Reading Rehabilitation Hospital: Implementing

Patient-Focused Care

Question 1: Who are RRH’s stakeholders? What do they want from RRH?
How do they define quality?

Stakeholders of RRH’s are following:

Users Governance
 Patients being admitted for rehab  President and CEO Clint
 Doctors, nurses and therapists Kreitner
tending to everyday care  Director of services Rachel
 Social workers for smooth Pflum
discharge  Director of operations Jim
Lumsden
 Adventist Health Ministries
Inc.as parent company

Influencers Providers
Internal influencers Upstream Providers:
 Seventh Day adventist Churches  Acute care hospitals
External influencers  Outpatient surgery
 Federal Government  Primary Care
 Insurance Companies Downstream Providers:
 Acute care hospitals trying to gain  Home care
rehabilitation license  Nursing home
 Outpatient care

Question 2: What are the benefits of the new system in which care delivery is
organized around diagnoses or "service line" in comparison to the old system
where patient care was organized by function? What are the drawbacks?

Benefits of the new system in service line are as follows:

  In “patient focused care” staff members were assigned to interdisciplinary
service lines, each focusing on patients with a particular diagnosis
 This approach was patient Centered which put the emphasis on the patient’s
needs and convenience rather than the caregivers
 entire service line located on same floor
 ideal for getting doctors, nurses and therapist to work together in
interdisciplinary way
 therapist began to do their evaluation together to avoid many duplicate
questions for patient
 Ongoing coordination among staff members resulted in maximizing the
experience of patients with a particular diagnosis outside of the weekly team
conferences.

Question 3: At 116 therapists is RRH overstaffed? How many therapists

would you hire?
I think the no. 116 therapists are overstaffed because:
 Low therapist utilization and low billing hours were the major concerns for
RRH. The therapist utilization target was 75%, whereas actual was much
lower than that. Thus, to improve its financial health RRH should focus on
reducing the therapists’ wages cost and increasing the billing hours
 With pressure from managed care, it was difficult to pass on the overstaffing
costs to the payors. Also, understaffing had its own problems of adverse
impact on relations & patients’ health
 The variation in daily number of patients in particular service line (worsened
in recent years due to shorter patient stays) and big disparities in the number
of patient days across service lines in RRH, for instance just 206 patient
days for arthritic patients to 6198 patient days for orthopedic patients
(Exhibit 4), makes determining a fix number of ideal therapists difficult
 Still, we should decrease the number of therapist to at least 107. This is
because, even in 1995, when the total patient days were 27000+, RRH was
operating well with 107 therapists. By 1998, the total patient days have
reduced to 22,571, but still the number of therapists has increased, whereas
ideally the same should have decreased.

Question 4: Should RRH keep service lines, or return to the earlier way of
organizing care around functions?

Problems with earlier way of organizing care-

 1. Average patient stay at RRH was fewer days in length
2. The amount of time the staff spent in weekly interdisciplinary team
conferences did not become less along with the shorter patient stays, which
made it inefficient
3. Delay in start of patient’s physical therapy and also in discharge, leading to
unreimbursed cost

Problems with service line-

Kreitner idea to change the company strategy lacked a cost benefit analysis

1. The efficiency of the patient focused care shortened the lengths of stay
leading to decrease in revenue
2. Unknown supply of patients
3. Falling short of its therapist utilization

We would like to continue the service line while incorporating few changes-
 Reorganize the disciplines and cross train staff members to work across
multiple service lines to reduce therapist downtime and increase the therapist
utilization
 To increase demand for its services, RRH should look for ways to use the
staff for other than inpatient referrals