Managing Length of Stay Performance

Ali Birjandi is currently VP of Performance Improvement at CHRISTUS Trinity Mother Frances Health System. He is an accomplished leader with significant career progression culminating in a senior management positions in a nationally recognized 2.5 billion dollar multi-facility integrated delivery system. His expertise is in the ability to develop enterprise-wide performance improvement strategies and assist business unit leaders in converting them into tactical action plans. He was formerly the COO Palm Beach Garden Tenet Hospital, VP of Operations Improvement ProMedica Health System and Director of Business Process Improvement Carle Clinic and Hospital. He holds an MBA and an MHA from the University of Florida. He holds the CPHIMS certification from HIMSS and a ASQ Six Sigma Black Belt.

Preface

Chapter 1: Importance of LOS and how to measure it

Many organizations don’t understand the impact of LOS in an organization. Additionally, most organizations don’t know how to measure LOS appropriately. Understanding the nuances of what should be and not be included in the measure is critical to knowing how to manage it.






Defining LOS as an opportunity



Common methods of measuring LOS and GLMOS



What items should be included and excluded from the measure



Common mistakes in measuring LOS

Chapter 2: How to create the infrastructure to roll out the changes

Organizations require significant infrastructure in order to roll out a sustainable LOS program in their organizations. Building all the components from the ground up is critical to get the organization firing on all cylinders to keep LOS down.






Developing the steering committee



Developing the working group



Developing the teams



Developing the meeting schedules and project tracking

Chapter 3: Negotiating with payors to improve approvals

If the payers are not cooperating or you are not negotiating well, the organization will never achieve GMLOS. Knowing what to ask for is critical and getting it into the contract even more so.






Collecting performance indicators for approvals



Setting the required standards for approvals



Meeting with the payors



Negotiating the contracts

Chapter 4: Utilizing hospitalist to manage "inlier" patients

The utilization of hospitalist is critical because an organization has control over them. For the first time the priority of an organization can be part of play in getting LOS down to GMLOS.






What are inliers and how to identify them



Significance of managing inliers



Utilization of hospitalist in managing inliers



Specific information required to manage the hospitalists for LOS

Chapter 5: Setting up post-acute care services to manage "outlier" patients

The most expensive place to treat the patient is in the acute care setting. Any other location will by default be less costly. Knowing clinically when to transition the patient to the right level of care is critical.






What are outlier patients and how to identify them



Significance of managing outliers



Negotiating with post-acute care services



Setting up communication forms with post-acute care facilities

Chapter 6: New innovative reports for managing ALOS and its process

A new level of performance requires newer innovative reports. Reports showing utilization patterns of providers, LOS broken down by inliers and outliers, discharge patterns, and operator discharge times are critical to managing every aspect of the discharge.






New processes require new reporting



How to use these reports



Troubleshooting LOS using reports



Ranking opportunities using reports

Chapter 7: Inter-disciplinary review structure that provides the most benefits

Daily reviews are critical to keep tabs on the patient’s condition. The escalation is critical to enable the IDR to function effectively.






Do you have all the right people at the table?



What is the expectation of the team?



When and where are they meeting?



Creating an escalation process.

Chapter 8: Getting the benefits of reducing LOS

It’s one thing to reduce LOS but it needs to work in conjunction with labor and non-labor to get the benefits. For the department is not staffing to volumes the cost structure will change.






What does LOS mean to resources



Metrics to track for benefits (labor and non-labor)



Tracking readmissions to make sure LOS is not pushing too hard



Quantifying avoidable days

Chapter 9: LOS management is a perpetual process

Sustainability for LOS requires constant vigilance. Infrastructure that is constantly monitoring the metric is critical. These metrics need to be monitored in conjunction with reciprocating metrics such as 30 day re-admissions to make sure LOS is not decreased at the expense of patient condition.






What happens when the team disbands



Components that need to be in place for CQI process



Monitoring at each level of management



Making it part of the culture

Chapter 10: Leadership drives culture and results through proper communication

The most critical part of the book is making sure you have the right leadership in place. What are the characteristics of a good leadership that can drive the culture.






The value of strong leadership



The communication methodology