Case Studies

Physician Leadership Drives Cross-departmental Collaboration to Enhance Patient Care

Saint Francis Memorial Hospital

Hospital Beds 356
Annual ED Visits 32900
ED Beds 19

Administrators at Dignity Health’s Saint Francis Memorial Hospital in San Francisco believed that working closely with both the hospitalist team and emergency department (ED) would smooth transitions of care, maximize safety, and improve patient experience. Toward that end, CEP America's leadership and culture of ownership provided an impetus for closer clinical integration, resulting in:
  • Median time to provider (TTP) under nine minutes
  • ED turnaround time to discharge less than 120 minutes
  • Average length of stay of 3.6 days
  • Sepsis mortality decrease of 19%
  • Increased staff engagement and openness to change
Uniting for better care

CEP America, a leading provider of hospital-based physician management solutions, offers clinically integrated services in emergency and hospital medicine, ambulatory and urgent care, and skilled nursing. It has successfully managed Saint Francis’ ED for over 35 years. With the second busiest ambulance traffic in San Francisco and a 30-minute TTP guarantee, Saint Francis couldn’t afford missteps when it came to throughput.
To continue achieving the highest levels of efficiency, Saint Francis’ emergency physicians knew they would need assistance from their hospitalist colleagues, who were employed by a single specialty group. "The biggest factor holding patients in the ED is hospital beds," says Joanne Sun, MD, director of emergency medicine at Saint Francis. "If hospitalists discharge patients in a timely manner, patients can move from the ED into more appropriate care."

An opportunity to improve alignment arose in 2009 when Dignity Health selected CEP America to manage Saint Francis' hospitalist program based in part on CEP’s success in the ED. By uniting these key departments, administrators hoped to lay the groundwork for more coordinated patient care.

Leading change together

The medical directors of the newly unified emergency and hospitalist teams saw a need for increased communication. In the past, the departments had operated independently—and sometimes at odds. "Each specialty has its priorities," says Joseph Mallon, MD, medical director of the hospitalist program. "We hadn’t taken much time to discuss how we could help one another."

To bolster communication, the medical directors implemented quarterly joint clinical meetings, inviting providers, nurses, and staff to attend. The meetings are used to share data across departments and identify processes that need improvement.

"The culture of CEP America is about ownership and transparency," says Sun, who drew on leadership training she received from CEP to spearhead the cultural shift. "The cross-departmental data helps us collaborate to make better decisions for our patients."
 
Aligning with administration

The joint meetings also create an opportunity for Saint Francis' administration to work closely with both departments. "With everyone in one room, we can use that time to review data and provide education on current initiatives,” says Jill Welton, vice president of quality. In addition, the ED and hospitalist teams send a liaison to the other team’s department meetings to provide updates and discuss issues.

The collaboration has been fruitful. The departments have worked together to flex staffing, allowing for more coverage during peak times and less when volume is low. Recently, representatives from both teams worked closely with the infectious diseases department to create a new sepsis protocol, which has reduced sepsis mortality from 41% to 22%. Both teams are also active in the hospital's throughput task force and are currently collaborating on a hospital-wide protocol to address ED surges.

Nurturing robust relationships

Mallon says the high level of communication between the departments is their biggest accomplishment. "Because we’re aligned, we tend to work more efficiently, which leaves more time to focus on the patients’ needs," he says. "There’s a lot of give and take, a lot of camaraderie."

Saint Francis administrators have been thrilled by the results. "Not only are CEP America ED and hospitalist teams very engaged with our hospital-wide initiatives, but their regional leadership is very supportive and involved," Welton says. "That relationship has been positive for us because CEP America's goals align with our own."