D-H’s Throughput and Access for Patients Project (TAPP): Increasing Access through Change Management

From left: Jeff O’Brien, Karen Clements and Maria Padin

For D-H patients, there is often more demand than our ability to provide inpatient care. Every month, approximately 200 patients who need high-level hospital care in their community have to be treated elsewhere, often far away from their families and home. Receiving care in a distant city is financially and emotionally expensive for patients, especially those who are very ill.

In July, D-H initiated the Throughput and Access for Patients Project (TAPP) which aims to increase the availability of needed hospital beds and services at DHMC. In this first of a series of articles about TAPP, D-HH Connections spoke with TAPP Executive Committee Co-leaders Maria Padin, MD, chief medical officer, Karen Clements, chief nursing officer, BSN, RN, MSB, MHCDS, FACHE, and Jeff O’Brien, MHA, MHCDS, senior vice president for clinical operations, about the project and its goals.

What is TAPP and why is it important to D-H?

O’Brien: TAPP is a redesign of inpatient processes so we can meet demand while improving quality, efficiency, and patient and staff experience. The TAPP project will work to decrease variations in clinical processes and improve communications between teams, which will enhance the quality of care. Our goal through this work is to reduce the average length of stay by half a day.

What is the project’s biggest challenge?

Clements: Improving patient throughput requires culture change and that’s difficult. Projects like TAPP are not successful if leaders don’t have a foundation in change management. Leaders have to be using the same language with their teams so that messages and conversations are consistent.

O’Brien: Making sure that the “Why?” is clear to everyone is critical for successful change management.

How is D-H addressing that challenge?

Clements: This summer, 200 leaders from across the organization—from direct care areas and departments including Finance, Communications and Marketing, Social Work, Environmental Services and IT—participated in a course that covered needed leadership skills, team and organizational education, communication requirements and accountability.

O’Brien: Each participant was asked to create a Business Case for Action for TAPP. They articulated the importance of the project and even began discussing how, for example, better coordination between teams that schedule tests, arrange transportation and source home-care equipment will lead to a smoother, more predictable patient discharge. This training will help leaders with other change management projects as well.

What have been some of the accomplishments so far?

Clements: Maria and I have realigned inpatient nurse manager/medical director pairs. Joni Menard, DNP, RN, CENP, vice president for ambulatory nursing and Rich Rothstein, MD, chair, Department of Medicine, are doing that work for the ambulatory clinics.

O’Brien: We’re redesigning how staff communicates within and between units and departments, and are building structures to collect and report data. We’ve also started to connect with organizations like nursing homes and rehabilitation centers that receive discharged patients to improve our communications and processes with them.

Padin: We have initiated interdisciplinary rounds in all hospital units. Interdisciplinary rounds are when all members of the team responsible for the patient's care gather to discuss the patient’s condition, progress and/or readiness for discharge and together identify and develop a plan to help meet the medical milestones that will allow the patient to safely be discharged either to home or the appropriate next level of care. This type of rounding enhances communication within the team and the coordination of timely care for the patient.

Additionally, we have a group that is working on improving operating room scheduling. Operating room cases impact our bed availability, and how and where we schedule these cases can have an impact on our bed availability allowing us to potentially increase our capacity to take some of those patients we currently have to turn away.

Finally, in the ambulatory space, we are redesigning the process for access to care. This is important because seeing a patient in a timely fashion can potentially prevent the patient from needing to be admitted into the hospital.

How will the improvements through TAPP be sustained?

Padin: We are essentially changing how we do our work. The development of new leadership, the creation of new tools that provide real-time data to the teams to help inform their daily work, and the accountability and measurement structures will help hardwire this into our organization.

We are also changing expectations and creating educational tools for patients as part of this work. By engaging them in understanding their plan of care and target for discharge, we all become accountable to each other.

O’Brien: TAPP is sponsored by the highest levels of the organization. Leaders including Dr. Joanne Conroy, our CEO and president, and Dr. Ed Merrens, our chief clinical officer are engaged and encouraging. They are helping us set the stage for a multi-year journey.

What will happen when TAPP’s one-year timeline ends?

Padin: Our consultants will transition leadership of weekly accountability meetings with each workgroup to Karen, Jeff and me. We’ll rely on data to help us look for continual improvement opportunities.

O’Brien: This will be an iterative process that we will continually have to track and evolve. We are building a new patient tower to meet inpatient demand, but, if we do not continue this work, the tower will fill up in a few weeks and we will be right back to have to deny inpatient placements.

What benefits will TAPP deliver?

Padin: The longer a patient stays in the hospital, the higher their risk of contracting a hospital-acquired condition, such as an infection, so if we reduce length of stay, we reduce that risk.

Clements: TAPP will lead to consistency across the organization so quality and safety will follow the patient from admittance through discharge.

O’Brien: Staff burnout is real, and there is a lot of frustration when processes are not aligned and communication is a struggle. Streamlined processes will improve employee engagement and satisfaction.

What would you like all employees to know about TAPP?

Padin: No matter what role you are in, whether you work in direct patient care or finance, marketing, housekeeping or social work, you have a part to play in improving quality and the patient experience. Your hard work is really appreciated.