Unleashing Creativity to Manage Demand for Care

UH Clinical Update | March 2023

By Paul R. Hinchey, MD, MBA, Chief Operating Officer

Paul R. Hinchey, MD, MBA

Clinical operations in a health system like UH are complex. Beyond providing support for the high-quality personalized medical care our caregivers provide every day, clinical operations guides the improvements and design decisions we make as a team to determine how and where we can best deliver that care.  High-quality, personalized care is what differentiates us from other health systems and will not change. The how and where we deliver that care has to.

The COVID pandemic accelerated retirements and the migration of people into different areas of healthcare. Some healthcare professionals left the industry entirely. This has impacted health systems across the country. We’ve all faced an imbalance between the number of patients that need care and the staff we have to provide it. This imbalance is evident, not just in nursing, but in many positions across healthcare. There are dozens of different roles that come together to help us support and take care of every patient, and filling many of these jobs has been challenging.

We are adapting to this new reality. We're fortunate that we began our journey to systemness even before the onset of the pandemic. Our evolution helped us manage the incredible demand we saw during the peak of COVID. Instead of thinking as individual hospitals or sites of service, we began thinking as a system of pooled resources with a common purpose to serve and care for the communities of Northeast Ohio.  That change in thinking allowed us to shift resources to help meet the unprecedented number of patients we saw across the system.  While the number of patients has returned to more normal levels, we have fewer staff available to care for them.  It’s helpful to think of it as a simple supply and demand equation, with supply being our caregivers and demand being patients needing care. The imbalance of the equation is particularly acute in our hospitals. To restore balance, we are working on solutions to both sides of the equation – supply and demand in order to achieve a sustainable balance faster.  We have to continue to evolve.

The Talent Acquisition team in Human Resources, and Michelle Hereford and her team in Nursing, are doing an amazing job to increase our supply of talented and dedicated caregivers at UH. Unfortunately, there are simply not enough nurses or working-age people to fill all the jobs in Northeast Ohio. To meet the changing environment, we need to rethink how and where we deliver care.  We can change our delivery model with the “Care Team of Tomorrow,” creating different roles to support care delivery or leverage technology to reduce the workload, but we also need to address the demand.

Initiatives currently underway concentrate on keeping patients healthy to avoid the need to come to the hospital or, if hospital care is needed, to shorten the length of time hospital care is required. The work across these initiatives – and others – is ongoing and will continue to be refined to meet the needs of the patients and communities we serve.

Directing patients to alternative sites of care early in their illness can result in a shorter hospital stay or no hospital stay at all.  Alternative sites of care can include treating individuals at the nursing home before a patient is so sick they require the emergency department or providing same-day access at our clinics or specialized clinics for congestive heart failure or lung disease.  Alternative sites of care can even be in a patient’s home through the use of technology like video visits or remote patient monitoring.

Currently, our Population Health team is leading the effort to monitor and communicate with patients diagnosed with congestive heart failure, COPD and diabetes. These interactions help patients maintain their health or begin treating a change in their condition before it requires hospitalization. For patients who do end up in the ED, access to same- or next-day follow-up with UH specialists allows the team to treat the patient and assure that patient is connected with the right caregiver without having to spend a night in the hospital.

Another notable option, which you can read more about in this issue of UH Clinical Update, is Hospital@Home. This program, now entering its third year, allows us to deliver hospital level care to select patients in their home. Expanded use of the program has the potential to reduce the workload on the hospital team and help restore the supply and demand balance.

For patients who are hospitalized, we’re working to create the shortest and safest length of stay possible for them. In some cases, it is not the patient’s illness creating a lengthier hospital stay, but rather our ability to move them efficiently through all our processes. We are taking a hard look at factors that may delay discharge, such as placement in a skilled nursing facility, availability of durable medical equipment and lab or imaging diagnostics. We are finding ways to expedite care or to deliver the needed service in another setting.

While reducing demand on our hospitals and caregivers is forefront on our minds, our commitment to providing patients with access to high-quality care and ease of use is unwavering. To increase access, we are early in the process of developing convenient healthcare hubs in communities across Northeast Ohio that include both UH primary care and specialty care in the same building, and exploring ways to consolidate like services. We are also expanding access to UH care by increasing Urgent Care facilities, expanding walk-in orthopedic injury clinics and improving access to ambulatory clinics.

We already provide high-quality, personalized care that differentiates us from other health systems in our market and makes UH a top choice for those seeking care.  Like other aspects of the healthcare that have been changed forever by the pandemic, patient expectations and how they want to engage healthcare have changed, too.  Post-pandemic patients value timeliness of appointments, lower out-of-pocket cost and ease of use far more than traditional differentiators like location or even in-person visits.  Meeting patients’ needs, solving their access challenges and delivering care in the way they want to consume it is critical to standing out above all others and driving the growth that is critical to our success. 

To make it as easy as possible for patients to schedule their appointment, we have streamlined the process, which you can read more about from our Vice President for Consumer Experience and Clinical Access, Lisa Griffin, in this issue of UH Clinical Update. We will continue to work to make healthcare a convenient service, with all the features people expect from online shopping or banking or even booking a restaurant reservation. The move to Epic will only accelerate our evolution. Using our technology, ingenuity and by engineering our health system to engage patients and direct them to the most appropriate site of care, we can make it easier to access the best care available and provide the best outcomes for all.

These are just some of the changes we are making, and I am sure there are other ideas from among our talented UH caregivers that can help us adapt and optimize clinical operations and care for our patients. Everyone plays a part in evolving our healthcare system. If you see opportunities to optimize, take advantage of them and share your ideas. Every improvement counts, no matter how small, whether in patient experience, ease of access, cost savings or finding novel ways to solve patients’ problems. Please share your best ideas with me at PHinchey@UHhospitals.org. We're all a part of making success happen. As we continue to travel down the challenging road that is modern healthcare, we can be proud of our progress and our role leading innovation. Thanks to all of you for making it happen.