Helping Health Care Change

Research by Kathryn Bartol, Susan Taylor, Michael Faulkender, Bruce Golden and Gordon Gao

Do more, and do better – but at a lower cost. This challenge is forcing health care professionals to become business savvy, amplified by the recently enacted Affordable Care Act. Robert H. Smith School of Business professors are conducting research and training professionals to develop a new breed of health care worker. These doctors, nurses and administrators approach patients as customers and possess greater financial, IT and strategic management acumen to deliver patient-centered, cost-efficient care through finely tuned organizational structures. Here’s a look at recent Smith projects:

Leadership Researchers, MBAs Impact Maryland Hospital

Smith’s Center for Leadership, Innovation and Change (CLIC) researchers recently trained MedStar Southern Maryland Hospital managers to deliver a higher level of cost-efficient, patient-centered care. CLIC co-directors Kay Bartol, the Robert H. Smith Professor of Leadership and Innovation, and Susan Taylor, the Smith Chair of Human Resource Management and Organizational Change led the year-long project.

They used psychology- and personality-based assessments to identify individual management styles and maximize team building. Managers learned to be innovative in providing better patient service, and a patient satisfaction component involved training by customer service experts from Ritz Carlton and Southwest Airlines. Other workshops covered interpersonal relationships and negotiation, and the training extended to a Smith MBA consulting project. The MBAs worked with unit managers to strengthen recruiting, hiring and staff training. They produced an employee toolkit that covered issues related to employment law, the Family and Medical Leave Act, and maintaining personnel files. “The students showed tremendous ability to hone in on the issues and pull together the resources needed for this task,” said Reba McVay, the hospital’s vice president for cardiovascular services.

Ryan Finucane (MBA ’13), said he and his Smith project teammates “appreciated the opportunity to create a ‘human capital’-focused solution that delivers tangible and needed results to the hospital staff and their charges.”

The consulting fit with the hospital’s focus on quality care and customer service. “Staff must be skilled clinicians, kind, caring and willing to go the extra mile for their patients and family members,” McVay said.

Overall, CLIC’s training was “especially timely by clarifying, and focusing on, our paramount goal for consistent quality patient care, and it recognized the cultural changes our organization would undergo as part of our [MedStar Health-Southern Maryland Hospital] merger,” said Paul Zeller, the hospital’s vice president for human resources and development.

Next up, CLIC is developing team-building and diversity training for Nexus Health, a nonprofit company that specializes in acute and long-term care services in Maryland and the District of Columbia. The center also is working with the University of Maryland Medical Center (UMMC) to develop new leadership and teamwork approaches to improving clinical outcomes following surgery.

“We’re the Center for ‘Leadership,’ ‘Innovation’ and ‘Change,’ and I can’t think of a field other than health care where these three concepts are more vital,” said CLIC Executive Director Pat Stocker. “The industry is undergoing such rapid change and won’t be able to meet its obligations without being innovative.”

Finance for Nurse Leaders

Hospitals and doctors are feeling the financial squeeze with mounting health care spending and the strains of an aging population. Nurse managers with financial savvy can help relieve the pressure. Thanks to a recent Smith School executive education program, nurse managers at the University of Maryland Medical Center (UMMC) learned analytic and financial strategies to improve processes and reduce costs.

Mike Faulkender, associate professor of finance, shared his expertise with 35 nurse managers in the seven-day session. Faulkender drew from his research in corporate finance and risk management. “The program gave these leaders an understanding of their department’s financial role in the overall financial health of the hospital system and the importance to the system of finding innovative ways to curb cost growth.”

The program explored tradeoffs between investing in technology and allocating human resources to achieve health and financial objectives, “and some of the discussion centered on whom – among doctors, physician assistants, or registered nurses -- should provide care for different ailments,” Faulkender said.

UMMC CFO Keith Persinger said one of the takeaways for the participants was an understanding of the real cost of registered nurse turnover. “High turnover of RNs is extraordinarily expensive in terms of such factors as training and overtime pay,” he said.

Faulkender also covered IT utilization as a means to reduce the duration of hospital stays without sacrificing patient outcomes. He also addressed balancing the dual objectives of providing quality care and teaching and research.

Persinger said the program contributed to UMMC’s commitment to keeping its patient-care leaders informed with the most current business knowledge. “Investing in these key leaders simply makes sense as we work diligently to navigate through lower hospital reimbursements and changing health care fundamentals."

Insight for Hospital Efficiency

Bruce Golden, Smith’s France-Merrick Chair in Management Science, is widely respected for his consulting work and strategic operations research. Recently, his investigations have focused on ways for hospitals to operate more efficiently.

A recent study, with Smith colleague Sean Barnes, proposes social network modeling to control hospital-acquired infections. The work complements other recent studies involving hospital operations that compromise patient outcomes.

Worth the Wait

In a working paper, Golden and Gordon Gao, an associate professor in Smith’s Department of Decision, Operations and Technologies, show patients who arrive in the emergency room in the middle of the night receive quicker access to surgery and the ICU, but fare worse than daytime arrivals. The findings call for managers to be aware of, and strategize according to, the key factors in play: Senior surgeons work during the day, and the generalists working overnight are reluctant to call in specialists. Additionally, surgeons often work the night shift just a few times a month, and therefore would be tired from not being used to working such hours.

Bed Shortages and Hospital Readmissions

A set of studies in Health Care Management Science co-authored with Smith associate professor Wolfgang Jank find revenue-driven surgery and poor planning send some surgical patients home too early. Golden suggests that surgeons use checklists before discharging patients and that hospitals increase the flexibility of where patients go post-surgery. Allowing them to be moved to units with empty beds, for example, could curb premature discharges.

Residencies Boost Emergency Care

Recently published in IIE Transactions on Healthcare Systems Engineering, findings from Golden and his co-authors refute a common hypothesis that physicians-in-residence hinder emergency care in academic hospitals. To the contrary, residents improve patient treatment efficiency. In high-severity cases, they help to decrease waiting times, decrease treatment times and increase throughput. While Golden acknowledges efficiency might not be of highest priority in patient assignments, he recommends residents see as many high-severity patients as possible to complement the mission of an emergency department residency program.