It’s budget time again here at Asante
When I prepare the budget I ask myself: Will the changes result in more, or less, quality? And: Will the changes add or subtract value from our communities?
When I used to participate in interviews of Speech Pathologist candidates, one of our staff had a very interesting question that he’d ask them: “If you are asked to choose between high productivity and high quality, which would you choose?” It’s really a trick question because the two choices are not mutually exclusive. In fact, from the customer’s viewpoint—those who pay our bills—higher productivity is likely to be seen as higher quality. If a customer sees waste and then gets a bill and makes the connecton between the charges and the waste, they would not feel that we deliver quality.
What are the indicators of quality? I look for the following key indicators: (1) Safety: We do not harm anybody. (2) Patient satisfaction. (3) High performance of our outcomes compared to benchmarks.
What is an indication of value? Value is really a sum of quality (safety, satisfaction and outcomes) compared to cost. If cost goes up without an increase in quality, then value goes down.
I’ll give you a value story: Last winter I stayed for an extended stay in a particular motel. In making up my mind which motel I’d would be staying in, my deciding factors for choosing this particular facility was that it was the newest motel in the area and it offered free meals at both breakfast and dinner. It also had a spa. All of this, with a competitive price, made it seem like a higher value than the other nearby motels. However, I noticed as I stayed there that the dinner meals tended towards the red-meat, or fried, or bacon-laced varieties. In other words, not what I considered healthy or even something I would eat. So it turned out that the free dinner had little value for me. And I also noticed that the motel made no efforts to be “green.” There was no in-room recycling bin, and the spa pump seemed to run continuously. A wasteful facility! Plus I noticed my first night there that the grab bar in the bathtub was loose and posed a risk. I informed the front desk, and they asked me, “do you want us to fix it?” Hello? The final straw on the safety issue was that the sidewalks in the morning were poorly lit and there were tree branches hanging over the walks that I had to dodge, and there was black ice that was not de-iced. Clearly a hazard. It is interesting that what I turned out valuing was a little different that what I thought I would value. Things that I took for granted (safety, healthy food, environmental consciousness) were not part of this facility’s quality consciousness.
I could go on about how this wonderful new facility let me down in the value category, but at the end of the day I will not go back, I will not recommend it to friends, and I posted a review on TripAdvisor that’s been read over 500 times. Who knows how much business they’ve lost. (I have to admit that bacon-lovers might actually gravitate to the place after reading my review.)
As a hospital, we’re under the same sort of scrutiny. Not only does the government rate our performance against quality benchmarks, but our patients click away on their computers to share their experiences. Our industry expects that—in terms of reimbursement—these are the good ol’ days; it will get tougher to achieve a bottom line that allows us to invest our “profits” in new technology, buildings, and so forth. How do we continue to deliver better value and better quality on tighter budgets? The answer is that we don’t yet know, but we know that we must. And we also know that the answers will come from all levels of the organization, not just the “top.”
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Speaking of adding value: The Inpatient Rehabilitation Center (IRC) is about to complete its fifth year of operation. Have we added value by adding this service line? I’ll provide some data points below, and you can decide.
ü Outcomes are generally better than our comparison group of regional rehab facilities.
o Discharges to community are 2.15% higher than benchmark
o Patients are admitted to the IRC 4.15 days earlier from date of onset than benchmark
o Average length of stay is .59 days shorter
o FIM change per day (rate of functional improvement) is 25% greater than benchmark
o Total functional improvement of our patients is 9.2% higher than benchmark.
o The rate of discharge back to an acute facility is 35% of the benchmark rate.
ü Our market share of inpatient rehab discharges in this county now stands at 63% and is slowly growing.
ü A significant number of our patients are employees or family members of employees of Asante
ü Acute patients are generally admitted much more quickly than they would have been prior to establishment of the facility. We are also able to admit and treat patients with problematic payment sources, outright charity, or whose discharge plans who might otherwise have made them difficult placements at other facilities.
ü We’ve also treated some high profile cases that have brought positive publicity to Asante
ü Financially, the unit continues to be a contributor to the RVMC bottom line so that we can offer a full range of services at Asante
By those measures, I believe we are delivering great quality and value to the community. I see cards, letters, and Values In Action submissions that tell me we show outstanding compassion to our patients and families. This unit is part of Asante ’s Mission
Thanks and congratulations to all who work on the unit, those who help cover when workload or staffing fluctuate, those who work in the background to assure the unit is supplied, cleaned and that the billing processes work. Truly, this is a team effort and there is not enough praise to touch on what a jewel this is!
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