Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: WEDNESDAY, December 29, 1993 TAG: 9401040004
SECTION: CURRENT PAGE: NRV1 EDITION: NEW RIVER VALLEY
SOURCE: BRIAN KELLEY STAFF WRITER
DATELINE: RADFORD LENGTH: Long
That's because a new philosophy known as ``patient-focused care'' is guiding the relocation to Virginia 177 between Radford and Interstate 81.
The idea is simple enough. Redirect the staff's attention and the hospital`s resources to improving and shortening a patient's stay, in the process reducing costs.
It sounds like a prescription for a medicine hospitals should have taken years ago. But traditionally, hospitals have been organized by functions, specialities and hierarchy.
Rethinking that mix is the challenge - a challenge made even more significant because Radford Community is planning its new $40 million building with patient-focused care in mind.
That means, according to hospital President Lester Lamb, that patients in years to come will find the 750-member staff more accessible, even though the number of employees should drop by 10 percent through attrition. Workers from all levels of the hospital will give patients more attention and try to do so in a more personable way.
In October, Radford Community divided its management into four ``centers'' and set up teams of 10 to 15 employees from each section to look at how the hospital staff functions now and how that could be improved.
The plan is to start most of the changes by next fall. Hospital officials believe they can incorporate about 80 percent of the concept into the existing building, the oldest portions of which date back to World War II. Some of the patient-focused care will involve design changes that would be impossible in the current setup.
This cutting-edge theory in hospital management is a close cousin to total quality management, the movement that's the rage in everything from manufacturing to academia. It shares the focus on quality and the use of increased employee participation.
Radford Community is part of the Carilion Health System, a network of hospitals across Southwest Virginia. Carilion, which committed to total quality management two years ago, is looking at Radford Community`s experiences with patient-focused care as a testing grounds.
Eight hospitals across the country have conducted experiments with patient-focused care, including Sentara Norfolk General in Tidewater.
``This is getting back to basics in some respects,'' Lamb said.
Two of the major ways to improve care are cross-training employees and decentralizing laboratories and other facilities, Lamb said.
The former marks an attempt to reverse the specialization, much of it technology-driven, that characterized the last three decades of health care.
``In many cases it resulted in hospitals having in excess of 300 job descriptions,'' Lamb said.
With overspecialization, there can be wasted time and redundancy built into the system. The patient-focused care groups will look for ways to reduce that by having employees trained to do more than one or two functions.
In Norfolk, for instance, a warehouseman was retrained to be a ``service associate.'' Along with his regular duties, he learned how to help patients take walks inside the building.
``To him, it makes a difference,'' Lamb said. Though some duties cannot be shared because of licensing requirements and state regulations, other hospitals have found that the approach means that the time staff members spend with patients goes up. That occurs even as the number of managers, and the size of the hospital bureaucracy, drops.
Based on the experience at other hospitals, ``There is the impression initially that hospitals can display a 10 percent to 20 percent savings'' with the approach, Lamb said.
Money is a factor, since the hospital will need capital for the move to a new location. But patient, employee and physician satisfaction are also motivations. ``This is appropriate even if you don't make a dime savings,'' Lamb said.
The other part of the equation, decentralization, also goes against the grain of traditional hospital management. But by having central laboratories and equipment, hospitals built delays into the system: first to move the patient to the lab; second because the testing was batched together so a lab technician could process them all at once.
One of the eight hospitals included in the original patient-focused care study found that it was not unusual for a patient who stayed five to six days in a large hospital to move around as much as five miles for testing and other reasons, Lamb said.
The new theory will be that for routine tests, equipment will be stationed at nursing units and staff there trained to use it. That way, a physician could have test results in some cases before the end of her rounds, rather than waiting hours or a day for them.
The result will be that the average length of stay will go down, he said. That dovetails with the nationwide trend toward less in-patient use of hospitals.
For the time being, Lamb cannot discuss the specifics of how patient-focused care will fit into the new hospital design, or even how many beds the new building will have. Those plans will gel in the coming year.
By next fall, Radford Community expects to have a contract with an architect to design its new complex. Construction is scheduled to begin in 1996 and last two years.
The Radford and Montgomery County governments reached an agreement this year to share the costs and the benefits of developing the Virginia 177 corridor, which is expected to grow significantly with the new hospital. And in the coming year, the county Public Service Authority will negotiate utility agreements with the hospital.
Radford Community also may find out early next month if it will win approval to build a major cancer treatment center at the site of the new hospital. It has been competing for certification with Pulaski Community Hospital.
Meanwhile, the four teams - studying family care, acute care, emergency and diagnostic services and community based services - will continue the work that will lead to the new design.
by CNB