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In This Issue:
A Strategy for Continued Success
Strategic Plan Summary Presentation
As part of the hospital’s commitment to its Agenda for Change, BWH has formulated a strategic plan that lays out institutional priorities until 2005. The plan covers seven areas that will cumulatively make it possible for BWH to reach a margin designed to sustain and grow the hospital’s mission. It stands as the guide for administrators, managers, clinicians and all staff to follow to ensure BWH’s continued success in the intense health care environment in Boston and across the nation.
The strategic plan was presented to the hospital community at the Town Meeting on Wednesday, November 28. “It is imperative that word gets out about this comprehensive strategic plan. Every staff member needs to have an idea of what is going to happen over the next several years. Fueling staff with the appropriate context for these changes will make it easier for the hospital community as a whole to understand and accept such changes as they occur,” said BWH’s Chief Operating Officer Matt Van Vranken at the Town Meeting.
The plan packages hospital activity into the following seven areas—bed supply, inpatient service mix, Faulkner Hospital integration, outpatient services, cost reduction, revenue enhancements and length of stay. Each area has ownership at the executive management level, has specific accountabilities, and includes set goals and a projected action plan.
“It is important to understand that a strategic plan provides us with a framework for growth. Although key initiatives and priorities may not be expressly stated in a strategic plan of this nature, they remain as integral initiatives in fulfilling our mission and moving the strategic plan forward,” said Van Vranken.
1. Bed SupplyThe plan calls for BWH to increase its number of beds from 718 to 800 by 2005. This includes opening a total of 82 additional beds in the Pavilion, 5AB (bone marrow transplant and oncology beds) and the eventual opening of one pod on Tower 4, along with the movement of the medical library in 2003, then subsequently opening three more pods in 2004; converting a medical/surgical pod to a five-bed ICU; and moving medical/surgical activity (equivalent to 21 beds) to Faulkner Hospital. Van Vranken is responsible for the increased bed supply.
2. Inpatient Service MixThe service mix goals are complex, with specific goals related to medicine, surgery and obstetrics. Medical beds will moderately increase by 2005, surgical beds will increase substantially by 2005 and obstetrical beds will decrease by 2005. In order to accomplish these goals, BWH will work to increase tertiary referrals in medicine and surgery; streamline admissions policies to meet service mix goals and institute new policies related to ED admissions to general medicine beds; move gynecology beds to the Connors Center to make room for addition med/surg beds in the Tower and use the Partners network and other relationships to re-align the number of births at BWH and other institutions; and establish department specific five-year goals on size and mix of patients and designated resources. Van Vranken and Troy Brennan, MD, president of Brigham and Women’s Physicians Organization, are responsible for the inpatient service mix.
To integrate with Faulkner Hospital in a way that makes sense to both Faulkner and BWH, there are specific goals over the next several years to continue to fortify this merger that took place in 1998. Most of the aggressive steps taken to continually strengthen the BW/F relationship involve expanding Faulkner’s ORspace and capacity, adding MRI services to the Faulkner campus, continuing to grow Faulkner’s inpatient volume and planning for additional ambulatory care and garage space. Margy Hanson, RN, senior vice president of Network Development, is responsible for the Faulkner integration.
4. Outpatient ServicesImprovements in the delivery and efficiency of ambulatory services at BWH hinge on determining the service mix and size, planning appropriate space and location of each outpatient service and concentrating on cost reductions to bring about higher revenue. This involves identifying services with the greatest reimbursement and return on investment, pinpointing the best technologies that will compliment such services, and growing and siting the appropriate ambulatory services. In addition to service placement at BWH, Faulkner and 850 Boylston, service growth and space allocation at other satellite locations and community health centers will also be considered. Brennan is responsible for the outpatient services goals.
5. Cost ReductionThe goals in this area are precise: to achieve a one percent reduction in base inpatient costs and a two percent reduction in base outpatient costs in each of the next three years. The plan to achieve these monetary savings includes continued implementation of BWH’s value analysis program; reducing utilities consumption; reducing inpatient lab, pharmacy and radiology use by five percent in 2003, two percent in 2004 and one percent in 2005; and reducing discretionary spending. Van Vranken is responsible for BWH’s strategic cost reduction goals.
6. Revenue EnhancementAs a way to counteract the current $6 million loss each month due to denied claims and other losses related to billing, BWH has set revenue enhancement as a high priority. To accomplish the related goals, objectives are primarily associated with reimbursement. Specific actions include, but are not limited to, establishing a pre-registration function; improving data exchange with all hospital entities; a more careful verification that reimbursement occurs at the contracted HMO rates; an improved patient data and master file quality; reducing account receivable days through collection of co-pays and prior balances at the time of the patient’s visit; reducing referral denials and suspended claim volume by 25 percent through staff referral management and enhanced information technology; and developing and implementing a policy to ensure that free care is available to those patients who meet the criteria. Roger Deshaies, BWH’s chief financial officer, is responsible for the revenue enhancement component of the strategic plan.
7. Length of StayCurrently, the length of stay at BWH is 5.5 days. The FY 2002 budget includes a target of 5.4 days and 2003-2005 goals project an incremental decrease of .2 days for each year. In order to reduce length of stay to 5.0 days by the end of FY 2005, actions will include reducing the number of pre-op bed days through the use of the outpatient setting; increasing the percentage of patients and family informed at pre-op clinic visits and throughout the stay of the expected length of stay; improving timeliness of discharge paperwork; ensuring sufficient ancillary services to optimize patient flow; as well as other clinical initiatives. Currently, BWH employs only one care coordinator per 35 patients. Therefore, improvements in coordination of care call for enhancing continuity of care; coordinating services through pre and post stay calls, rounds and consults; increasing the use of BWH clinical care pathways; and elevating the understanding of practice patterns of care. Anthony Whittemore, MD, chief medical officer, is accountable for the length of stay goals.
According to Van Vranken, the quality of worklife is key to accomplishing the goals of the strategic plan. Critical are recruitment and retention of high quality staff, adherence to a comprehensive space allocation plan and maintenance of worklife programs such as the Staff Survey.
The successful implementation of the strategic plan will allow the hospital to sustain its long-standing commitment of excellence to patient care, research and teaching while continuing to support the community.
For more information on the strategic plan, email BWHBulletin@partners.org or consult your manager or vice president.