First of all, Florence Nightingale most certainly didn’t actually say that. We recently read of a hospital administrator, however, who invoked Nightingale in defending a new plan to have nurses mop and clean patient areas. Her reasoning: Cleanliness improves the patient’s health and experience, and “even Florence Nightingale” knew that was true. Even though Nightingale did pioneer environmental theory to improve patient experience, we doubt the nurses at this hospital embrace the administrator’s analogy. And we’re not buying it, either.
But we do recognize the cost control pressures that administrator feels these days. Thus the title of our post, which we imagine some misguided hospital executive in a boardroom saying out loud, earnestly suggesting it as a way to cut skyrocketing costs.
It’s “efficiency by desperation,” and while we can understand its roots, we question its effectiveness. Asking scarce and overworked nurses to “just do more” non-clinical activities threatens to wreck morale and diminish bedside time with patients. [UPDATE: Just to reiterate, we do not think that asking nurses to also take on the job responsibilities of environmental services is a good idea. It’s a short-sighted quick “fix” to cut costs, while harming care quality and patient and nurse satisfaction. In the end, it will cost hospitals much more in diminished throughput and experience.]
We did find a second reference to Florence Nightingale that we think hits the mark much better. On the Health Facilities Management website, nurse and consultant Debbie Hurst shares a thoughtful overview of Nightingale’s philosophy of nursing and the patient experience. She champions collaboration, celebrating the efforts of nurses, environmental services, transport, technicians and everyone responsible for care to deliver Nightingale’s vision of the ideal patient experience. In doing so, she says, hospitals will build positive spirit across all teams while improving care quality and HCAHPS measures.
Her vision of teamwork across departments mirrors that of the hospitals we see transforming operations to truly do more with less, while still keeping patients, doctors, nurses and executives happy. Instead of cutting corners and temporary costs by handing mops to nurses, hospitals must embrace efficiency and continuous improvement in every aspect of patient care coordination. It requires new logistical thinking proven in other industries, supported by technologies and tools built to make the system work. We’re working on a case study with a Southeastern hospital now that adopted a logistical control system for patient throughput as part of a committed transformation journey. The results in six months have been remarkable:
- Reduced the average patient length of stay by 0.4 days
- Saved $4 million in annual costs by improving efficiency
- Added capacity to care for 2,200 additional patients per year with no additional increase in fixed costs
- Provided more responsive and efficient care even as patient clinical needs increased, improving length of stay as adjusted by case mix index by 17 percent
And here’s a San Francisco Gate article from just last week showcasing how San Francisco General Hospital is applying the logistical management methods of Toyota to improve efficiency in patient care. Teams work together to improve communications and handoffs and continuously improve care quality and processes.
These hospitals are improving care quality and patient experience while driving down costs by working as a system to coordinate care. Groups and departments work in harmony to advance patient care and throughput, not at cross purposes. Patients win, nurses and other caregivers win, hospitals win. We think Florence would approve.
POSTED BY Doug Walker