemes,• Walking and
bicycle tracks to encourage physical activity
39. 39. Strengthen Community Action:• Focuses on building links between individuals and the community and the
centres around the community working together to achieve a common goal. Skills need to be developed in the
community in order for action to be taken to improve healthy.• Giving the community a sense of ownership of a
health strategy increases the likelihood of its effectiveness.• Example: Governments immunisation strategy
involves the media, doctors, schools, parents Neighbourhood Watch and Safety House Programs, Driver Reviver
Stations
40. 40. Examples: Developing skills to read food labels and select healthy foods, develop financial and budgeting
skills, practising safe sex, being sun smart, exercising as part of one’s life, healthy eating habitsDevelop Personal
Skills• Education is the key aspect of this priority. It refers to gaining knowledge and life skills to make informed
decisions that may indirectly effect their health.• Personal skills need to be developed to assist people to live
healthy lives• Many parts of society have a role in educating – school, work, families, government, non-government
organisations
41. 41. Reorient Health Services• Refers to reorienting the health system so that it promotes health as opposed to only
focussing on diagnosis and treating illness, as is the case with the biomedical model.• To reorient health services,
the health system must encompass not only doctors and hospitals, but all members of the community including
individuals, community groups, health professionals, health service institutions and governments.• This priority
area suggest incorporating health promotion to play a more significant role thereby addressing all the determinants
of health, not just disease.• Example – focusing on healthy eating rather than on surgery to reduce the impact of
CVD, doctors prescribing activity before the development of damaging conditions such as type 2 diabetes, self-hep
groups, police and emergency services (ie Fire Brigade) working with schools to support road education programs,
42. 42. Oxfo Focusing on all five areas may spread resources too thinly, meaning the strategy may not achieve its
goals. However it is not necessary to address all five priority areas and some effective programs may only focus
on one or two priority areas. The Ottawa Charter provides governments and health promotion organisations with
an effective tool to use when planning effective strategies.rd handout
43. 43. Graduated Licensing system (GLS) for young drivers (1.7.08) to ensure young drivers get adequate
supervision and experience as learners. introducing an additional requirement for registration of new cares – cars
manufactured after 31.12.10 must be fitted with electronic stability control, cars manufactured after 31.12.2011
must be fitted with head protecting technology such as side curtain airbags.  Through this strategy the Vic
government has: built healthy public policy by : Arrive Alive Campaign (2008 – 2017) is theVictorian
Government’s road safety strategy.
44. 44. Build healthy public policy: laws and legislation – 50km zones, 40 zones near schools, Graduated Licensing
System Develops personal skills through a public awareness campaign focused on reducing driving under the
influence of drugs. Created supportive environments: by funding a major infrastructure program to improve roads
 and roadside in Victoria aimed to reduce the most common types of crashes as well as a heightened enforcement
effort.Arrive Alive Campaign
45. 45. Using the Ottawa CharterElement of the Build public Create Strengthen Develop Reorient healthCharter health
policy supportive community personal skills services environments actionIssue to beAddressedchildhood obesity
Develop a healthy Run a breakfast Develop a whole Teach students Invite a local Dr.in primary schools lunch
policy. program and school approach about healthy or dietitian to talk Tax on junk food make the canteen to
healthy eating eating so they can about the dangers a healthy food and include make healthy of unhealthy zone.
healthy recipes in choices in food eating. the school technology and newsletter health classesthe issue of Anti-
bullying Provide safe Whole school Parenting School nurse /bullying in schools policy in schools places during
approach to anti- courses, self- counsellor /youth recess and lunch bullying esteem and ‘no worker providing
breaks blame’ classes health promotion for students education to students
46. 46. Case Studies and exam questionsCase Studies and exam questionsCancer is the correct diseaseBuild
Healthy Public Policy – Government puts in place policies re tobaccosmoking – e.g. none in covered areas e.g.
hotels, restaurants that limit wherepeople are able to smoke, governments increase taxes on cigarettes to
deterpurchase and reduce risks
47. 47. Develop personal skills – the program provides education about managing diabetes. It improves cooking skills
as well as understanding about diabetes. It also improves communication skills and raises the confidence of
participants. Visual posters to educate understanding of diabetes and how to monitor blood glucose levels.
Create supportive environments – provides support groups for indigenous diabetics, where families learn to cook
together and share meals with other families dealing with diabetes. The scheme promotes group sharing and
provides a non-threatening atmosphere where people can ask questions and receive answers.Answer:
48. 48. DVD VCAA exam 2011Activities

Improvement Stories

 Resources

o How to Improve
o Measures
o Changes
o Improvement Stories
o Tools
o Publications
o IHI White Papers
o Case Studies
o Audio and Video
o Presentations
o Posterboards
o Other Websites

Better Patient Flow Means Breaking Down the Silos

Patients who worry that their hospital’s emergency department (ED) is too busy to reliably deliver prompt care are in good company.
A majority of hospital leaders worry about this, too.

Some 200 hospital administrators addressed this concern in a recent survey conducted by the American College of Emergency
Physicians, and most named overcrowding as one of their top five management concerns. Sixty percent said overcrowding in their
facility forces the diversion of patients with urgent needs elsewhere. Twenty-eight percent said these diversions occur more than 20
times per year. Forty-eight percent say their hospital fails more than half the time to meet the goal of admitting patients from the ED
within two hours of arrival.
Expanding the capacity of the ED to handle more patients is often identified as the obvious solution. But experts say this misses the
underlying factors responsible for the logjam: inadequate systems to manage the flow of patients throughout the hospital. In other
words, the ED can’t solve this problem alone.

Institute for Healthcare Improvement faculty member Kirk Jensen, MD, MBA, FACEP, an expert on patient flow in acute care
settings, says that in order to improve flow, hospitals must work at both the macro- and the microsystem. “A hospital is a great
example of a complex adaptive system,” he says. “You have a number of people who are making day-to-day, even minute-to-
minute, decisions in their own microsystem, or particular domains, that impact hospital-wide patient flow, and they are making these
decisions without access to information about the macro view, or what is going on in the rest of the hospital. So even if they optimize
flow within their microsystem, that’s just within their own individual field of play.”

Andrea Werner, MSW, Director of Heart and Vascular Center at Bellin Health in Green Bay, Wisconsin, knows this from experience.
“If you don’t focus on the big picture, you can optimize one area and suboptimize another,” she says. For example, when Bellin
began to improve “patient throughput,” as it’s sometimes called, in its ED and operating rooms, “we were excited,” she recalls. “Then
we realized that those patients have to flow onto the units. We didn’t have enough beds available for them. We learned that there is
a very intimate connection between the macro and the micro, and you make a mistake if you don’t look at both.”

Diane Jacobsen MPH, Director of IHI’s Learning and Innovation Community on Improving Flow Through Acute Care Settings
(2007), says several electronic tools are available to support flow improvement, as well as specific changes hospitals can implement
to eliminate bottlenecks and improve flow.

But to be successful, the type of organizational commitment Bellin has shown to this effort is absolutely key. “They have made it a
priority within their hospital, tied it to organizational goals, and addressed all the pieces involved in improving flow,” she says. “It’s
paying off for them.”

A Dual Focus

Bellin Health, an integrated health care delivery system that includes 167-bed Bellin Hospital as well as a network of ambulatory
clinics, has been a part of IHI’s Flow Community since October 2002. The focus on both macro- and microsystem change in its
hospital has resulted in measurable improvements at both levels. Door-to-doctor time in the emergency department — the time from
when a patient arrives until he or she is seen by a physician — dropped from 57 minutes to 22 minutes in one year, and capacity in
the gastrointestinal operating suite has increased by a third without adding new staff or space. At the macrosystem level, the
average length of stay has decreased from 4.2 to 3.8 days, and the acuity-adjusted bed turn rate — the average number of times
hospital beds turn over in a year, a measure of how efficiently beds are used — is 109. IHI advises hospitals to work toward an
adjusted bed turn rate of greater than 90 with minimal delays, as measured by ED door-to-floor time, diversions, and the number of
patients who leave without being seen. Jacobsen emphasizes that increasing the bed turn rate is only effective if delays are also
minimized.

Improving throughput of surgical patients at Bellin was a micro-level project that got great results, says Werner. It started with
educating the patients. “In the pre-surgical clinic, we do expectation management with our patients and their families. We tell them
up front how long they will be here, and they meet with the discharge planner to schedule a discharge appointment and any follow-
up appointments. We also make sure transportation home is arranged.”

To guide discharge decisions, once patients are out of surgery and recovering on a surgical unit, the hospital uses guidelines to
reduce the arbitrariness in all patients’ length of stay. “If a patient has gall bladder surgery, for example, their length of stay is
determined by whether or not they are nauseous, not by habit or staff’s personal preference,” says Werner. This way, length of stay
is driven only by factors related to the patient’s clinical condition.

Once the patient’s care team has determined that the patient meets the pre-approved discharge criteria, they can issue conditional
discharge orders and notify the surgeon, who still makes the final decision.

Paul Signorelli is a mechanical engineer who works in Bellin’s Quality Resources Department. He says that in the gastrointestinal
surgical suite, the biggest operational change involved modifying the schedule so that one surgical suite is always available for
unplanned surgeries. “We did this by assigning two surgeons to alternate between two surgical suites apiece.” “This allows us to
handle 80 percent of our average daily volume in four surgical suites, leaving our two remaining suites available to handle all the
remaining procedures.” This change decreased unpredictability and disruptions, and now planned surgeries almost never get
bumped. It also increased the hospital’s capacity for GI surgery without adding new staff. “Our surgeons can turn and scrub and go
right into the next procedure,” says Werner.

Flow Command Center

To keep tabs on patient flow issues at the macrosystem level, Bellin relies on a “flow group” with representatives of many key
departments and units. The group meets bi-weekly to review data, identify opportunities to improve, and create action plans.

But to really manage patient flow effectively, Bellin recognized the need to match supply and demand on a system-wide, real-time,
continuous basis. For this, Bellin established a Flow Command Center and implemented a sophisticated web-based, color-coded
system that provides a bird’s-eye-view of capacity across the entire hospital, updated every four hours.
“Each unit regularly updates the system with information about their census, acuity, and staffing, and it creates a picture of how well
they are doing,” says Werner. “If supply and demand are matched, the unit is green. If there is a mismatch and they are beginning to
stretch their resources, they go to yellow, and then to orange, and finally to red, which means they are overwhelmed.”

“With this tool we can identify exactly how each unit is doing,” says Laura Hieb, RN, BSN, MBA, Bellin’s chief nursing officer. “We
can see if they are handling their census, and if they have discharges waiting.”

Bellin’s Paul Signorelli says the computer-based demand and capacity management tool they use, called ACOMS, for Acute Care
Operations Management System, helps the organization focus on efficiency. “The overall goal is to achieve balance throughout the
system,” he says. “If a unit operates within a silo, it has the potential to overstaff or understaff, depending on the patient population.
When you broaden your focus, you can use and manage your resources more effectively.” “The overall goal is to achieve balance
throughout the system,” he says. “If a unit operates within a silo, it has the potential to overstaff or understaff, depending on the
patient population. When you broaden your focus, you can use and manage your resources more effectively.”

Sometimes effective resource management across units happens spontaneously, says Chief Nursing Officer Hieb. “Recently our
medical unit was at full capacity, getting into the red zone and struggling,” says Hieb. “The surgical unit staff saw they were in crisis
and since their unit was slower, they showed up on the med unit and asked how they could help.” Hieb says this is one of the most
rewarding aspects of ACOMS.

The hospital’s success at reducing length of stay and increasing bed turns is directly related to the ability to see the big picture. With
a better overall understanding of the hospital’s flow patterns, for example, Signorelli says they are increasingly able to expand their
planning horizon and look forward as far as a week to identify potential bottlenecks, instead of reacting within 24 hours. “If we can
get better at long-range forecasts and continually refine as each day approaches, we can address things ahead of time.”

Getting Home on Time

Bellin’s Andrea Werner is quick to point out that the bed management tool — and indeed all the flow-related work — is “not a way to
make nurses work harder and longer. We look at the data proactively; we manage our staffing ratios proactively. We are getting rid
of the days when there was a huge patient load and not enough nurses by moving the variability out of the workload, moving the
resources to the right places.”

Jayne Schoen, ADN, charge nurse on the orthopedics unit, agrees that the tool has been good for nurses. “It has changed the
culture into one in which we all help one another, rather than focusing strictly on our own unit,” she says. “Everyone knows that they
are expected to float to another unit if they are needed, and they know the help flows both ways. Now when a unit gets overloaded,
they don’t have to beg for help.” Not only has this cut down on nursing overtime costs, says Shoen, but it also means that “nurses
are getting home on time,” a personal benefit that can’t be quantified.

Chief Nursing Officer Laura Hieb agrees that the culture of nursing has changed, in large part because the hospital has been
sensitive to nurses’ concerns about floating across units. “You can’t just arbitrarily float nurses to wherever the need is,” she says. “If
they aren’t familiar with the unit and the work, they become anxious, and it’s not good for them, and not good for the patients.”

Hieb and her nursing leadership team conducted a survey to learn more about nurses’ experiences and needs when they work on
other units. Two specific initiatives have been launched based on the survey results.

“First, every unit has created a ‘helper list,’ activities they can ask a floating worker to help with, defined by discipline. So if a nurse
comes to the unit, or a certified nurse assistant, there are specific tasks they would be given,” says Hieb. The nursing supervisor on
the unit facilitates the list and makes sure the floating nurse is supported.

Second, says Hieb, each department has created a more in-depth guide to how things are done on that unit, especially useful for
nurses who float to a new unit for an entire shift rather than for an hour or two during a crisis. “Everything isn’t standardized across
the hospital,” says Hieb, “so you need to know the routines on any given unit, things like how they do report and where certain
equipment is kept.” In addition to the guide, nurses floating for a shift are assigned a “buddy,” an experienced nurse on the unit who
supports them and checks in with them hourly.
Ultimately, says Hieb, the goal is to facilitate good patient care and satisfied nurses, which means making sure nurses feel
comfortable within their scope of work. “If it’s not in their scope, we won’t assign it to them,” she says. She adds that the nursing
leadership team is working to create curriculum for every unit that can be used to familiarize other nurses with their work in advance
of actually working there. “We would like to orient nurses proactively rather than reactively. So we’re working to develop
competencies across units and set this as part of the expectations for nursing.”

Nurses aren’t the only staff who can affect patient flow. “Housekeeping has their own scorecard, and when they turn rooms around
within their target goal, they are green, and when they are off by a certain percent, it’s yellow, and so on,” says Andrea Werner. This
has prompted the housekeeping staff to implement several ideas to improve their services, including the use of text paging for
housekeeping staff so they can go directly to where the work is instead of returning to a central location for direction, minimizing the
amount of time between the need for cleaning and the arrival of the cleaning crew.

Bellin’s flow leaders point to each other as a key factor in the hospital’s success at improving patient flow, and to the hospital’s
senior leaders. “Our leadership is really supportive and involved,” says Andrea Werner. “Our flow work is directly connected to our
strategic plan. This is our future. If we get this right, we’ll be the chosen provider in our market. My peers in other hospitals say, ‘You
are so lucky to be working there.’”