Pleasing Patients Through Coordination of Services

An Expert Interview With William Gillespie

Steven Fox

March 09, 2011

March 9, 2011 (Orlando, Florida) — Editor's note: When patient services are not well coordinated in healthcare settings, the result can be significant dissatisfaction among patients and their families. For example, family members arriving at a patient's room during visiting hours, only to find the room empty and the patient somewhere else, undergoing tests, can lead to frustration.

Devising ways to avoid such unfortunate circumstances was the focus of a session presented here at the HIMSS 11: Healthcare Information and Management Systems Society 2011 Annual Conference and Exhibition, called Pleasing Patients Through Coordination of Services, presented by William Gillespie, vice president and chief information officer at WellSpan Health, an integrated healthcare delivery system based in York, Pennsylvania. Mr. Gillespie formerly served as vice president of information services at Allegheny General Hospital in Pittsburgh, Pennsylvania.

Medscape Medical News spoke with Mr. Gillespie about ways healthcare facilities can promote satisfaction among patients and their family members.

Medscape: Why is coordinating inpatient care such a challenging task for most hospitals?

Mr. Gillespie: Coordinating inpatient care is a significant challenge, and it's rarely achieved in hospitals. I think there are several reasons for that.

It requires significant department coordination. It forces the hospital to rethink transportation management and other support services. It requires complex interdepartment process reengineering and implementation of sophisticated work-flow tools. Besides that, there are numerous political and organizational hurdles that have to be overcome.

Historically, this sort of effort has been called "centralization," a term that was associated with negative connotations and loss of control. Increasingly, though, hospitals have adopted the term "coordination," which seems to represent less of a threat to the status quo.

The big challenge we're facing now is how to coordinate without turning everything upside down. There are a number of common issues that healthcare facilities face when they're trying to standardize and streamline across an organization that is composed of disparate health programs and different operational practices.

For example, different departments have different patient priorities, and ancillary departments have different rules and protocols that need to be embodied in their scheduling system. There is often a real question as to whether one system can handle all this specialized variability.

There's also often concern that "centralizing" scheduling functions will diminish control that individual areas have over their respective day-to-day operations.

Medscape: Some healthcare facilities are moving away from central scheduling of patient procedures and adopting novel programs to coordinate services among departments. What are the advantages of such an approach?

Mr. Gillespie: Well, there are several. Here's a case example: With the engagement of outside help and flexible software, WellSpan went live with a novel scheduling system in. . . 2 major hospital facilities and 15 outpatient diagnostic centers in November 2008.

In some cases, we chose not to replace existing scheduling systems because of the estimated time or costs involved. Some departments, such as radiation oncology, required unique scheduling protocols that were embedded in the department's diagnostic equipment software; they were left in place, but we linked them to a master schedule coordinator.

The coordinator linked 11 automated and manual scheduling systems together. That allowed them to generate a true patient itinerary. Now patient service schedules can originate in any of the 11 systems, and that information is shared across all systems to avoid conflicts and to streamline operations.

Using these novel approaches, WellSpan was able to initiate the process of achieving full inpatient care coordination.

Future considerations will include:

  • replacement of all patient scheduling systems

  • implementation of short-term measures, such as electronic bed/status boards

  • adding case managers or care coordinators

  • using radio frequency identification technology, coupled with smart pagers, etc, to help accurately track patients

  • overlaying a coordination scheduler on top of current systems.

Medscape: Can you elaborate on the role that electronic patient records and scheduling software play in this sort of approach?

Mr. Gillespie: Once the "people" issues are resolved, the most critical success factor becomes the information technology infrastructure. The major components of the infrastructure are the electronic medical record (EMR) and the Enterprise scheduling software.

The EMR contains the clinical history of the patient. Overlaying the EMR is the Enterprise scheduling software, which acts as the traffic cop across scheduling functions at the multiple points of care. Enterprise scheduling software facilitates department system notification, patient registration, ancillary orders, clinical logic/sequencing, block timing, work lists by department, [and] conflict resolution, and provides the conduit across the process continuum.

Medscape: Often improvements in coordination of patient care seem to spark organizational and political battles. Coordination of unscheduled emergency services seems to be an especially tough challenge. How can those sorts of problems be avoided?

Mr. Gillespie: With the ability to coordinate patient schedules across all services, whether inpatient or outpatient, many problems can be mitigated, especially unscheduled emergency services, which can occur at any time. Coordinated services can significantly improve patient satisfaction by eliminating or greatly reducing wait times at the ancillary departments. Coordinated services can also help eliminate situations in which family members come to visit and the patient is out having tests or other procedures.

Medscape: Many hospitals that try to improve the efficiency of inpatient services fail in their attempts. How can hospitals avoid common pitfalls and improve their chances of success?

Mr. Gillespie: The goal is to build a better delivery system, coupled with the mission of improving the patient experience. Strong governance, along with the support of senior management, can help break down traditional barriers and promote interdepartmental coordination.

At the tactical level, the implementing of common data files and flexible software can provide the collaborative infrastructure that's necessary to achieve full-service coordination. The result is improved efficiency of inpatient services.