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Becker’s Healthcare Podcast
Transforming Patient Flow and IT Quality at University Health with Ashley Schutz
00:22:45
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- [00:00]
A
This is Scott Becker with the Becker's Healthcare podcast. We're thrilled today to be joined by a brilliant lifelong leader, our favorite type of leader. We're joined today by Ashley Schutz. And Ashley is the Director of IT Quality Assurance at University Health Texas in San Antonio. Ashley has done a tremendous job overseeing so many interesting efforts at University Health, whether EPIC implementation, Lean TOSS implementation, and so much more. Going to talk to her today about operating room technologies and just technologies in general and trying to implement them well and working with teams to do so. Ashley, can you take a moment to introduce yourself and tell us a bit about yourself and your work in healthcare at University Health in San Antonio, Texas?
- [00:45]
B
Yeah. Thank you so much. First and foremost, thanks for having me. I'm really excited to share our story and my thoughts on healthcare it, but a little bit about me. I've actually worked for University Health for 13 years. I started with them. It's kind of a long, winding road, but I started my career with them as a medical laboratory scientist in our microbiology department. But basically I latched on to anything related to process improvement and especially crossover with other departments. So in 2018, the opportunity came up to join the EPIC team and I thought what better time to get more involved than the implementation of a system wide EHR system? So that was like a big switch in my career from microbiology into it, but story for another day. We actually went live during the COVID pandemic, which was also pretty exciting times. But pretty quickly after going live, I got back into that process improvement mindset where I saw a lot of opportunities where we could bridge the gap between operations and it. And basically I moved into my current role, which is that IT Director of Quality Assurance. And then a few years ago I ended up going back to school. I got my master's in Healthcare administration just so I could pull the whole picture together. And basically over my career, I feel like I've kind of turned into this Swiss army blade. I like to bridge the gap in between IT and operations. That's where I found my little niche area. And one year ago, I would say we got the news that we were going to be partnering with Lean Toss for our inpatient throughput and our coo, who was our CIO at the time, actually asked me if I wanted to oversee the implementation. So here we are a little over a year out from our discovery and kickoff call and sharing our success story.
- [02:41]
A
Thank you. And what's fascinating is you're like the epitome of a lifelong learner microbiologist to IT back to do a master's degree. I mean, it's such an impressive thing and congratulations on a fantastic career. You somewhat bring a unique perspective to someone who grew up in the healthcare IT world. When you look at health IT today, hospital IT teams adopting and implementing new technologies effectively, what have you found most important? What works when people are getting things going or starting new technologies? Cause you've been on the EPIC team that the implementation there, you've worked on this, the IQ for Inpatient Flow team with Lean Toss. Talk about what's most important in implementing new technologies effectively.
- [03:28]
B
Yeah, that's a good question. From my perspective, I think the most important thing is to really get in there, to know your end users, know their workflow, and then become as familiar as you can with the system architecture. I think in today's world we are becoming so dependent on it, I mean, with increasing patient volumes and it's impossible to keep up with the workload if you are not keeping up with your technical systems. And it's there to be a tool, it's not there to replace anything, but really it should be enhancing your work. So if your IT team can get to know what your needs are and I'm not talking about your technical needs, but how do you serve your patients and how do we get your IT processes to fit seamlessly? We have this really nice marrying of the two different sides and it helps everybody out. So going back, I think my number one thing that I would say is important would be to just immerse yourself in what you are doing for your end users. Ask the questions, go in shadow if you can, and try and figure out what the need is. Not just what can the system do, but how can we make the system.
- [04:51]
A
Work for you, but that point and being totally connected to the end user, the actual user technology, whether it's epic, whether it's Lean Tosses technology, the IQ for inpatient flow, whatever IT is that is so important because you see so many people historically in IT that almost thought they were in a silo. And that silo is not meaningful unless it's really connected to the end user. Can you take a moment, Ashley? Is there a moment where that really stood out, where that concept of being really end user connected really showed importance?
- [05:29]
B
Yeah, for sure. We have seen this probably most prevalently in our implementation of Lean Toss. So as we were doing discovery, with my background in IT and knowing the EPIC systems, as we started meeting with our end users to discuss what were our biggest opportunities, we had to tie that back because you really, you start becoming a translator for these services. So you have one system that's connecting to another, you have data that's being ingested constantly, and you have to really know where it's coming from. And, and you have to know the workflows that drive that documentation. So EPIC is our source of truth system. That's where we do all the bulk of our documentation. But leantas is wonderful in the fact that it surfaces all of that in a big picture way. So it's great for your managers, it's great for your clinical leaders that really need to think about that big picture. And looking at the numbers was just one piece of the puzzle. So whenever we started first getting that data over, we started looking at it and saying, well, this doesn't make sense. We hear anecdotally about all of these barriers that are occurring, but we're not seeing anything in the data and it didn't really match what we were expecting to see. And that's whenever we had to start kind of reverse engineering and say, okay, where is this data supposed to be coming from? Go and check our source system. Okay, we went and checked the source system and we said, okay, well there's stuff that's populating and whenever it does populate, it comes over, but why isn't it populating all the time? And that's when we actually went several steps back and we started shadowing and sitting with our end users and saying, hey, I noticed that you didn't document this over here, you documented it in this place instead. Can you talk me through that purpose? So by digging into that, we were able to not just validate the data and really give us some meaningful metrics and what it actually is tied to, but we were able to discover opportunities within our workflows. On our clinician side, we were able to discover opportunities to correct within our EHR system to say, this would be an easier workflow, let's clean this up a little bit. And so now we have a great representation of what is actually occurring on the floor and all of that is tying together. And now as leaders, we're able to look at that data and make actionable decisions that are impacted directly by what we are doing. It's very correlated. And that was to me, the biggest thing that we've been able to accomplish by having this collaboration between our IT operations and clinical folk.
- [08:17]
A
Thank you. And that's just a great example of where things can go very right if you get that integration correct and where they can really struggle if they don't. So I think that is so important and I love that talk for a second. University Health is in its first year since going live with IQ for inpatient flow. What have you learned about improving patient flow now that your paths go live in what parts have been transformative so far? The most transformative. Where have you had the biggest impact so far?
- [08:47]
B
Well, I would say our biggest impact would probably be just in the transparency that Lean Toss has been able to provide our group. As we mentioned before, documentation is happening in epic, but that is, I think of EPIC as more of a tool where people are doing the documentation that are taking care of the patient directly. If you need to start making decisions and actions and looking at how all of these things tie together, Lean Toss is fantastic at taking all of that data, putting it in a way that puts your most important pieces in the forefront. And by that I mean they're surfacing those barriers that we are encountering in real time. They're surfacing the expected data discharge so that we can plan more proactively. It's identifying patients that maybe could take an alternative route for discharge. And they're going to our transitional care center, which is our discharge lounge, and we're saving bed minutes, even if it's only an hour here or there. But ultimately, just the transparency and now being able to see everything that is going on as it relates to throughput has been eye opening. We have people talking, we have a push instead of a pull method. Now our house supervisors are calling proactively to say, hey, it looks like we're running into some issues over here. What can we do to help clear them up? Our EVS team has actually really been excited because now they're also able to get into it. And you wouldn't think so much. It's usually direct patient care that you think about having that impact. But the EVS team, something as simple as getting real time information in advance to them to say, hey, on this unit, it looks like we're going to have quite a few discharges. Can we make sure that we have extra support to make those go quick, smoothly? Can we get transporters involved so that they're ready to go and move our patients from the ED up to that floor as soon as possible? So summary of all the things that I just said is the transparency that it's able to provide us so that we can enhance our communication has really had the biggest impact.
- [11:03]
A
Thank you. And so critical for people to understand where there's openings, where there's not, how we move things along better, how logistics work Better and just leads to a ton more efficiency, that transparency and the ability to quite frankly generate more revenues because there's better usage of operating rooms and procedure rooms and everything else. Talk for a second about sort of where have real time insights or predictive tools made the biggest difference in daily operations. Where do you see that biggest difference?
- [11:32]
B
So going back to the barriers, I think was the first huge win that we had. Whenever we went live in April, before going live, we looked at our data and I think even though we knew that there were barriers to discharge, they weren't being documented in a way that was visible to everybody that needed to be involved. And they were often just communicated verbally. So we knew, hey, this patient is waiting on a walker before they can go home. But that really wasn't documented in a way that other people could step in and help. So I think we went from documenting one to two barriers a week to over 500 a week just in the first month. And talk about eye opening. I think immediately as we went through our daily huddle at 9:30, we could start talking through those barriers and actually having ownership conversations. So we could say, hey, this has a barrier. Maybe the, the physician hasn't had a chance to do their med rec because they're waiting on something. We were able to assign ownership to say, you need to call the physician and find out when that's going to be done. If we needed to coordinate with PT and OT to do a final eval for some reason, we could do that. If we are waiting on an MRI read, we could reach out. We had all the stakeholders involved to be able to say, we have it documented. This is what we're waiting on. What can you do to help us in your area to move this along? So having the documentation there was great. And then I will also touch on that transitional care center, that discharge lounge. We were for the first time able to actually have criteria built into the system to where we could predict which patients would be most likely to go to the transitional care center. And we've increased our volume. That being said, there's always room for improvement. So that's one of the big things that we're looking into next is how do we use this system to now incorporate a new standard of practice? How do we transform into being reactive into okay, now that we know this ahead of time, what can we do to plan? What can we do to prepare patients for the tcc? There have been so many benefits to having the real time insights. It's transformed us from being able to fight fires Every day to go to the source of the fire and put it out. Because before it becomes a fire.
- [14:09]
A
No. And I love that. And pretty soon we'll ask you what's coming next for University Health and where do you see the partnership with Lean Tasks evolving to in your needs and as your needs continue to scale and continue to get larger and larger. Before I ask you that, you also opened a new command center in November. How is this command center, what does that command center look like and how has that shifted the way that teams coordinate and what has helped strengthen sort of cross functional buy in to use of some of these operational changes and the use of the command center? What does that look like and how is that shifted how teams coordinate?
- [14:46]
B
Yeah. So the command center, it's kind of like a Cinderella story, if I can speak frankly. We actually, I believe three years ago now we opened up our women and children's tower. So we moved all of our previous women and children's units. So what we did was we took our fifth floor NICU in one of our towers and we gutted it to basically turn it into a command center. We had to run all new data, we had to get it ready, we had to put carpet in, we had gas lines that we had to cap all the way back to the wall. So it was a major construction process. And now we have this beautiful command center. And within that command center we have a core area that houses our bed planners, our house supervisors. We have representatives from EVS and transport that are involved. We're working on getting a physician of the day role to step in. We also have our transfer center, our patient placement area off to one side of that. So it's an open, it's a big open area so we can easily get back and forth to them if we need to communicate quickly. We are also working on our stars as our float pool nurses and their staffing office has moved up there so we can start to balance our resources. And in that command center, the main area has 10 full screen monitors that are constantly displaying current real time status of what's going on in our system. We opened, yes, just it feels like it was yesterday, but honestly it's probably been about three weeks. It's been a very fast paced implementation of that. Biggest thing right off the bat once again is EVS having them there. I believe they told me preliminarily that they've already carved 10 to 15 minutes off of their average turnaround time for bed cleans. Still gotta validate that data. But it the fact that people can feel it is really what makes a difference. Our house supervisors now have several reports that they look at every day to kind of go over our quick wins. If we had to make capacity at the drop of a hat, where would our biggest opportunities be? And having that command center allows everybody to communicate those needs and has a central point of contact to kind of. It really is like an air traffic control area that allows somebody with a big picture to step in and help make decisions to control the whole house.
- [17:22]
A
I mean, that's really amazing, the positives so far in that. And you can really see the changes. And I think it's really important for your operational teams, your clinical teams to see those changes, to continue to buy in. And it becomes like a flywheel. If it's going well where people see the changes and see the positive, then they're more vested in it and more positive about the whole thing. I take it.
- [17:42]
B
Yes. We talk about this a lot of times in our, like, leadership groups about. It's very easy to become so metric focused whenever you throw numbers up on a screen. Especially a lot of times they're color coded. So green means good, red means bad. And I think a lot of people, whenever you start putting those numbers in a spotlight, get really focused on the numbers and just making them go green. But it's a lot more than that. We could have a green metric or a good metric, I should say. But if your staff aren't feeling that, and if they can't tie back what the data says to how they're feeling, it becomes really difficult to get that buy in or to continue that momentum with lean toss. I think one of the first things that, for me personally at least gave me this sense of, okay, we are actually impacting things, we are making a difference, was whenever I talked to the head of our emergency department and we were seeing that there was better movement. But what she told me, she goes, ashley, I am so excited because we are actually starting to function like an ED again. They could feel it down in the ED as we were creating more movement up on the units, that they could move their boarding patients up a lot faster. And it allowed them to breathe a little bit, honestly. And our median ED boarding time is kind of indirectly related to all the patient movement on the floor. But it was one of the biggest things that we saw right away, and not just saw it in the numbers, but to see it in how the staff are feeling. And to have that relayed really tied it in and reinforced that what we're doing is first and foremost for our patients and then helping our staff feel that they can do their jobs more effectively and provide good patient care.
- [19:43]
A
That's fantastic. Literally fantastic. And Ashley, take a moment. University Health San Antonio is going through a growth phase. The system continues to grow. What's coming next for University Health and how do you see your partnerships Lean Toss evolving as your needs and scale continue to grow and expand?
- [20:04]
B
We are on a path for growth, and it is coming at us fast. And we've known about it for a while. And I can tell you from an IT perspective, everybody's kind of like, oh, my gosh, how are we going to do all of this in such a short amount of time? But I feel confident that we will be able to. So growth plans. We currently our main hospital, including our women children's tower, is a little less than 1,000 beds. And then over the next two to three years, I say by the end of 2027, we are on track to have three other hospitals within the San Antonio area. These will be community hospitals. One of the big things in our mission is always serving our community. So expanding our growth out to other areas within San Antonio, because we're a pretty big physical city so that more people have access. So we have those three new community hospitals, and with those, we'll probably be adding close to 600 beds. We are looking at, this is the first time that we've ever had another hospital within our own system that we might have the ability to kind of move patients in between or more appropriately, based off of acuity, put patients where the best care is possible or maybe closer to their families. So we are looking at all of that in relation to Lean Toss. We're starting to work through our capacity protocols. We're starting to look at how are we going to connect all of these areas together, what is our escalation policy? What are our thresholds? And within all of that, we're also looking at all of our other IT systems to say, how are we going to grow this to where everything still talks really well to one another and supports each other so that we aren't building out silos of, well, this community hospital does it this way and our main hospital does it this way. We really want to try and standardize as much as we can so that no matter where you go within our system, you can still expect the same level of care or quality level of care that you would get at our main hospital.
- [22:10]
A
It sounds like an amazing journey that University Health San Antonio is on. Simply remarkable. I love your take on it. I love your constant ability to be a lifelong learner and connect dot, connect the it to the users, the clinical staff, to procedure management, to predictive analytics, to the operating rooms. It's really remarkable leadership. Thank you so much for taking the time to join us today on the Becker's Healthcare podcast. What a pleasure to visit with you. Thank you so much.
- [22:39]
B
Thank you. I really appreciate it. This has been great.