Speaker 0: This is Scott Becker with the Becker's Healthcare Podcast. I'm thrilled to be joined by a brilliant leader from Cedars Sinai. And Cedars Sinai, for people that are not familiar, you gotta be familiar. One of the top five systems in the country ranked by quality, a fantastic health system. We're joined today by Heidi Hai.

Heidi is the executive director of capacity management, and we're gonna talk today a lot about thorough throughput, patient flow, and a lot more. Heidi's got this fascinating background before coming to Cedars Sinai. She spent she's been at Cedars Sinai for fifteen, seventeen years. So he's had a great, great career there and watched that system just blossom and blossom. Before that, she spent time in Hawaii.

So, you know, it had to be a great, opportunity to leave Hawaii to come to Cedars Sinai. It's just a fantastic career. Heidi, can you take one moment to introduce yourself, and then we'll talk about capacity management, some of the initiatives that Cedars Sinai is is working on, and and a lot more.

Speaker 1: You bet. Thank you, Scott, and appreciate the opportunity. I am a ICU nurse by background and, got into logistics of hospital flow while I was in Hawaii. And, yes, that was a wonderful, place to live. And there I was a nursing supervisor and really got intrigued by the workings behind the hospital.

How how do we care for all of these patients, in such a seamless way? And it, really opened my eyes and I've been in hospital flow ever since.

Speaker 0: Thank you very, very much. And hospital flow must have changed tremendously over the last fifteen years and and even the ten years that you were in Hawaii. But but talk about trying to improve patient flow. What were some of those pressing challenges that your teams were facing at Cedars Sinai as you try to sort of work through patient flow and try to improve and try different approaches? Tell us a little bit about what you were looking at when you began to try and improve patient flow.

Speaker 1: In my fifteen years here, it really is always been the same problem in that we do not have enough beds for all of the patients seeking our care. And so probably the greatest challenge in that is you are dealing with human lives and you wanna be able to care for every single patient that comes to your, site for care. And I would say, probably, the second biggest challenge is in the collaboration that is required at such a large organization. The bigger your organization gets, the bigger your team gets, and the harder it can be to align, at times. We have an aligned organization, but, again, with it being so large, makes it difficult to bring everybody, on the same

Speaker 0: page. A 100%. And talk a little bit about how is patient flow evolved and what tactics are you focusing right now to sort of improve patient flow? And and and Cedars is a large institution, but but it's not thousands of beds. It's it's one of the great hospitals in the country, but patient flow and throughput is so important.

How have these things evolved and what techs are what techs are using or focusing on right now to improve this?

Speaker 1: Yeah. So fifteen years ago when I started, we were using paper. I remember rounding with a clipboard and writing down information about upcoming discharges and admissions. And by the time I had rounded on all 40 some units, of course, the information was old, but that's how we were doing it. And if there was, whatever well, whoever wanted to declare that we were having

Speaker 0: an

Speaker 1: emergency and that we had too many patients waiting in the emergency department, we'd all come into a conference room and everybody have their piece of paper, and we would report out again on information that was old. Through time, one of the greatest things that we've done from a cultural change perspective is start daily huddles, and that was started back in 2019. And utilizing, technology, being more transparent with our data and how many patients were waiting, where the discharges were, where the bottlenecks might be, Everybody from the frontline nursing staff to our environmental services to pharmacy to lab to physicians and beyond come to our daily huddle, and that has been the most, transformative from a cultural perspective. From a data and technology perspective, whatever system that we're using, the most important part of that has been what information we actually bring to the surface because we are very data rich. And so how do we actually drive behavior using that technology?

It's been an important journey.

Speaker 0: Heidi, a lot of the initiative is about how rethinking how patient flow works, how discharge works, and so forth. Can can you talk a little bit about walk us through how Cedars Sinai approached redesigning discharge workflows and what was the most meaningful changes that you did to to try and drive collaboration and to help people adopt in the process?

Speaker 1: Yeah. So probably where we gained our greatest gains is in bringing the information as close to the hands of the people doing the work that we could. So I mentioned our daily huddles, and while we have charge nurses in those daily huddles, they aren't always the ones that we're asking to discharge a patient or asking to send a patient to our departure lounge. So once we were able to get that information to the bedside nurses and with actionable items of what we were actually asking them to do, such as your patient qualifies for the discharge lounge, please consider patient sending the patient to the discharge lounge, you know, signifying whether they have a discharge order or not. This is where we really started to see, incremental improvements in, especially, our discharge lounge metrics.

In addition, our discharge order processing time, so the time from when we get a discharge order to with the time the patient is discharged, that is improved. We have put tools in the hands of our support services department for prioritization. So whether it's a CT, whether it's pharmacy delivering meds to beds, our support services departments have the information they need on who to prioritize patients first.

Speaker 0: Thank you. And talk a little bit about, sort of, when you work through changes and how you do systems, how you work through systems, how you work through discharge, how how do you deal with, sort of, culture change and getting people involved in this, and and what steps you take to keep people sort of aligned with how you're changing things? So as you make changes, it always bothers or causes stress for some people. How do how do you deal with that?

Speaker 1: Yeah. One of the greatest things that we've done is bring our nursing leadership to the table very early on and really listening to them and what motivates them, what motivates their people. Of course, food is always a great motivator, but I don't have a budget for that for these folks. So we have done a lot of celebrating. We have something that's called move awards, and they are tied to the metrics that we are trying to improve, such as our departure lounge utilization, our discharge order processing time, our pulling patients up from emergency department.

And I tell you, if you bring them to the table, give them the safety in being able to express their concerns and why it might not work, and then bring them along and have them help with the joint ownership of the problem, we've we've really made great strides. And I call them our Suite 16 because initially, it was 16 nursing leaderships then it started to expand and now we call them our BFFs, our best friends in flow. And, they are absolutely key to our improvements that we have seen.

Speaker 0: Thank you very, very much. And and and talk for a moment about follow-up. Looking back, as you change the system for patient flow, how you as you adopted new systems, new artificial intelligence, new technology, were there any unexpected moments of buying or resistance that helped shape how you led the transformation to changing your your system for discharge, your system for patient flow, and any unexpected changes or resistance or or or challenges?

Speaker 1: Well, I expected resistance when we were asking teams to utilize the system outside of the electronic health record. Where the surprise came in is I did not expect such early buy in, but as soon as they, were able to see the value and the information that they were able to gain that really came to the surface, cut out, hours of chart digging. They started to spread the news themselves. When I say they, it's really the nursing group because there are such a large workforce and without them, it's hard to move any initiative forward. So a resistance I knew was coming, but actually was surprised by the buy in.

Speaker 0: It it's fantastic. And any other lessons or closing thoughts do you have, and how you work through sort of changing systems on patient flow and discharge and so forth, to make sure it both it works great, improves efficiency, and improves the quality that Cedars Sinai is so known for. Any sort of closing thoughts on trying to make these things work?

Speaker 1: Yeah. Considering not just the collaboration within your organization, but also collaborating with those outside of your organization. Because in inside of organizations, capacity management leaders can often feel like they're on an island. They're kind of a end of one, we say. But when you get out of outside of your organization and learn from what other organizations are doing, it it really helps.

Not only in validating that the initiatives that we're implementing are the right ones, but also sometimes just in commiserating in the struggle and the challenges that it takes, to be improving capacity management.

Speaker 0: No. A 100%. You know, I wanna thank you, Heidi, for taking the time to join us. I I know you're busy and doing fantastic work. We are so appreciative of you taking the time to join us, in the Becker's Healthcare podcast to share some of your lessons in sort of moving to a new system on patient flow, moving a new system on discharge, and the work that you're doing.

Thank you so much for joining us today on the Becker's Healthcare podcast. Thank you very, very much.

Speaker 1: Absolutely. Thank you, Scott.