Hospital silos out, integrated operation centre in

Using an integrated approach to healthcare is a must for all hospitals, asserts Dr Stephen Ayre, Executive Director for Medical Services, Royal Hobart Hospital.

Patient John does chemotherapy sessions at your hospital. He’s also a patient under children’s services. One day he’s rushed to the emergency unit, but the staff in the emergency department do not have access to his records. Because your hospital has been working on silos, John receives fragmented, therefore, confusing treatment.

A year has passed since the Royal Hobart Hospital (RHH) in Tasmania, a 200-year-old public hospital in Australia, introduced its Integrated Operation Centre (IOC), primarily to conquer the “silo mentality” within the organisation.

One of Tasmania Health System’s three regional integrated care centres (all of which are currently operational), the IOC at Royal Hobart aims to give the organisation a cross-hospital view, which was not possible with departments working as semi-independent units.

Integrating departments, coordinating care

Patient flow and patient access are often a problem for most hospitals, including Royal Hobart as it is Tasmania’s largest hospital and major referral centre.

Underlying this, however, is the issue on care coordination, Dr Stephen Ayre, Executive Director for Medical Services at RHH, tells Hospital Insights Asia, seeing that departments such as surgical services, medical services, mental health services, women’s services, and children’s services were working as silos.

Integrating these departments together into a command centre enables the hospital to bring the components to work as a whole system rather than as separate little patches. This way, they are able to discuss issues that urgently need attention, through a coordinated approach and a daily 10-minute quick meeting between the patient flow staff and senior hospital staff.

A recent bottleneck they have identified through their IOC is on the mental health inpatient units. The number of patients waiting for beds is overwhelming, as patients have been staying longer on the emergency department even before they are admitted. Identifying the problem, they quickly tapped the team to look at beds and review staffing so they can move patients into the right beds.

Since the operation centre allows for faster data verification, early action on potential bottlenecks on patient access is doable. There were fewer complaints about admission delays and patients have better communication with the staff; hence, increasing patient flow and optimising patient care. After all, Dr Ayre believes that longer hospital stays are not commensurate to better patient outcomes.

Similarly, the operations centre at Royal Hobart uses focus boards, such as patient flow focus board and emergency theatre focus board, enabling access to real-time information, which has come in handy in their outbreak response. The IOC’s COVID-19 focus board identified patients who tested positive, those who have undergone testing, those in quarantine, and their locations in the organisation, making it easier to manage the facility and the critical patient cohort.

Necessary changes for innovation

But with all innovations come organisational changes that need to be made. Getting buy-in from all stakeholders is one. For Royal Hobart, the consultation period took about six months, and almost a year to actually integrate all relevant units.

Reconfiguration of organisational structure, in line with changes to staff roles, is equally crucial. They needed to retrain existing staff and hire new ones to fill in new roles, for example, an ambulance service officer and associate nurse unit manager.

Change management and getting buy-in are inevitable aspects of building an integrated care centre. Hospitals should first develop a good admission-discharge electronic and management information systems, not necessarily electronic medical records (EMR) system although this “could add another level to it”, before looking at efficient care coordination.

Nonetheless, hospitals surely benefit from having an integrated operation centre, as they need to become “increasingly efficient and effective in using scarce resources” whether they are government or private institutions. Private hospitals, in fact, will need to consider building a command centre earlier as it improves profitability and optimises resources, although it does hinge on hospital size and fund.

The Royal Hobart plans on moving their IOC to a larger space to accommodate large meetings and display more dashboards. This isn’t just a goal on size, but more on improving opportunities for care coordination within the organisation, and across the state once the state-wide centre becomes operational, generally resulting in better quality of care and improved patient and staff satisfaction.