Imagine a healthcare system where there is system-wide coordination, visible real-time data to inform action, properly allocated care resources, automation to reduce administrative burden and cognitive load, minimized delays and wait times, and happy patients and clinicians. This is a common dream for most of us in healthcare. Instead, we are used to hearing a cacophony of criticism: insufficient coordination, difficult-to-extract data, daily staff shortages, long waits, burnt-out staff, old technology, and budget shortages. In this context, our dream may seem unobtainable; however, many organizations have dared its pursuit. Command centers, specifically designed to address the issues of flow (patient and otherwise) through our system, are emerging in all shapes and sizes. They are showing tremendous success, not only in streamlining the patient journey but also in enhancing the day-to-day flow of clinicians.
Ideal state of the patient access and control center
These patient access and control centers come in all types of configurations. Some are on premises, where people can run in and out and act on data. Others are off premises, where their focus is protected from distractions of daily operations, and well-thought-through actions can be initiated. Some centers have a central hub off premises with a satellite of boots-on-the-ground coordinators in each facility. Many are brick-and-mortar physical spaces uniting teams for a common purpose, while some have virtual options to expand beyond the physical walls with the ability to coordinate remotely during environmental catastrophes. Some organizations have purchased their product as an entity, while others have leveraged existing tools and built from scratch.
Amidst the variability, there are common functionalities and outcomes. These centers include a display of data with visibility into patient needs, staffing, bed management and are replete with communications, alerts, and predictive analytics with accompanying action plans. Typical outcomes include improved transitions, decreased wait times, reduced congestion, enhanced capacity, accurate prediction and timely response to surges, reduced length of stay, enhanced safety measures, and improved patient outcomes. Some centers have even improved employee satisfaction through well-designed coordination of flow.
Critical success factors
In developing a command center, there are several factors critical to its success: governance and leadership, committed resources, skillsets and capabilities, change management, partnership, collaboration, and dedicated training.
Enlisting the support of the initiative from CEOs is essential for a successful journey. It is a common tale to hear of initial misalignment of administration, clinical, and IT. Often clinical is left out or in the peripheral at the start of the initiative. True success comes to fruition when there is strong clinical leadership who have a good understanding of clinical flow, an understanding of clinical informatics, and a strong clinical network for feedback that is coupled with support from IT and administration.
To drive outcomes after implementation, there needs to be dedicated human resources and room in the operating budget to support them. Reliable data are also a critical resource. If it does not exist, false errands can be generated. A best practice is to work on data stewardship and have a thorough understanding of data point definitions before building.
A new staffing skillset is needed to manage and present data in meaningful ways that trigger teams to take the appropriate action. If using artificial intelligence (AI) in algorithms, clinical leadership must be able to understand and communicate the limitations of data sets and statistics to help prevent the perpetuation of systemic bias. This may require new leadership and upskilling of clinical staff.
Critical to the success of a command center is the ability to change user behavior. This requires the understanding of why change is needed now, how the change will achieve the objective, an understanding of everyone’s new role in the future state, education to learn new behaviors, and the understanding of how the change will continue to evolve over time.
There is no better way to build improved workflows than by asking those who use them to participate in their creation. A bottom-up build is ideal. Clear training and competency assessments are essential to leveraging the new tools. Do not fall into the trap of “if you build it, they will come.” People do not intuitively use data to drive action.
Bringing it back to the clinicians
Patient flow through a system is dependent upon the coordination of all parties in a system. This requires a well-choreographed interplay of workflows conducted with regular checks for repositioning, no simple feat for our complex healthcare systems. Critical to this is the day-to-day workflow of the clinicians. In a project like this, there is tremendous opportunity to make improvements in clinicians’ lives.
For example, an organization was building a command center when it heard loud and clear from its end users that they were not interested in receiving messages from a command center about their unit being under pressure and requiring an action plan to mitigate. They knew when things were going south before any AI tool could predict it, as it begins the moment a clinician loses flow. Perhaps it is in the third failed attempt to place an intravenous catheter, or the minute the lunch tray hits the ground (creating a mess in the patient’s room), or the arrival of an emotional relative who needs some extra support to work through what’s happening to their loved one. Far better than AI is the voice of the clinician to the command center, saying, “I’ve lost flow. I need help.” And therein lies the opportunity to intervene prior to the crisis. With this feedback in mind, the organization’s command center was developed with two-way communication, making it less about command and control, and more about protecting and elevating clinician flow.
The dream is closer than we think
A patient access and flow center, or command center, is not about a fancy room filled with screens, graphics, flashing lights, and people wearing headsets, though that may be how it appears. It is a mindset. It is a relationship with one another that is flexible and allows us to bend collectively without breaking. It requires systems designed for optimal clinician workflow, responsive teams willing to listen and take action to remove barriers, and a focus on the desired outcomes. With all these elements coming together, the dream state of healthcare may be more obtainable than we anticipated, and there certainly are some dreamy patient access and command centers out there.