Every health care organization, be it a stand-alone hospital or a multi-hospital system, finds itself with a long list of capital needs competing for scarce capital dollars. Difficult decisions have to be made about what projects to fund at what cost and at what size. Here's how three of our clients found solutions to their problems.

An inner-city tertiary care hospital with a successful cardiac surgery program lacked sufficient or appropriately sized ORs to attract other sophisticated surgical cases or specialists. As part of a large multi-hospital system, capital dollars were not available to fund a major overhaul of the OR suite especially given decreasing use rates and population declines in the primary service area, and a fluctuating market share. On the other hand, the existing OR suite was ill-equipped to accommodate advances in surgical technology or to attract skilled surgeons necessary to protect the medical center's market from erosion.

After reviewing OR utilization and modeling future OR volume by product line, New Solutions, Inc. developed a plan to reconfigure the OR suite to create two large ORs from four non-functioning minor procedure rooms and to relocate minor procedures to new space outside the OR suite. The solution also provided for better use of OR personnel. Scheduling changes were also initiated to increase OR suite efficiency.

A sole provider in a rural county had postponed replacement of major infrastructure systems and inpatient care areas of the hospital due to a number of financially lean years. The challenge of potential major system failures and asbestos abatement issues finally forced the hospital to identify a financially viable solution.

At a time when most hospitals were expanding their inpatient complement, NSI created a plan that decreased licensed beds and used the money saved to enhance patient-friendly outpatient treatment areas. Today, despite population growth, increases in market share, and new programs in diagnostic cardiology and oncology, the hospital has maintained its smaller bed complement due to a strong reliance on ambulatory care and length of stay reductions to improve throughput.

A large suburban tertiary care provider with a strong local reputation had seen growth over a number of years translate into multiple needs for program expansion, diagnostic/treatment and outpatient space.

One of the approaches used to ensure adequate inpatient and support space was acquisition of a _________ sf. ambulatory care building. NSI helped the hospital identify a mix of profitable outpatient services that with ambulatory surgery and radiology services could be moved from the hospital or developed on-site to free up diagnostic/treatment space within the medical center.

Developing Medical Staffs to meet identified Community Needs

Having the right complement of physicians on staff continues to be one of the primary keys to maintaining a competitive position. New Solutions, Inc. has prepared and developed numerous medical staff plans and strategies. A sample of how NSI has help healthcare organizations develop viable strategies to enhance their competitive positions is illustrated below.

A teaching hospital located in a very competitive market was seeking ways to improve its competitive position, increase its market share and add to its bottom line.

New Solutions, Inc. consultants developed a medical staff development plan. Linked to the hospital's strategic direction, contribution margin and community need, opportunities were identified for primary care and specialty physicians. As a result, the hospital recruited physicians in several specialties: obstetrics, geriatrics, palliative care, uro-gynecology among others.

These recruitment activities have yielded success in several areas. In particular, obstetrical volume increased nearly 300 births per year and is anticipated to continue increasing; a new uro-gynecological practice was established and has a patient waiting list of over a month for a new patient and a floundering geriatric program was strengthened.

Measuring Outcomes for HIV Services

In 1995, the HIV/AIDS Bureau of the Health Resources Services Administration (HRSA) began to implement a congressional mandate to assess the extent to which Ryan White CARE Act funds were accomplishing their intended objective, i.e. improve the health status of HIV-infected individuals. Faced with the challenge of measuring outcomes on behalf of its funded providers, a Title I grantee asked New Solutions, Inc. to design and implement an outcomes evaluation program.

The solution evolved over several years of working with over twenty service providers. Initial steps included identification of appropriate outcomes measures and indicators for each of nearly a dozen different service categories including, but not limited to primary medical care, substance abuse treatment, mental health therapy and case management. Outcomes and indicators were first introduced conceptually and then developed over a series of interactive workshops. Providers were asked to relate their definitions of outcomes and indicators to their own quality improvement programs.

The process continued with a data collection process, which would be used for evaluation analysis. Data collection tools were developed along with a unique database formed from client level provider observations. Client satisfaction surveys were also employed to complement the data collection. Over 30,000 records were incorporated annually into an outcomes measurement database, a process which has continued since without interruption.

Each year, the results of the data collection were reported and presented in full-day workshops with the participating providers. Each provider received information about its own program as well as comparative analysis across peer providers. Summary evaluations provided the information necessary to respond to the HRSA mandate to document outcomes.

Today, this client is recognized as a pioneer for similar programs across the country. The program developed by New Solutions, Inc. has since expanded into a web based interactive system designed to continue the process by utilizing the technology of on line data collection. As the ultimate goal of the program, outcomes are being measured and linked to quality improvement programs on behalf of Ryan White service recipients.

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