1. Leveraging Perioperative Capacity to Optimize System Efficiency How simulation can enable holistic capacity strategies October 5, 2015 GE Healthcare Partners Ryan Treml – Consulting Manager Steve Verdi – Senior Consultant

2. 2 GE Healthcare Confidential and Proprietary ©2015 General Electric Company – All rights reserved. All illustrations or examples are provided for informational or reference purposes and/or as fictional examples only. Information contained herein is proprietary to GE. No part of this publication may be reproduced or used for any purpose without written permission of GE. GE, the GE Monogram Centricity, and imagination at work are trademarks of General Electric Company. General Electric Company, by and through its GE Healthcare division

3. Agenda GE Healthcare Partners Overview The Need for an Institutional Capacity Strategy Systems Approach to Capacity Optimization using Simulation Modeling Simulation Outputs and Insights Putting Model Insights into Action

4. 4 GE Healthcare Confidential and Proprietary GEHC Partners Expertise Change Leadership & Strategy Activation Create market leaders by helping activate strategy and unlock potential Care Delivery Management Transform flow of patients to help optimize utilization and decrease cost Integrated Whole System Care Create actionable strategies to drive growth, enhance market position and improve financial performance Strategic Resource & Cost Management Help clients improve operating margins via resource allocation and utilization optimization Change leadership Advanced analytics and decision supportKnowledge Transfer and sustained results GE Healthcare Partners

5. 5 GE Healthcare Confidential and Proprietary GE Healthcare Partners GE Healthcare’s independent consultancy US ClientsInternational Clients Clients determine our success. Data trumps a good guess. Optimize the system and the parts. Agnostic. Institutions and individuals must change. Heroic is great. Sustainable is better. Diverse global experience

6. 6 GE Healthcare Confidential and Proprietary Capacity Related Trends in AMCs “There cannot be a crisis next week. My schedule is already full.” - Henry Kissinger

7. 4-8 Hours of ED Boarding 4-8 Hours of ED Boarding 25+ OR Holds/week 25+ OR Holds/week 55+ Incoming transfer declines/month 55+ Incoming transfer declines/month 7 90+% occupancy rates lead to operational challenges:

8. 8 GE Healthcare Confidential and Proprietary Re-Thinking Capacity Management

9. 9 GE Healthcare Confidential and Proprietary System Impact of Variation Decisions only delay the individual Only major events trigger delays Minor events have large impact Hospitals facing high occupancy require systems thinking to appropriately manage capacity

10. 10 GE Healthcare Confidential and Proprietary The Hospital as a System

11. 11 GE Healthcare Confidential and Proprietary The Hospital as a System

12. 12 GE Healthcare Confidential and Proprietary Why Simulation? Creates visibility to ‘hidden’ factors for consideration in next generation of operations management Produces a clear view of the interdependencies & adjacencies that challenge operations and patient satisfaction Allows for investigation of multiple solutions in a test environment – reduces the risk/difficulty of testing solutions in an active patient care environment Enables data driven and informed decisions to plan for today’s needs while also highlighting future constraints and opportunities Simulation is used to gain a systems view of potential changes, providing non-intuitive insights to solve complex problems

13. 13 GE Healthcare Confidential and Proprietary Model Design & Build Pathways Thousands of unique physical pathways based on historical sequences Patient Types Groupings of patients with similar pathways & statistical behavior Arrival Volume Growth, seasonality, daily and hourly variations OR Length of Stay Distribution in hours Unit LOS Distribution in days Exit Unit D/C curves by hour applied on final day of stay

14. 14 GE Healthcare Confidential and Proprietary Analysis Enabled by Simulation Modeling Examples of Commonly Tested Scenarios Growth and Other Volume Change Managing Variation Bed Capacity and Routing Organic volume growth Add/loss of surgeons Change in case mix/type Capping ICU postings Shifting block time Opening buffer capacity Inpatient bed algorithm Flexible Prep/PACU Utilizing outpatient space Demand-based discharge

15. 15 GE Healthcare Confidential and Proprietary Example Model Insights Reducing week-to-week ICU arrival variation Variation in scheduled arrivals to ICUs results in census variation, creating weeks of high occupancy and other weeks of underutilization. Balancing the block schedule can reduce arrival variation and prevent weeks in which the ICU is full. ICU Census - BaselineICU Census – Reduced Arrival Variation 54% reduction in Hours at Full Capacity 40% reduction in census variation 38% reduction of wait time to enter ICU

16. 16 GE Healthcare Confidential and Proprietary Example Model Insights Shifting Inpatient Discharges to Lead Demand Misalignment of bed demand and bed capacity creates a midday census peak on inpatient units that prevents queued demand from finding beds. By freeing the right capacity at the right time, we can level census and reduce waiting for beds. Discharge Targets: 1 discharge by 10a 1 more discharge by 2p 1 more discharge by 5p … 18% reduction in ED Census 22% reduction in ED boarding 30% reduction in OR holds for ICU beds 9% reduction in ICU utilization

17. 17 GE Healthcare Confidential and Proprietary Solution Prioritization Matrix Scenario BReduce PACU LOS CSharing Capacity DReduce Empty Bed Time EReduced LOS FED Process Improvement GExtended Stay Recovery Unit HAdd Monitored Beds IElective ICU Capping JCase sequencing within the day KShift OP Volume to Outpatient LDedicated OP PACU in Surgery Unit MPool PACU Capacity NPediatric OBS unit OFully Staff PACU PPeds Routing by Age Only QFully Staff ICUs High LowHigh Solutions tested in the simulation model are compared based on the overall impact on capacity and difficulty to implement. This prioritization funnel feeds the project timeline and sequencing of work.

18. 20152016 2345678910111212345678910 Urgent Admission Transfer Process IPOM (Interactions, Procedures and Op Mechs) Wall of Analytics Aligned Discharge Perioperative Throughput Project Timeline Access Line, Admitting, Bed Center Workflows Patient Placement Practices Solutions are grouped into project workstreams, then evaluated for proper sequencing to prioritize capacity improvements to allow flow Command Center Go-Live

19. Discharge by Protocol Additional Phase 2 capability RN staffing and documentation Mgmt of ICU patients in PACU Project Timeline – Perioperative Workstream Initial Focus Areas Projects were targeted to address immediate capacity needs and key processes Initial Focus Areas Projects were targeted to address immediate capacity needs and key processes Perioperative Throughput PACU Throughput Outpatient Surgery Center ICU Centralized Scheduling Potential Future Focus Areas Block Scheduling Scheduling Policies Utilization Governance OR Process Efficiency OSA / ESR patients Reduce exclusionary criteria Shift add’l OP cases to OPSC Review need for additional rooms Address sequencing of cases to reduce downstream bottlenecks Identify alternative capacity options to cover post-surgery ICU demand Create additional capacity for extended stay patients Address monitoring capacity Improve standardization of case scheduling / posting sheets Improve sequencing of cases / volume Adding additional OR volume would exacerbate downstream problems, therefore Block Schedule, Governance, and OR processes were sequenced in second phase

20. 20 GE Healthcare Confidential and Proprietary Command Center with Wall of Analytics GE Healthcare Proprietary Co-locate staff & concentrate information to: Improve access to the people and information necessary to make critical decisions at the moment they are needed Provide real-time decision support tools that make data meaningful and actionable Deliver detailed information that aides in identifying opportunities to improve hospital operations

21. 21 GE Healthcare Confidential and Proprietary Wall of Analytics – Under Construction

22. Takeaways Optimizing for the individual is no longer possible; impact of localized decisions need to be compared against system efficiency At high occupancies small changes have a large impact Managing variation is the hardest and most critical area of focus Cultural transformation is needed… modeling helps build the case for change

23. Questions? Thank You! Ryan Treml, Consulting Manager Ryan.Treml@ge.com (773) 518-0316 Steve Verdi, Senior Consultant Stephen.Verdi@ge.com (262) 951-1595