1 00:00:00,080 --> 00:00:02,879 This is Scott Becker with the Becker's Healthcare 2 00:00:02,879 --> 00:00:03,379 Podcast. 3 00:00:04,240 --> 00:00:06,480 I'm thrilled to be joined by a brilliant 4 00:00:06,480 --> 00:00:09,199 leader from Cedars Sinai. And Cedars Sinai, for 5 00:00:09,199 --> 00:00:11,199 people that are not familiar, you gotta be 6 00:00:11,199 --> 00:00:13,279 familiar. One of the top five systems in 7 00:00:13,279 --> 00:00:15,855 the country ranked by quality, a fantastic health 8 00:00:16,335 --> 00:00:19,074 system. We're joined today by Heidi Hai. Heidi 9 00:00:19,135 --> 00:00:21,535 is the executive director of capacity management, and 10 00:00:21,535 --> 00:00:23,454 we're gonna talk today a lot about thorough 11 00:00:23,614 --> 00:00:24,114 throughput, 12 00:00:24,494 --> 00:00:26,974 patient flow, and a lot more. Heidi's got 13 00:00:26,974 --> 00:00:29,614 this fascinating background before coming to Cedars Sinai. 14 00:00:29,614 --> 00:00:31,429 She spent she's been at Cedars Sinai for 15 00:00:31,429 --> 00:00:33,189 fifteen, seventeen years. So he's had a great, 16 00:00:33,189 --> 00:00:35,270 great career there and watched that system just 17 00:00:35,270 --> 00:00:36,250 blossom and blossom. 18 00:00:36,630 --> 00:00:38,710 Before that, she spent time in Hawaii. So, 19 00:00:38,710 --> 00:00:40,149 you know, it had to be a great, 20 00:00:40,469 --> 00:00:42,549 opportunity to leave Hawaii to come to Cedars 21 00:00:42,549 --> 00:00:43,034 Sinai. 22 00:00:43,435 --> 00:00:45,674 It's just a fantastic career. Heidi, can you 23 00:00:45,674 --> 00:00:47,914 take one moment to introduce yourself, and then 24 00:00:47,914 --> 00:00:50,155 we'll talk about capacity management, some of the 25 00:00:50,155 --> 00:00:52,634 initiatives that Cedars Sinai is is working on, 26 00:00:52,634 --> 00:00:53,774 and and a lot more. 27 00:00:54,395 --> 00:00:56,155 You bet. Thank you, Scott, and appreciate the 28 00:00:56,155 --> 00:00:56,655 opportunity. 29 00:00:57,490 --> 00:01:00,229 I am a ICU nurse by background 30 00:01:00,770 --> 00:01:01,270 and, 31 00:01:01,890 --> 00:01:04,609 got into logistics of hospital flow while I 32 00:01:04,609 --> 00:01:06,209 was in Hawaii. And, yes, that was a 33 00:01:06,209 --> 00:01:07,829 wonderful, place to live. 34 00:01:08,290 --> 00:01:11,670 And there I was a nursing supervisor and 35 00:01:11,810 --> 00:01:13,295 really got intrigued by 36 00:01:13,994 --> 00:01:16,715 the workings behind the hospital. How how do 37 00:01:16,715 --> 00:01:18,415 we care for all of these patients, 38 00:01:19,114 --> 00:01:21,435 in such a seamless way? And it, really 39 00:01:21,435 --> 00:01:23,435 opened my eyes and I've been in hospital 40 00:01:23,435 --> 00:01:24,494 flow ever since. 41 00:01:25,290 --> 00:01:26,890 Thank you very, very much. And hospital flow 42 00:01:26,890 --> 00:01:28,810 must have changed tremendously over the last fifteen 43 00:01:28,810 --> 00:01:30,969 years and and even the ten years that 44 00:01:30,969 --> 00:01:32,189 you were in Hawaii. 45 00:01:32,489 --> 00:01:35,469 But but talk about trying to improve patient 46 00:01:35,530 --> 00:01:36,030 flow. 47 00:01:36,409 --> 00:01:38,695 What were some of those pressing challenges that 48 00:01:38,695 --> 00:01:40,855 your teams were facing at Cedars Sinai as 49 00:01:40,855 --> 00:01:42,534 you try to sort of work through patient 50 00:01:42,534 --> 00:01:44,454 flow and try to improve and try different 51 00:01:44,454 --> 00:01:44,954 approaches? 52 00:01:45,255 --> 00:01:46,454 Tell us a little bit about what you 53 00:01:46,454 --> 00:01:48,295 were looking at when you began to try 54 00:01:48,295 --> 00:01:49,674 and improve patient flow. 55 00:01:50,454 --> 00:01:52,775 In my fifteen years here, it really is 56 00:01:52,775 --> 00:01:53,275 always 57 00:01:53,680 --> 00:01:56,560 been the same problem in that we do 58 00:01:56,560 --> 00:01:59,200 not have enough beds for all of the 59 00:01:59,200 --> 00:02:00,739 patients seeking our care. 60 00:02:01,280 --> 00:02:04,400 And so probably the greatest challenge in that 61 00:02:04,400 --> 00:02:06,640 is you are dealing with human lives and 62 00:02:06,640 --> 00:02:08,479 you wanna be able to care for every 63 00:02:08,479 --> 00:02:09,104 single patient 64 00:02:10,144 --> 00:02:11,284 that comes to your, 65 00:02:11,985 --> 00:02:12,805 site for care. 66 00:02:13,344 --> 00:02:15,504 And I would say, probably, the second biggest 67 00:02:15,504 --> 00:02:17,685 challenge is in the collaboration 68 00:02:18,384 --> 00:02:19,444 that is required 69 00:02:19,824 --> 00:02:21,525 at such a large organization. 70 00:02:22,569 --> 00:02:25,129 The bigger your organization gets, the bigger your 71 00:02:25,129 --> 00:02:27,530 team gets, and the harder it can be 72 00:02:27,530 --> 00:02:28,349 to align, 73 00:02:28,889 --> 00:02:29,710 at times. 74 00:02:30,409 --> 00:02:32,349 We have an aligned organization, 75 00:02:32,650 --> 00:02:34,969 but, again, with it being so large, makes 76 00:02:34,969 --> 00:02:36,590 it difficult to bring everybody, 77 00:02:37,770 --> 00:02:38,384 on the same 78 00:02:39,344 --> 00:02:39,844 page. 79 00:02:40,305 --> 00:02:42,324 A 100%. And talk a little bit about 80 00:02:42,544 --> 00:02:44,405 how is patient flow evolved 81 00:02:44,864 --> 00:02:47,025 and what tactics are you focusing right now 82 00:02:47,025 --> 00:02:49,685 to sort of improve patient flow? And and 83 00:02:49,745 --> 00:02:50,324 and Cedars 84 00:02:50,879 --> 00:02:52,099 is a large institution, 85 00:02:52,560 --> 00:02:54,879 but but it's not thousands of beds. It's 86 00:02:54,879 --> 00:02:56,959 it's one of the great hospitals in the 87 00:02:56,959 --> 00:02:59,599 country, but patient flow and throughput is so 88 00:02:59,599 --> 00:03:00,099 important. 89 00:03:00,479 --> 00:03:02,639 How have these things evolved and what techs 90 00:03:02,639 --> 00:03:04,560 are what techs are using or focusing on 91 00:03:04,560 --> 00:03:05,805 right now to improve this? 92 00:03:06,444 --> 00:03:09,104 Yeah. So fifteen years ago when I started, 93 00:03:09,164 --> 00:03:11,724 we were using paper. I remember rounding with 94 00:03:11,724 --> 00:03:15,025 a clipboard and writing down information about upcoming 95 00:03:15,084 --> 00:03:15,584 discharges 96 00:03:15,884 --> 00:03:16,625 and admissions. 97 00:03:17,324 --> 00:03:19,405 And by the time I had rounded on 98 00:03:19,405 --> 00:03:22,199 all 40 some units, of course, the information 99 00:03:22,259 --> 00:03:24,419 was old, but that's how we were doing 100 00:03:24,419 --> 00:03:24,919 it. 101 00:03:25,379 --> 00:03:26,840 And if there was, 102 00:03:28,580 --> 00:03:29,080 whatever 103 00:03:29,379 --> 00:03:31,300 well, whoever wanted to declare that we were 104 00:03:31,300 --> 00:03:32,439 having an emergency 105 00:03:32,819 --> 00:03:34,835 and that we had too many patients waiting 106 00:03:34,835 --> 00:03:37,495 in the emergency department, we'd all come into 107 00:03:38,194 --> 00:03:40,675 a conference room and everybody have their piece 108 00:03:40,675 --> 00:03:43,155 of paper, and we would report out again 109 00:03:43,155 --> 00:03:44,775 on information that was old. 110 00:03:45,155 --> 00:03:47,094 Through time, one of the greatest 111 00:03:47,474 --> 00:03:49,689 things that we've done from a cultural change 112 00:03:49,689 --> 00:03:52,250 perspective is start daily huddles, and that was 113 00:03:52,250 --> 00:03:53,870 started back in 2019. 114 00:03:54,889 --> 00:03:56,189 And utilizing, 115 00:03:56,969 --> 00:03:57,469 technology, 116 00:03:58,169 --> 00:04:00,729 being more transparent with our data and how 117 00:04:00,729 --> 00:04:03,370 many patients were waiting, where the discharges were, 118 00:04:03,370 --> 00:04:05,150 where the bottlenecks might be, 119 00:04:05,655 --> 00:04:09,175 Everybody from the frontline nursing staff to our 120 00:04:09,175 --> 00:04:12,875 environmental services to pharmacy to lab to physicians 121 00:04:13,574 --> 00:04:16,475 and beyond come to our daily huddle, and 122 00:04:16,535 --> 00:04:19,095 that has been the most, transformative from a 123 00:04:19,095 --> 00:04:20,074 cultural perspective. 124 00:04:20,980 --> 00:04:23,639 From a data and technology perspective, 125 00:04:24,259 --> 00:04:26,120 whatever system that we're using, 126 00:04:27,300 --> 00:04:30,020 the most important part of that has been 127 00:04:30,020 --> 00:04:32,360 what information we actually bring to the surface 128 00:04:32,420 --> 00:04:35,055 because we are very data rich. And so 129 00:04:35,115 --> 00:04:37,915 how do we actually drive behavior using that 130 00:04:37,915 --> 00:04:38,415 technology? 131 00:04:39,115 --> 00:04:40,814 It's been an important journey. 132 00:04:41,675 --> 00:04:43,995 Heidi, a lot of the initiative is about 133 00:04:43,995 --> 00:04:47,855 how rethinking how patient flow works, how discharge 134 00:04:47,915 --> 00:04:50,199 works, and so forth. Can can you talk 135 00:04:50,199 --> 00:04:52,599 a little bit about walk us through how 136 00:04:52,599 --> 00:04:56,839 Cedars Sinai approached redesigning discharge workflows and what 137 00:04:56,839 --> 00:04:59,500 was the most meaningful changes that you did 138 00:04:59,800 --> 00:05:01,639 to to try and drive collaboration and to 139 00:05:01,639 --> 00:05:03,259 help people adopt in the process? 140 00:05:04,365 --> 00:05:05,745 Yeah. So probably 141 00:05:06,365 --> 00:05:08,464 where we gained our greatest gains 142 00:05:08,925 --> 00:05:11,104 is in bringing the information 143 00:05:11,805 --> 00:05:14,444 as close to the hands of the people 144 00:05:14,444 --> 00:05:16,990 doing the work that we could. So I 145 00:05:16,990 --> 00:05:19,810 mentioned our daily huddles, and while we have 146 00:05:19,870 --> 00:05:22,269 charge nurses in those daily huddles, they aren't 147 00:05:22,269 --> 00:05:24,209 always the ones that we're asking 148 00:05:24,750 --> 00:05:27,709 to discharge a patient or asking to send 149 00:05:27,709 --> 00:05:29,810 a patient to our departure lounge. 150 00:05:30,134 --> 00:05:31,495 So once we were able to get that 151 00:05:31,495 --> 00:05:33,595 information to the bedside nurses 152 00:05:34,214 --> 00:05:37,254 and with actionable items of what we were 153 00:05:37,254 --> 00:05:40,375 actually asking them to do, such as your 154 00:05:40,375 --> 00:05:42,794 patient qualifies for the discharge lounge, 155 00:05:43,159 --> 00:05:45,240 please consider patient sending the patient to the 156 00:05:45,240 --> 00:05:48,039 discharge lounge, you know, signifying whether they have 157 00:05:48,039 --> 00:05:49,740 a discharge order or not. 158 00:05:50,199 --> 00:05:52,120 This is where we really started to see, 159 00:05:52,599 --> 00:05:53,099 incremental 160 00:05:53,479 --> 00:05:53,979 improvements 161 00:05:54,439 --> 00:05:57,019 in, especially, our discharge lounge metrics. 162 00:05:57,355 --> 00:06:00,634 In addition, our discharge order processing time, so 163 00:06:00,634 --> 00:06:02,314 the time from when we get a discharge 164 00:06:02,314 --> 00:06:04,175 order to with the time the patient 165 00:06:04,795 --> 00:06:06,014 is discharged, 166 00:06:06,795 --> 00:06:09,595 that is improved. We have put tools in 167 00:06:09,595 --> 00:06:12,095 the hands of our support services department 168 00:06:12,860 --> 00:06:13,759 for prioritization. 169 00:06:14,220 --> 00:06:16,399 So whether it's a CT, 170 00:06:16,939 --> 00:06:19,600 whether it's pharmacy delivering meds to beds, 171 00:06:20,300 --> 00:06:23,020 our support services departments have the information they 172 00:06:23,020 --> 00:06:24,319 need on who to prioritize 173 00:06:25,180 --> 00:06:26,160 patients first. 174 00:06:27,014 --> 00:06:28,775 Thank you. And talk a little bit about, 175 00:06:28,775 --> 00:06:30,694 sort of, when you work through changes and 176 00:06:30,694 --> 00:06:32,295 how you do systems, how you work through 177 00:06:32,295 --> 00:06:33,915 systems, how you work through discharge, 178 00:06:34,694 --> 00:06:36,795 how how do you deal with, sort of, 179 00:06:37,975 --> 00:06:40,574 culture change and getting people involved in this, 180 00:06:40,574 --> 00:06:42,699 and and what steps you take to keep 181 00:06:42,699 --> 00:06:44,860 people sort of aligned with how you're changing 182 00:06:44,860 --> 00:06:47,199 things? So as you make changes, it always 183 00:06:47,339 --> 00:06:49,740 bothers or causes stress for some people. How 184 00:06:49,740 --> 00:06:51,279 do how do you deal with that? 185 00:06:52,060 --> 00:06:54,220 Yeah. One of the greatest things that we've 186 00:06:54,220 --> 00:06:54,720 done 187 00:06:55,020 --> 00:06:55,920 is bring 188 00:06:56,504 --> 00:06:59,145 our nursing leadership to the table very early 189 00:06:59,145 --> 00:06:59,645 on 190 00:07:00,264 --> 00:07:00,764 and 191 00:07:01,145 --> 00:07:04,025 really listening to them and what motivates them, 192 00:07:04,025 --> 00:07:05,564 what motivates their people. 193 00:07:05,944 --> 00:07:08,285 Of course, food is always a great motivator, 194 00:07:08,985 --> 00:07:10,665 but I don't have a budget for that 195 00:07:10,665 --> 00:07:12,470 for these folks. So we have done a 196 00:07:12,470 --> 00:07:13,370 lot of celebrating. 197 00:07:13,910 --> 00:07:16,629 We have something that's called move awards, and 198 00:07:16,629 --> 00:07:18,389 they are tied to the metrics that we 199 00:07:18,389 --> 00:07:21,189 are trying to improve, such as our departure 200 00:07:21,189 --> 00:07:22,089 lounge utilization, 201 00:07:22,709 --> 00:07:23,985 our discharge order processing time, our 202 00:07:25,024 --> 00:07:27,524 pulling patients up from emergency department. 203 00:07:28,544 --> 00:07:30,865 And I tell you, if you bring them 204 00:07:30,865 --> 00:07:31,685 to the table, 205 00:07:32,064 --> 00:07:33,524 give them the 206 00:07:33,985 --> 00:07:36,899 safety in being able to express their concerns 207 00:07:36,959 --> 00:07:38,579 and why it might not work, 208 00:07:38,879 --> 00:07:40,259 and then bring them along 209 00:07:40,959 --> 00:07:43,779 and have them help with the 210 00:07:44,160 --> 00:07:46,959 joint ownership of the problem, we've we've really 211 00:07:46,959 --> 00:07:49,615 made great strides. And I call them our 212 00:07:49,615 --> 00:07:50,355 Suite 16 213 00:07:50,895 --> 00:07:51,715 because initially, 214 00:07:52,175 --> 00:07:54,415 it was 16 nursing leaderships then it started 215 00:07:54,415 --> 00:07:56,735 to expand and now we call them our 216 00:07:56,735 --> 00:07:58,754 BFFs, our best friends in flow. 217 00:07:59,295 --> 00:07:59,795 And, 218 00:08:00,415 --> 00:08:03,490 they are absolutely key to our improvements that 219 00:08:03,490 --> 00:08:06,610 we have seen. Thank you very, very much. 220 00:08:06,610 --> 00:08:08,389 And and and talk for a moment 221 00:08:09,329 --> 00:08:10,149 about follow-up. 222 00:08:10,849 --> 00:08:12,849 Looking back, as you change the system for 223 00:08:12,849 --> 00:08:14,849 patient flow, how you as you adopted new 224 00:08:14,849 --> 00:08:15,345 systems, 225 00:08:16,545 --> 00:08:18,964 new artificial intelligence, new technology, 226 00:08:19,345 --> 00:08:22,144 were there any unexpected moments of buying or 227 00:08:22,144 --> 00:08:24,225 resistance that helped shape how you led the 228 00:08:24,225 --> 00:08:27,105 transformation to changing your your system for discharge, 229 00:08:27,105 --> 00:08:28,725 your system for patient flow, 230 00:08:29,050 --> 00:08:32,009 and any unexpected changes or resistance or or 231 00:08:32,009 --> 00:08:32,670 or challenges? 232 00:08:33,769 --> 00:08:34,990 Well, I expected 233 00:08:35,290 --> 00:08:35,790 resistance 234 00:08:36,170 --> 00:08:37,629 when we were asking 235 00:08:38,250 --> 00:08:38,750 teams 236 00:08:39,929 --> 00:08:42,809 to utilize the system outside of the electronic 237 00:08:42,809 --> 00:08:46,164 health record. Where the surprise came in is 238 00:08:46,164 --> 00:08:49,064 I did not expect such early buy in, 239 00:08:49,605 --> 00:08:51,064 but as soon as they, 240 00:08:51,524 --> 00:08:54,084 were able to see the value and the 241 00:08:54,084 --> 00:08:54,584 information 242 00:08:55,204 --> 00:08:57,605 that they were able to gain that really 243 00:08:57,605 --> 00:08:58,664 came to the surface, 244 00:08:59,059 --> 00:09:01,799 cut out, hours of chart digging. 245 00:09:02,820 --> 00:09:05,779 They started to spread the news themselves. When 246 00:09:05,779 --> 00:09:07,539 I say they, it's really the nursing group 247 00:09:07,539 --> 00:09:10,579 because there are such a large workforce and 248 00:09:10,579 --> 00:09:13,159 without them, it's hard to move any initiative 249 00:09:13,220 --> 00:09:13,720 forward. 250 00:09:14,179 --> 00:09:14,679 So 251 00:09:15,035 --> 00:09:17,355 a resistance I knew was coming, but actually 252 00:09:17,355 --> 00:09:19,134 was surprised by the buy in. 253 00:09:19,754 --> 00:09:20,975 It it's fantastic. 254 00:09:21,514 --> 00:09:24,075 And any other lessons or closing thoughts do 255 00:09:24,075 --> 00:09:24,654 you have, 256 00:09:25,195 --> 00:09:27,195 and how you work through sort of changing 257 00:09:27,195 --> 00:09:29,830 systems on patient flow and discharge and so 258 00:09:29,830 --> 00:09:30,330 forth, 259 00:09:30,789 --> 00:09:33,690 to make sure it both it works great, 260 00:09:34,309 --> 00:09:35,370 improves efficiency, 261 00:09:35,990 --> 00:09:38,870 and improves the quality that Cedars Sinai is 262 00:09:38,870 --> 00:09:41,350 so known for. Any sort of closing thoughts 263 00:09:41,350 --> 00:09:42,889 on trying to make these things work? 264 00:09:43,585 --> 00:09:47,125 Yeah. Considering not just the collaboration within your 265 00:09:47,184 --> 00:09:47,684 organization, 266 00:09:48,144 --> 00:09:50,785 but also collaborating with those outside of your 267 00:09:50,785 --> 00:09:51,285 organization. 268 00:09:52,384 --> 00:09:54,085 Because in inside of organizations, 269 00:09:54,465 --> 00:09:56,865 capacity management leaders can often feel like they're 270 00:09:56,865 --> 00:09:58,740 on an island. They're kind of a end 271 00:09:58,740 --> 00:10:00,120 of one, we say. 272 00:10:00,660 --> 00:10:02,500 But when you get out of outside of 273 00:10:02,500 --> 00:10:05,320 your organization and learn from what other organizations 274 00:10:06,019 --> 00:10:06,680 are doing, 275 00:10:07,300 --> 00:10:09,639 it it really helps. Not only in validating 276 00:10:09,860 --> 00:10:12,840 that the initiatives that we're implementing 277 00:10:13,735 --> 00:10:14,554 are the right 278 00:10:14,855 --> 00:10:17,035 ones, but also sometimes just in commiserating 279 00:10:17,975 --> 00:10:19,754 in the struggle and the challenges 280 00:10:20,134 --> 00:10:23,434 that it takes, to be improving capacity management. 281 00:10:24,294 --> 00:10:25,915 No. A 100%. 282 00:10:26,134 --> 00:10:26,700 You know, 283 00:10:27,500 --> 00:10:29,100 I wanna thank you, Heidi, for taking the 284 00:10:29,100 --> 00:10:31,179 time to join us. I I know you're 285 00:10:31,179 --> 00:10:33,660 busy and doing fantastic work. We are so 286 00:10:33,660 --> 00:10:35,340 appreciative of you taking the time to join 287 00:10:35,340 --> 00:10:37,980 us, in the Becker's Healthcare podcast to share 288 00:10:37,980 --> 00:10:40,139 some of your lessons in sort of moving 289 00:10:40,139 --> 00:10:42,504 to a new system on patient flow, moving 290 00:10:42,504 --> 00:10:43,804 a new system on discharge, 291 00:10:44,264 --> 00:10:46,105 and the work that you're doing. Thank you 292 00:10:46,105 --> 00:10:47,544 so much for joining us today on the 293 00:10:47,544 --> 00:10:50,284 Becker's Healthcare podcast. Thank you very, very much. 294 00:10:50,824 --> 00:10:52,445 Absolutely. Thank you, Scott.