MBA Team Prescribes Changes in Hospital ER: After USC Team Study, Palmetto Health Richland Alters Patient-Flow Procedures

By James T. Hammond, The State, Columbia, S.C.

Jan. 10–Palmetto Health Richland hospital this year will change the way ER patients are handled based upon recommendations from a team of MBA students at USC’s Moore School of Business.

At their most basic, the changes will include requiring medical staff to use checklists for procedures much like airline pilots do before they can start a jetliner’s engines.

But the changes also will include hiring staff to be patient flow coordinators, or PFCs, to track patients from start to finish through admission, diagnosis and treatment.

Hospital officials say the measures ultimately will save the hospital money, ensure patients get the appropriate treatment and cut as much as two hours off the admission-to-treatment time.

The team of Moore School students were participating in a course in operations and supply chain management taught by Sanjay Ahire. Most of his students were assigned projects in traditional private sector businesses, including Sonoco Products, a packaging technology supplier based in Hartsville.

But Dr. Ellis Knight, a medical doctor and vice president for medical affairs at Palmetto Health, also believed the discipline and efficiency developed in manufacturing would be valuable for the delivery of health services.

That was heresy to many in the medical field. “They called it cookbook medicine,” Knight said.

“We are going to have to get over that attitude in this country if we are going to improve patient care,” said Knight, who also has a masters of business administration degree. “If we care enough to ensure that the BMW gets built right, shouldn’t we also care enough to ensure the patient gets treated properly?”

So he entered a partnership with Ahire and the Moore School to see how they might apply those lessons to health care. The goals were to curb costs, speed up service delivery and generally improve patient care.

The work-flow study was carried out in the same fashion as a review of work on a manufacturing floor.

Some of the issues uncovered by the study seemed simple.

“You’d never get in an airplane and fly without the pilot going through a checklist,” Knight said. “Yet, we have doctors operate every day without a checklist.”

Ahire said it just takes fresh eyes sometimes to discover the obvious.

“The lack of medical background was a blessing to us,” Ahire said. “We could ask what might sound to a doctor like a stupid question.”

Palmetto Health Richland’s emergency room handles 200-250 cases a day, as many as 70,000 per year.

“We found that 85 percent of problems have nothing to do with competencies of doctors and nurses,” Ahire said. “They are largely administrative bottlenecks.”

The patient flow coordinators that the hospital plans to hire “is a cutting edge solution,” said Josh LeQuire, one of the students. They will track every patient to ensure they are seen and treated faster, and the patients will be reassured that someone is in charge of their care, that they are not being forgotten, he said.

David Dreyfus, another MBA student, coincidentally had a medical emergency during the semester and checked himself into the hospital’s ER.

“It took two hours for something that should have taken 15-20 minutes,” Dreyfus said. “It definitely was good insight.”

Student Jeffrey Poquette helped design the PFC system.

Each PFC will be responsible for several patients, he said, and will be solely responsible for their flow through the emergency room process.

Knight and Ahire said they estimate two to seven PFCs will be needed in the ER, based upon historical patient flows at various times, days and seasons.

That will require additional spending of $150,000 to $250,000 per year. But Knight said the hospital expects to recoup that and possibly more in savings as the ER sees more patients.

Many people who come to the ER leave out of frustration over the delays in seeing them, Knight said. And Medicare has a program to pay hospitals bonuses for improved performances, he said.

The changes brought on by the Moore School study “absolutely will provide better patient care,” Knight said.

Reach Hammond at (803) 771-8474.

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