Five Ways We are Working to Optimize Care at UH

UH Clinical Update | September 2023

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

Optimization as a concept gets perhaps its widest use in business school classrooms and corporate boardrooms. But it also has great relevance for us in healthcare. Today’s savvy and demanding healthcare consumers, plus retail giants like Walmart and Amazon now competing with us for market share, mean that we must increasingly make the best and most effective use of our resources. We need to think of short-term solutions to assure long-term sustainability -- because there is real risk in failing to change and adapt. Just ask Kodak and Blockbuster and scores of others who failed to optimize and innovate.

The demographics of our 16-county service area are an instructive example of what we face. We’re expecting a population decline of approximately 1 percent in our 16-county market, but a 10.2 percent increase in those age 65 and older. To put it bluntly, the world we find ourselves in has a shrinking younger population, a growing older population with escalating healthcare needs and a constrained group of providers to care for all of them. We have little choice but to begin to do things differently. Single-digit margins and double-digit cost increases also create an impetus for change.

So what does this look like in practice at UH? For one, optimization is not a one-off project. Our recent efforts to rebase our cost structure are not meant to be a singular push to solve a short-term problem. Instead, they are a part of our transformation for how UH delivers its care so we can persevere and take care of our patients for generations to come while staying true to our mission. But we also have to survive and strengthen our organization to be available for these patients.

A lot of good work to make this happen is already well underway. Specific optimization initiatives at UH include these five broad areas:

1. Improving access: Assuring patients can get appointments or procedures in a timely fashion.
2. Finding opportunities to use our space better: Combining practices or imbedding specialists within primary care sites to deliver a one stop site of care.
3. Creating volume centers: We’re identifying hospitals in each market where the majority of services are provided. This reduces redundancy in equipment and training and provides focus for future investment. But perhaps most importantly, volume drives repetition, which drives excellence. Higher volume centers have better outcomes, shorter stays, fewer complications and better patient experience.
4. Seeking to eliminate waste: This can include everything from not opening disposable items to even turning off the lights. Other frugal options include using lower-cost sites of care or combining sites and maximizing the use of high-cost equipment.
5. Providing exemplary experience: We already provide warmer, more compassionate high-quality care. We have an opportunity to take things to the next level, where every patient is like a family member and every touch is a chance to help solve someone’s problem. The ideal is to always say ‘yes’ instead of ‘no,’ or at the very least, ‘I’ll find a way to get you what you need.’

There’s no doubt that we’re facing challenging times, not just at UH, but in all of healthcare. But UH has been there before – and prevailed. In his 1991 book “The Lives of University Hospitals of Cleveland,” author Mark Gottlieb details the many obstacles and unforeseen circumstances UH has overcome over its storied history, including the onset of the Great Depression at the beginning of construction of Lakeside in October 1929, causing great financial uncertainty and putting the very survival of the project in jeopardy.

Gottlieb quotes physician Robert H. Ebert, MD, who was former Director of the Department of Medicine at UH Cleveland Medical Center, about the unique nature of UH: “This is the story of a great health-care institution. Above all, it is the story of farsighted, dedicated individuals who have made lasting contribution not only to the life of the institution but to medicine and healthcare as well. It is not, however, a history of tranquil progress. Given all of the problems that have plagued the component hospitals of the medical center over the years – from leaky nineteenth-century roofs to debilitating twentieth-century financial depressions – their mere survival is itself a wonder.” 

The survival of UH back in those days may have been a wonder, but it was not a matter of mere chance. The continued success of UH was the result of the hard work of optimization – using your situation and resources to your best advantage. Now in our era, our approach is similar. Once again, our community is depending on us. By optimizing the care we provide, building a thoughtful, long-term approach to assure that UH will serve Northeast Ohio patients for decades to come, we will continue to fulfill our mission to our community: To Heal. To Teach. To Discover.