Spotlight on Med/Surg

by:

Rich Parsons, Vice President / Principal

Director of Management and Operations Consulting

While it can be argued, we believe that the Medical Surgical (Med/Surg) units are the most important department in an acute care hospital. They house the majority of patients, are the most operationally intensive, and generally provide the most revenue. It is on the Med/Surg units that inpatients generally form their patient satisfaction opinions, which gives a hospital its reputation for quality care.

From our productivity studies, it also appears as if the Med/Surg units are the most difficult to manage. Considering that nurses must meet the needs of dozens of patients in
terms of clinical and customer care, it’s easy to understand the challenges. In California, managers must work within the nurse-to-patient ratios, and other mandated break, lunch and Title 22 rules.

One means of helping Med/Surg nurse managers and their CNOs to improve is benchmarking their operational performance against their counterparts in similar facilities. Measuring a unit’s productivity, cost and quality against top performers provides guidance on where and how to direct improvement efforts. Until recently, rigorous and fair benchmarking has proved to be expensive and time consuming for most community hospitals that don’t have a large planning staff .

Recently, however, HFS created a tool that allows us to quickly evaluate operating performance in any hospital department. Using the Office of Statewide Health Planning and Development (OSHPD) Annual Financial Disclosure Reports, we developed a method of determining productivity and cost performance per unit of service quite economically. We are able to array this data against quality metrics as well. Med/Surg has traditionally been evaluated by dividing the number of productive hours by patient days during an equivalent period. Observation patients are included when placed in Med/Surg units, and the data are adjusted accordingly, using the OSHPD statistical method.

HFS recently analyzed Med/Surg productivity in over three hundred acute care hospitals. Figure 1 below displays the result of this analysis:

From our studies, it is clear that the best practice is 10.00 productive hours per patient day (“HPPD”) or less. The average / mean occurs at 11.50 HPPD, and the most expensive units operate at 13.00 HPPD or more. Because of the limits inherent in a 1:5 nurse to patient ratio, we believe that it is unlikely that Med/Surg nursing units can operate effectively below 8.20 hours per patient day, unless the department gets along without a charge nurse, certifi ed nurse assistants, or unit secretary. The issue of patient acuity usually arises when discussing nurse productivity. Many believe that higher acuity patients require more direct care staffi ng and it is self evident that staffing needs are higher in the Intensive Care Unit and the Step-Down Unit, than in Med/Surg.

The data from OSHPD suggests that there need be no conflict between a high Case Mix Index, a surrogate measure for acuity, and best practice staffing. The correlation is pretty

clear, but we will simplify the matter by using as examples two hospitals, which according to HealthGrades, Inc., are the best in California.

For 2011, only two hospitals from California appeared in the HealthGrades, Inc. top 50 Best Hospitals in the United States. They were Glendale Memorial Hospital and Health Center and St. John’s Health Center in Santa Monica.

Both had Case Mix Indexes in the highest acuity quartile, meaning that 75% (or more) of all hospitals were identifi ed as having a lower CMI. Glendale Memorial ran Med/ Surg at 9.22 HPPD, which is in the most efficient 10%. With a Case Mix Index of 1.45, St. John’s HPPD for Med/Surg was 10.59, which is strong performance that places this facility in the second best quartile.

The financial impact of controlling labor expense in this area is extraordinary. For a typical hospital with an average daily Med/Surg census of 100, a one hour per patient day improvement will net the hospital around $2 million per year. By benchmarking all departments to California top performance, our clients have seen labor savings opportunities between 7.6% and 20.6%.

For a comprehensive profile of department productivity, please contact David Kim  at 800-888-4966 ext. 229 or davidk@hfsconsultants.

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