Resource:

Celebration Health Florida Hospital Pioneers Use of RTLS to Understand, Improve Nursing Workloads and Workflows

Case Study

Challenge: Financial Sustainability  Care Continuum  Cultural Transformation  

Content provided by AHA Endorsement partner: STANLEY Healthcare

Read how Celebration Health has pioneered the use of technology to track, analyze and enhance clinical workflow.


Overview

The Need
Florida Hospital Celebration Health has long recognized that nursing is a key factor in the efficient delivery of high quality patient care. Nursing also represents the hospital’s highest cost of labor. Given these factors, administrators at Celebration Health sought ways to better understand current nursing performance and pinpoint opportunities for continuous improvement.

The Solution
Using STANLEY Healthcare’s AeroScout® RTLS platform and MobileView® software, Celebration Health has pioneered the use of technology to track, analyze and enhance clinical workflow. This investment has been accompanied by proactive change management and communication to ensure that nurses understand and support process improvement initiatives. This initiative leverages Celebration Health’s previous investment in the AeroScout solution for Asset Management and Environmental Monitoring.

The Results
By documenting travel patterns and time spent per location, administrators have been able to investigate specific aspects of nursing workflow, partnering with nursing staff to find new and better ways to optimize staffing levels, improve the efficiency of unit layout, and establish and implement best practices for compassionate, compliant nursing care. The redesigned workflows have helped Celebration Health raise hourly rounding compliance to greater than 90%, while also driving the separation rate for registered nurses to 8.57%, well below the industry average.


 

Challenges Faced
Celebration Health bases its care on a patient-centric philosophy. Taking as its starting point a simple question—What are patients afraid of?—Celebration Health has identified nine key factors that must be addressed to ensure a positive patient experience: Communication, Know Me, Medications, Infections, Loss of Control, Competence, Strange Environment, Lack of Care & Respect, and Pain. Any time a hospital team implements a new solution or process, they first examine whether and how it addresses one or more of those patient fears.

The 2011 design and construction of Celebration Heath’s Innovation Tower was no exception. The Innovation Tower includes a 31-bed surgical/medical unit designed to be a “living laboratory” for innovation. In keeping with that vision—and the hospital’s patient-centric philosophy—Celebration Health made a strategic decision to invest in a real time locating system (RTLS).

With RTLS, the hospital aimed to address a range of challenges—including asset management and environmental monitoring, as well as staff and patient visibility. Building on the early successes in improving asset tracking and monitoring of temperature and humidity, the hospital set its sights on larger, more complex challenges related to clinical workflow.

Solution Benefits
Since the unit’s launch in 2011, Celebration Health has monitored staff workflow in the Innovation Tower; in 2013, it added oncology and telemetry patient units, and the OR, as well. Today, over 123 nurses and techs are being tracked across those four units.

“Tracking nursing patterns was not new for us,” notes Chief Nursing Officer Patty Jo Toor. “But we had been using manual methods for observation and data collection. With the advent of new reimbursement models and staff needing to work more efficiently, we saw a tremendous opportunity to use RTLS for ongoing research and process improvement.”

Director of Performance Improvement Ashley Simmons concurs: “For years, hospitals have made certain assumptions about nursing staffing. We realized we could use our AeroScout solution to study nursing at a whole different level—to question many of those longstanding assumptions and to truly understand how and where our nurses spend their time.”

In deploying the solution, Celebration Health gave particular attention to managing cultural change, working closely with the clinical staff to educate them on the intent of the technology and to address any “Big Brother” fears. By making it clear that the solution was intended to improve the work experience by making shifts run more smoothly and efficiently, and that the data would never be used in a punitive way, the hospital has been able to turn the clinical staff into engaged participants, eager to see and understand their own workflow patterns.

Having access to detailed data—and being able to run a wide range of analyses and reports—has revealed some important findings. With the ability to drill down by service line, by time of day and even by individual nurse or technician, the hospital has uncovered opportunities to make small but important changes.

For example, heat maps confirmed just how much time and attention clinical staff members were devoting to Head and Neck Surgery patients. “The data showed that if you had multiple head and neck patients, you were just swamped,” Ms. Toor notes, adding that the hospital has since made assignment changes to better balance workload.

Celebration Health has also started to understand and respond to the different dynamics of the day and night shifts. It has become clear to the hospital that, contrary to a widely held assumption, the night shift is just as busy as the day shift. The way it is busy, however, is very different. Activity on the day shift is more or less constant, whereas the night shift is characterized by periods of intense activity at the start and end of the shift, with a lull in between.

By shifting some activities to the quieter hours, the hospital has helped reduce bottlenecks and addressed a point of dissatisfaction for the clinical staff. For example, it used to be routine to return IV pumps for sterilization at 6:00 am, just as patients were being prepared for discharge. Now, this task is performed in the early am period, when technicians have fewer demands on their time.

Significantly, the nursing staff is now taking ownership of identifying ways to enhance processes. The heat maps of movement across a shift enable each nurse to actually see how the day is spent, and identify areas for improvement; for example, by combining multiple trips to the supply room into a single visit to eliminate tiring “back and forth” movement.

“When they see data, they’re starting to think differently,” Ms. Toor says. “It has been rewarding to watch them take control of their own environments—to ask the tough questions and then try to fix it.” The anonymous sharing of hourly rounding compliance has sparked friendly competition to improve performance, helping to drive compliance above 90%.

Celebration Health follows a Purposeful Rounding practice, encouraging meaningful engagement between clinician and patient at every room visit. The data from the AeroScout solution provides objective validation that this is in fact occurring. “Each time that they round they’re spending at least 2 to 4 minutes in the room,” says Ms. Simmons. “It’s not just a quick poke your head in.”

Looking to the future, Celebration Health has plans to make the system more interactive—giving nurses and techs more visibility to data so they can make adjustments in real time.

“There is still a lot more we can learn from really understanding nurses and their workflow and how it impacts the bottom line for the hospital,” Ms. Toor notes.

Lessons Learned

  • Follow the leaders. As a pioneer in using RTLS for clinical workflow management, Celebration Health worked its way through a number of data-related issues. The team worked diligently to overcome some of those challenges—especially in the first year of deployment. “We wanted to be certain of the quality of data that we were using for our analysis and improvement initiatives,” says Ms. Simmons, adding that she and Ms. Toor have shared, and will continue to share, some of their key findings with other hospitals undertaking clinical workflow initiatives.
  • Technical challenges may prove simpler than cultural obstacles. Both Ms. Simmons and Ms. Toor advise their peers to be ready for potential resistance to change. They worked proactively to avoid that—informing nurses and technicians about the intent of the project. “By being transparent about the purpose and goals, we were able to maintain trust among our nursing staff,” Ms. Toor says, noting that she and her team didn’t just communicate at the onset of the study. “We found it was very valuable to continue communicating about the data we were collecting, and to reinforce the fact that none of the data would be used in a punitive manner.”
  • Reality is usually more complex than perception. The Celebration team found it valuable to monitor all events—not just clinical staff’s interaction with patients. This broader approach helped in uncovering some surprising results, including the findings related to different patterns in the night shift vs. the day shift. Similarly, the data has shown the wide variation that can exist among patients. Some patients are very satisfied with a relatively small amount of interaction with their nurses; others have greater needs and demand significantly more time from the nursing staff.