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With nearly 10,000 employees — including 1,400 physicians — Tampa General Hospital is one of the largest health care facilities in the country that isn’t part of a broader network.
But sometimes it can feel that way, TGH President and CEO John Couris says, because of how siloed the organization had become.
Couris, who joined the hospital two years ago, says quality of care was never a problem, but rather, the cost and length of patients’ stays had become vexing issues that cried out for attention.
“One of the first initiatives I brought to the team was CareComm,” he says, referring to TGH’s new $13 million command center, developed in conjunction with GE Healthcare, that harnesses the power of artificial intelligence and predictive analytics to make the hospital operate like a finely crafted Swiss clock. “We needed something seismic to happen.”
TGH is just one of four hospitals in the world to have a CareComm unit (the others are Johns Hopkins Hospital in Baltimore, Humber River Hospital in Toronto and Oregon Health and Science University Hospital in Portland, Ore.). The walls of the 8,000-square-foot facility are covered with nearly 40 large monitors that show real-time updates, 24/7, about what’s happening throughout the hospital in terms of patients’ treatment journeys.
TGH signed a deal with GE Healthcare in May 2018 and officially opened the facility, staffed by 30 hospital employees reassigned from other departments, in August this year.
“The problem we're trying to solve here is to really about flow and throughput,” says Dr. Peter Chang, the hospital’s vice president of care transitions. Chang joined the hospital in 2014 as its chief medical information officer and has served as an assistant professor of hospital medicine at USF Health.
But at a time when the U.S. health care system is under heavy fire from political forces on both the left and right, is a $13 million expenditure on what’s essentially a high-tech traffic management system the wisest use of resources? And how will TGH measure the long-term return on its investment?
EYE ON THE FUTURE
In response to that first question, Couris acknowledges CareComm represents a big outlay for a nonprofit, teaching hospital like TGH. But this isn't throwing money at a problem and hoping for the best.
“What I love about it is that it’s a systemic change,” he says. “It’s not about fixing a problem — it’s about sustaining the fix. As an industry, that’s where we struggle sometimes. We’ll go fix something, we’ll get it fixed, but we won’t have the discipline, the rigor, the systems in place to make the fix stick or to institutionalize the changes we’ve made.”
'“If anyone says, ‘Oh, everything's perfect,’ they're either not plugged in, or they’re not telling you reality.' John Couris, Tampa General Hospital
Both Couris and Chang note CareComm has not been developed and implemented in a vacuum.
A few months before CareComm opened, for example, TGH unveiled a new departure lounge, an area where patients who are ready to go home can wait for a ride and even pick up prescriptions at TGH’s in-house pharmacy. Not only does it free up much-needed bed space for incoming patients, but the lounge also ensures that discharged patients will go home with their medications already in hand instead of having to make a stop at an off-site drug store, where wait times can be long. That, in turn, lessens the chance that they’ll wind up back in the hospital due to not bothering to pick up medications.
“This isn't just about artificial intelligence and predictive analytics,” Couris says. “This is about reengineering the work we do and rebuilding health care from the inside out, not from the outside, and that is a huge shift in paradigm.”
For Chang, CareComm squarely aligns with how services across a wide range of industries are becoming highly tracked and quantifiable, down to the tiniest detail, through the use of technology.
“You look at retail, you look at the finance industry, everything is automated,” he says. “But we're dealing with patients, so not everything can be automated. We wouldn't want everything to be automated. But there are some basic things in regards to how the hospital operates that we could be much more efficient at doing.”
TAKE THE MEASURE
As a long-term investment, CareComm has already provided impressive returns when measured against TGH’s key performance indicators. One of those, length of stay, has been a primary focus. Chang says he and the CareComm staff set out to reduce what’s known as excess days.
“You have to have something that’s really well defined to determine what ROI is going to be,” he says, which could apply to any business or venture when measuring a project.
When a patient is admitted to the hospital, Chang explains, he or she is assigned a length of stay based on Medicare historical standards, which TGH, in turn, tries to beat.
“Let's say you get admitted with acute appendicitis and need to have your appendix removed,” he says. “That would result in maybe a 2.3-day length of stay. Now I have that target, and I need to socialize that target to the entire team, including the surgeons, who will now have the target for the patient sitting right in front of them, so they can react to it.”
When that patient’s surgery goes well, and he or she gets discharged in one day, vs. 2.3, that not only counts as one day saved, but it also frees up a plethora of additional resources to better — and more efficiently — treat other patients.
“We've saved around 10,000 excess days in the first year of the project, which is huge,” Chang says. “That not only benefits us but the patients as well because if our costs are less, then the patient's charges are less — it travels all the way down downhill. And it's not like we want to make a profit. We just want to be able to care for more patients because we create that capacity, and it’s immediately filled.”
On that point, Chang says CareComm’s efficiencies have created an additional 30 beds at TGH — without the need for additional space being built. It drives home the point that it’s not necessarily how many resources you have; it’s how you use them.
“You see a lot of hospital systems building bed towers,” Chang says. "And while they may have the need for it, every year there are things happening with hospital reimbursements; there are sequestrations with Medicare funds — a percent here, a half a percent here. It all adds up, especially for a hospital that runs on a tight margin.”
He adds, “By building a new bed tower and spending capital and then allocating operational resources and supply resources to run that unit every single day of every single year, you're only adding to the cost of health care.”
HUMAN TOUCH
CareComm is not all about data and dollars. It’s about people — both patients and staff — and making sure the hospital runs in an optimized fashion that allows workers to do, with utmost efficiency, what they do best: taking care of people.
The facility’s 30 staff members aren’t just IT specialists. They’re drawn from 10 different hospital departments, Couris says, running the gamut from environmental services to patient transportation and patient flow administrators. That means the CareComm staff have seen firsthand how and why bottlenecks happen in the hospital. And so to them, the numbers on the monitors aren’t just abstract figures.
“We're breaking down silos and promoting interdisciplinary teamwork to improve service outcome and costs for the organization,” Couris says. “It’s an enormous team effort.”
Part of that effort involves creating a culture where technological innovation can thrive. A company can throw gobs of money at the latest, greatest innovations, but without a workforce that’s willing and able to embrace technological change — and integrate it into the way business is done, day in and day out — that firm would be better off doing something else with its resources.
With artificial intelligence, for example, “the real challenge is not making sure the technology works,” Couris says. “It's the acceptance into the culture of artificial intelligence. The culture of your organization either accepts it or it doesn't. We are spending a ton of time on culture, to make sure our culture embraces new technology.”
Even with that push for cultural change, the CareComm rollout hasn’t been without challenges, Couris says.
“If anyone says, ‘Oh, everything's perfect,’ they're either not plugged in, or they’re not telling you reality," he says. "It is far from perfect. We are off to a very good start, but we have lots of road to travel. We're not anywhere where we need to be, which is exciting because even in the beginning of this journey, we're starting to see real results. But in order to get to that higher order of thinking and operating, we have to evolve the culture.”
To meet that challenge, Couris has been holding a series of forums — 17 in total — to communicate directly with TGH’s 10,000 staff members. He also throws on a uniform a few times a month and makes rounds, shadowing nurses, doctors, technicians and other workers who have to deal with the hospital’s complexities on a day-to-day basis. Additionally, he communicates with staff via blogs and social media and also takes part in new-hire orientation.
“As we were negotiating the deal with GE Healthcare, I was out communicating in those ways and explaining why [CareComm] is critically important for people to understand,” Couris says. “You have to explain the why behind the decision.”
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