Issue 31

CMS Briefing: Greater Focus on Compliance, Quality, and Satisfaction

Business Process Management (BPM): Fresh Lipstick on an Old Idea?

CMS Briefing: Greater Focus on Compliance, Quality, and Satisfaction

Issue 30

Rethinking the Physical Environment
An urban planning perspective enlightens and informs facility planning.

Developing and Prioritizing Market-Based Growth Strategies
Finding the right answer for the right market, prioritizing initiatives, and focusing on execution.

Heal Thyself: Improving IT Efficiency and Service
The Information Technology Infrastructure Library (ITIL ®) is helping health care CIO s sleep at night.

Issue 29

Measuring the True Value of an Ambulatory Surgery Center (ASC) Strategy
Determine the strategic value of acquiring an ASC by evaluating it as part of a broade rintegrated analysis of the hospital’s surgical services.

Setting the Stage for Personalized Health Care
Adv ances in genomics, proteomics, and molecular technologies are ushering in a new era of personalized heath care — one that promises exciting advances in predicting, preventing, and treating disease. Such advances also have implications for health care facility and information technology
infrastructure.

The Clinical Data Silo is Filling Up: Data Warehouse Planning Considerations
Growth in clinical information technologies is enabling the capture of meaningful electronic clinical data; however, a Clinical Data Warehouse is required to turn that data into actionable
information.

Issue 28
Start with ZIP Technological Solutions to Manage Change
Larger, more private facilities pose new communication challenges.

Technology is Not Enough to Offset Population Changes (Graphic)
Population growth and aging will be the major drivers for more inpatient care, offsetting continuing advances in technology and outpatient capabilities.

Freestanding Emergency Department Strategy Must Weigh Benefits, Costs
Mission, volumes, safety, technology, and staffing factor into the decision.

Codes: Market Segmentation Aids Ambulatory Development Strategy
Analyzing geographic submarkets provides a useful framework for long-range strategic planning and location of new ambulatory facilities.

Issue 27

Building Activation: Preparing for the Big Move
Planning for the occupancy of a new facility is as important as the effort spent developing the building itself.

Are RHIOs for Real?
Regional health information organizations (RHIOs) provide shared, comprehensive access to health information and tools to improve patient care and health care system efficiencies.

Issue 26

Anatomy of a Measure: Enabling Health Care Performance Measurement
Health care information technology is not making performance measurement reporting any easier — today.

Urban Hospital Strategy
To improve their ability to continue serving their populations, urban hospitals are exploring collaboration with a broad range of partners.

Minimally Invasive Procedures Drive New Facility Needs
KSA recommends hospitals planning new operating rooms and procedural suites consider the impact of minimally invasive procedures on operations and space.

Issue 25
Managing Construction Projects through Integrated Teams
There are three manageable aspects to every construction project: cost, quality, and timeframe. The old adage is that it is usually possible to meet targets in two of these areas, but extremely difficult (if not impossible) to achieve all three. In today’s health care environment, the conventional wisdom must change.

They’re Just Giving it Away — the STARK Reality
In 2004, President Bush set a goal to establish a national network of Electronic Health Records (EHR) within a decade. Critical to achieving this goal is the use of EHR software by solo and small physician practices, which deliver most of the country’s health care.

Strategic Aspects of Physician Employment for Community Hospitals
Academic medical centers and major teaching hospitals have always used employed physicians to further their academic missions. Today, community hospitals are revisiting this practice, as they are better equipped to employ specialists that align with their institutional strategic plans.

Issue 24

Service Desk Strategies: Help for the Information Technology (IT) Help Desk
The growing number of health care providers implementing Computerized Physician Order Entry (CPOE), Electronic Health Records, Clinical Information Systems (CIS), and PACS solutions is increasingly challenging for CIOs. Clinicians are demanding that application problems be resolved on the first call to the help desk.

Dynamics of the Evolving Medical Staff and Hospital Relationship
At community hospitals nationwide, a growing number of physicians are seeking increased compensation for services traditionally provided in the spirit of the community mission.

Joint Venture? Alternatives to Economic Partnering
With increasing pressure on clinical income, physician interest in ownership of clinical services continues to accelerate as physicians seek to secure their economic future.

Issue 23
Maintaining Functional and Efficient Hospital Emergency Departments
As emergency rooms become more and more crowded, adopting the right mix of solutions can ease congestion and better meet market demand.

Strategies to Ease Emergency Department Overcrowding
Leadership, it’s a classic case of balancing margin and mission.

Meeting ED Demands Takes More Than Space
Matching the right resources to the right patients is key. Once hospitals have diagnosed the source of their ED problems and have begun to implement strategic solutions, they may conclude they simply need more space — more treatment areas, more radiology rooms, more inpatient beds, etc.

The Patient Portal: Simplifying Life for the Health Care Consumer
When you need to pay the cable bill, you log on to your online banking account. When you need to book a flight to Hawaii, you log on to your favorite travel website. When you need to ask your doctor for some follow-up care advice, you probably call on the telephone, get caught in a cycle of voicemail and phone tag, and most likely become frustrated.

Issue 22

Rising C-Section Rate Fuels New Space Demands
Hospitals have traditionally invested in Obstetrics as a core, “front door” service and a significant contributor to overall discharge volume. Today, market forces are driving many hospitals to look differently at how they invest in Obstetrics facilities for the future.

Private Patient Rooms Yield Long-Term Payoffs, Operational Savings Offset Up-Front Capital Costs
Private patient rooms, long recognized as the standard preferred by patients, received a major endorsement in 2005 when the American Institute of Architects (AIA) included the all-private room model in its guidelines for new hospital construction.

Volume 21
Securing the Connection: Integrating Hospitals and the Physician Office
Developing and maintaining meaningful physician relationships is a top priority for hospital providers. Increasingly, organizations are recognizing the potential for information technology to enable this strategic goal.

Physician Employment: Time for Another Consideration?
While hospital employment of physicians has recently gained momentum, it is neither new nor revolutionary. At its heart, the arrangement still entails a trade-off, for both hospitals and physicians, between financial and control motives.

Proposed Reimbursement Change Will Redistribute Medicare Dollars
The centers for Medicare and Medicaid (CMS) recently announced their intent to recalibrate the DRG system by 2008. Because the proposal is revenue neutral and based on costs and severity, it will redistribute reimbursement dollars among providers, creating winners and losers.

Volume 20
Strategies for Ambulatory Care Development
Hospital leadership teams across the country are challenged with how to navigate the changing ambulatory care landscape. Competition makes ambulatory development a difficult and sensitive strategic initiative. Strategies vary by market and service based on identified goals and understanding of a hospital’s market objectives, service portfolio, and approach.

A New Growth Strategy for Urban Medical Centers: Divide to Rule
Urban medical centers have managed to stay ahead by constantly reinventing themselves through new technologies and services. Yet shrinking real estate has made it more difficult to sustain continued growth. Many are siphoning off their inpatient services to new locations ranging from highly focused facilities to highly complex hospitals. KSA’s experience suggests we can use four criteria to determine when such significant changes are successful.

Putting on Your SOX: What the Not-for-Profit CIO Should Know
The Sarbanes-Oxley Act (SOX) of 2002, originally passed in response to a series of corporate scandals, applies directly to publicly traded corporations regulated by the U.S. Securities and Exchange Commission (SEC). SOX focuses on the integrity of financial reporting and controls and is an expensive and top-of-mind issue for CEOs and CFOs of public companies. Health care entities have also taken their lumps in public opinion and the outcome has been a call for significant improvements in their governance practices. Regulators, prosecutors, and health care board members are viewing the provisions of SOX as a useful reference to address these concerns.

Volume 19
U.S. Steps Up Support for Electronic Health Record (EHR)
“Free” government software, though not actually without cost, will have a dramatic effect on the health care software marketplace.

Information Technology — The Hidden Building Project Cost
Information technology requirements add significant costs to facility plans — and should receive significant attention during facility planning and design.

Strategic Considerations in Divestiture Planning
As margins tighten, it has become more important than ever for hospital executives to routinely assess the performance of their hospitals’ clinical services.

Volume 18
Planning for Procedural Medicine — Growth in Procedure Sites Raises New Questions
Fueled by technological advances, procedures are continuing to migrate from operating rooms to procedure rooms, imaging suites, and even office-based practices. With growth and increasing dispersion of procedure sites, it is increasingly important to consider — and plan for — the best location and organization of procedural services. This article offers some factors for consideration.

Secure Communications — Matching the Tool to the Task
Health care organizations communicate private information electronically with their patients, other providers, payers, vendors, and numerous other parties to conduct the business of health care. This article reviews three basic solutions for securing the delivery route between the sending and receiving ends of the exchange, as well as two secure e-mail approaches to consider as part of an overall strategic approach to secure communications.

Pediatrics — How Much is Enough? Children’s Health Care in Community Hospitals
Since the 1980s, there has been an explosion of “children’s hospitals.” As this trend continues, KSA advises hospitals to consider the implications of increasing the complexity of pediatric care provided, for their own organizations and the overall health care system for children. This article outlines those implications and offers considerations for defining the level of pediatric care a hospital should provide.

Volume 17

The "ROI" of Stakeholder Involvement
With the continuing building boom in health care, many hospitals are involved in one or more major building projects. Effective planning can play a significant role in the success of such projects — and in particular, can help minimize costs. This article describes how to manage initial capital costs and minimize operating costs, and offers several keys to success.

Technology Supports Efficient and Safe Use of Multiple Applications
Single sign on (SSO) and patient context management (PCM) improve efficiency, convenience, security, and patient safety when using multiple applications in health care. This article outlines the challenges of using multiple information technology applications to manage administrative, financial, and clinical processes and describes two technologies that can resolve some of the issues involved. It also offers approaches and solutions for reducing the complication of authentication, user identity, and patient context management.

Maximum Effective Market Share for Systems
For multi-hospital systems, internal competition among hospitals can rival the intensity of external competition for market share. This article provides a four-step approach to enable a system perspective for strategic and program planning, and reviews considerations for identifying the maximum effective market share target.

Volume 16
Ambulatory DX: Assessing the Health of your Ambulatory Services

Programs serving a predominantly outpatient population continue to undergo rapid growth and change. Facilities and systems supporting ambulatory care are an integral component of ambulatory care strategy. A checklist of key indicators, including location, capacity, quality of space, flexibility and adaptability, and pre- and post-visit support, can help diagnose the health of ambulatory services and illuminate critical gaps.

Save the Rain Forest – Go Paperless!

Many organizations today are "digital," but none are truly paperless. M ost new inpatient and ambulatory facilities are being designed to be paperless from the day they open their doors. Organizations typically approach the transition incrementally, beginning with a pilot site. While significant effort is required to re-engineer and re-design processes to make workflow more efficient, the most significant challenges are cultural, not technical. The effort requires full organizational commitment, senior leadership, clinician involvement, process redesign, data integration, and adequate human resources. KSA poses key questions to help organizations prepare for this digital journey.

Health Care's Value Equation

A strategic differentiator health systems frequently overlook is the value of time, whether the hospital defines its customers as patients or physicians, or whether the treatment setting is outpatient or inpatient. There is a significant opportunity to make patient visits shorter and more convenient. Helping physicians maximize the time they spend generating professional fees demonstrates that the hospital values its physicians and understands their goals. Identifying and implementing specific opportunities to save time can yield significant benefits for patients, physicians, and the hospital.

Volume 15
Merging onto the Communications Superhighway

Disparate communication networks with differing capabilities create several challenges and barriers for health care organizations, including increased costs and multiple service agreements. The goal is for these independent networks to converge into a unified communications infrastructure (UCI), enabling visibility of any data, anywhere, anytime, and improving cost efficiency, robustness, and support capabilities. Planning and exploiting the opportunity of new and renovation building programs can bring health care organizations closer to the vision of a communications superhighway.

Hospital Campus Valuation: Replacement Cost Modeling

The cost to replace hospital facilities has grown dramatically. As a result, health systems are paying more attention to the value of their existing facility assets. Campus replacement cost assessment is the springboard to informed strategic, capital, and facility planning. KSA uses replacement cost projections to define the current benefit a specific campus should contribute to the system. KSA's approach incorporates campus size, complexity, and local construction environment, as well as facility system functionality, flexibility, and finish standards.

Volume 14
Secondary Care Services - Regional Referral Centers: Compete or Concede?
As local community hospitals continue to develop viable specialty programs, regional referral centers must balance the interests of surrounding communities with potential loss of volume and revenue.

Construction Cost Spike Should Not Derail Sound Planning
Sound facility planning is the best insulation against risks and uncertainties, such as rising construction costs.

Decision Support Technology Strategy
As last-generation decision support systems reach their life expectancy, successful organizations will take a strategic look at future-state information and analytical needs before making acquisition decisions.

Volume 13
Physician Specialty Integration in Ambulatory Clinics Improves Efficiency and Customer Service
When planning new ambulatory care facilities, defining the best organization of physician specialties and clinical services is a key consideration.

Linking Strategy with Financial Realities
Integrating strategic and financial planning is imperative for organizational strength.

Radio Frequency Identification Gets under Your Skin
World War II-Era technology finds new applications in health care to save costs and lives.

Volume 12
Comprehensive Capital Planning
Most multiple hospital systems struggle to efficiently allocate scarce capital dollars among competing needs.

Avoiding the Pitfalls of Balanced Scorecards
A balanced scorecard can be a powerful tool to help monitor and align operational behavior with strategy.

Outsourcing Partnerships are Not Always Marriages Made in Heaven: Pre-Nuptial Anyone?
Faced with several marketplace pressures, health care provider organizations have been under increasing pressure, frequently from their Boards, to consider outsourcing or other managed services of the information technology (IT) function.

Volume 11
Assessing the Opportunity of a Long-Term Acute Care Hospital
Long-term acute care hospital (LTACH) growth has been strong, and despite potential changes by Centers for Medicare and Medicaid Services (CMS), these facilities remain an effective strategy for managing long-stay acute patients.

New Hospital Planning: Complexities and Key Considerations
Hospitals and health care systems are increasingly planning and building new hospitals to serve growing or strategically significant market areas.

Manage Your Financial Risk, Not Your Credit Rating
Health care providers should base strategic decisions and investments on effective risk management, not credit rating management.

Volume 10
The Stark Reality of Community-Wide Health Information Systems
New Stark Law regulations pave the way for deployment of community information systems, but challenges remain.

Achieving Strategic Differentiation in a Commoditized Market
Hospital services are becoming largely commoditized. Differentiating your organization from competitors' requires a comprehensive understanding of the strategic landscape and the ability to continuously reinvent your strategy to maintain a competitive edge.

Mergers and Acquisitions: Setting the Stage for Success
Mergers and joint ventures are inherently fraught with pitfalls. Following the steps outlined in this article can limit risk and enhance the potential for success.

Volume 9
Where One Nurse Does it All
The challenge: With only a handful of staff members, to provide safe patient care spanning the acuity continuum across the full range of clinical services, with a high level of customer service and in an environment with wide census swings and limited capital resources.

Medical Staff Development: Planning for 2010
Clinical program success hinges largely on an organization's ability to assemble the physician resources to support its strategies. Proactive medical staff development planning ensures the right number and mix of physicians to support program goals.

Ambulatory EMR: Fitting into the Electronic Health Record Puzzle
The ambulatory care setting is a significant component of realizing community-wide health information exchange.

Volume 8
Strategic Considerations in Consolidation
Many local systems formed under the basis of a market leverage strategy now find that operational efficiency and capital management are significant issues, potentially requiring further integration or consolidation.

Implications of Controllable and Uncontrollable Factors in Business Planning
Future results are influenced by controllable and uncontrollable market factors.

PACS: No Longer "If & Why?" but "When & How?"
A number of coalescing factors are making Picture Archiving and Communications Systems (PACS) a viable technology requirement for health care organizations of all sizes.

Volume 7
Next-Generation Revenue Cycle Management: Has Its Time Finally Come?
Next-generation revenue cycle solutions, while in their infancy, hold the promise of streamlined, integrated, paperless, and reengineered patient and revenue management processes.

Selecting the Best NICU Facility Model
The benefits of private patient rooms are significant, but the resources required to implement this model within NICUs must be carefully considered.

Nursing Unit Size: How Many Beds?
Staffing models can be the key to determining optimal inpatient unit size and ensuring day-to-day staffing efficiencies.

Volume 6
Five Trends Driving Replacement Hospital Planning
A confluence of five major trends is driving replacement hospital development and will have a significant impact on major renovation/replacement projects in the next few years.

The "Bedrock/Bridge/Visionary" Strategy Formulation Approach
Linking strategic planning with financial realities provides a framework for integrating short- and long-term objectives.

HIPAA Hype: Three Common Security Compliance Misconceptions You Should Know
The preamble of the final security rule is not law, but rather a useful source of compliance guidance.

Volume 5
Need More Ambulatory Care Space? Take a Close Look at Operations.
In planning ambulatory care space, don't assume new facilities will solve operational problems.

Changing Technology Will Shape Future Health Care Landscape
Technologies affecting diagnosis, treatment, locus of care, and information sharing will significantly change the health care landscape by 2020.

Proactive Strategies Help Suburban Hospitals Capture Growth
High growth is challenging many suburban hospitals to redefine their roles.

Volume 4
Outpatient Simplicity in a Hospital Setting
Given their focus on inpatient care, many hospitals have difficulty providing a patient-friendly outpatient experience. Yet, with growing competition from freestanding centers, the ability to provide a comfortable, convenient environment for outpatients, their families, and physicians is more important than ever.

Breathing New Life into an Historical Site
Rapid growth, capacity constraints, a lack of expansion zones, and key operations in functionally obsolete buildings describe many hospitals. But The Reading Hospital and Medical Center (TRHMC) in West Reading , Pennsylvania , faced an added hurdle. Its obsolete structures were antiques in the best sense of the word: attractive, well maintained, historically significant, worthy of preservation, and bearing a likeness that is the hospital's trademark.

Performance Management Information Technology: Enabling Effective Corporate Strategy
It is not necessarily bad strategies that lead to inferior performance, but the inability to effectively deploy, monitor, and refine those strategies. Performance Management is of growing interest throughout the health care industry as a means of enabling effective deployment of good strategies.

Volume 3
Planning Your Next Building Project
One of the most difficult questions facing health care leaders today is how to address the demand for new or renovated facilities. Strategic, operational, technological, and financial inputs must be evaluated to make the appropriate facility decision. This issue of the KSA Outlook focuses on the key planning steps for developing a new or renovated health care facility.

Strategic Planning First...
The strategic plan sets the stage for facility development, yet it is the step most often overlooked or shortchanged. Often, a potential facility need is identified and administration and staff are immediately eager to design a building.

. . . Followed by Comprehensive Facility Planning
Imagine the dismay of a CEO who, upon completing a million dollar-plus ICU expansion, discovers the hospital's new master plan suggests gutting the new ICU to provide additional operating room space.

Remember to Include IT: Beyond the Wiring on the Walls
For years, the health care industry has embraced a vision for the future in which the quality of care is improved, customer service is paramount, and operational efficiency reigns. Many organizations are pursuing this lofty vision one baby step at a time, but those embarking on a major facility project have a unique opportunity to realize this vision in one giant leap.

Volume 2
Lessons Learned from Major Building Projects
Consider the hospital environment. Physical plants are wearing out, new technologies require new facilities, acuity and utilization are increasing, and care models are changing.

Computerized Physician Order Entry: The Reality
Attention to patient safety and the reduction of medical errors is a high priority for consumers, payors, and regulators.

Proactive Asset Deployment: A Key to Current and Future Success
Given the many financial pressures in health care today, executives must be proactive about how and where their organizations' assets are deployed.

Volume 1
Avoiding the Squeaky Wheel Approach to Capital Investment
Hospital volumes have been increasing for the past year. However, reimbursement has lagged as employers, payors, and the government tighten their belts.

The 21st Century Inpatient "Ward"
With higher acuity, infection control, privacy issues, family involvement, and rising patient expectations, the traditional patient "ward" - rows of patients in beds with only curtains separating them - is no longer viable.

HIPAA: The End is Near (or at least planning for it)
Congratulations to the health care industry! We passed the first HIPAA hurdle April 14, 2003 : the HIPAA Privacy compliance deadline.

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