| McKay-Dee Hospital Center is a 310-bed facility located in Ogden, Utah, and is a member of the Intermountain Health Care System. Under the direction of Dr. Gary Clawson, McKay-Dee re-organized the Respiratory Therapy Department, achieving 34% of the cited savings opportunity identified through its benchmarking program with HMC. |
| Staffing Model was Driving the Excess |
 | The Respiratory Therapy function at McKay-Dee Hospital Center showed a significant potential savings opportunity on a cost per procedure basis. Cost per procedure was among the highest in their peer group, showing little movement over time. Utilization of RT services also appeared somewhat higher than the comparison group. |
| The Respiratory Team identified the current staffing model as the primary driver of the cost variation. Of the targeted comparison facilities, McKay-Dee had the lowest number of procedures per FTE and the greatest number of worked hours per admission and per patient day. Two common factors were cited: a disproportionate amount of non-clinical time spent by therapists and ineffective staffing patterns due to a previous effort at de-centralization. |
Internal Analysis and Networking with Peers produced a wealth of ideas |
| A focused review of four better performing peers from McKay-Dee’s benchmark comparison group (Mount Sinai Medical Center, Miami Beach, FL; East Texas Medical Center, Tyler, TX; Rex Healthcare, Raleigh, NC; and Mary Washington Hospital, Fredericksburg, VA) revealed several practice variations with potential to improve McKay-Dee’s overall cost performance. A comprehensive action plan was devised:
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Re-centralization of the Respiratory Therapy department:
- Create a minimal staffing model and use staff scheduling software managed by one person
- Eliminate duplication of non-core RT functions
- Decrease overtime and call backs by cross-training staff for more flexible coverage
- Streamline the supply inventory and tracking process
- Decrease supply costs by modifying the frequency of vent circuit changes, changing all open-heart circuits from heated wire to HME, and changing in-line suction catheters prn rather than Q3 days
- Eliminate the practice of having a dedicated bronchoscopy team
- Review existing protocols for appropriateness; develop new protocols where needed
- Alter hours of operation, scope of service, and staffing for Pulmonary Function Lab
- Explore revenue enhancement opportunities in the PFT Lab, Sleep Lab, and other outpatient areas
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| "The HMC data helped us to look critically at our processes and showed our staff that by being more flexible we could reduce our costs."
Dr. Gary Clawson,
Director, Respiratory Services
McKay-Dee Hospital Center |
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Networking Results |
| Some of the key findings from networking interviews included:
- Less variability in shift hours at other facilities as compared to McKay-Dee
- Operating hours, staffing, and responsibilities of the PFT Lab
- Alternatives and benchmarks for the provision of bronchoscopy services
- Suggestions for more efficient allocation of non-patient care time
- A range for redefining true core RT functions
- Variation in frequency of vent circuit changes, including associated infection control study data
- Frequency of providing various RT services
- Organizational structure in terms of span of control targets
- Patient average length of stay comparisons
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Implementing Action Plan will Yield 34% of Cited Excess |
| Re-centralization of respiratory services will lead to an estimated cost savings of $244 K in the first year. |
| Elimination of a dedicated bronch team and cross-training of employees will save another $11 K. |
| Decreasing the frequency of vent circuit changes, changing all open-heart circuits from heated wire to HME, and changing in-line suction catheters to prn rather than Q3 days would reduce costs by $26 K. |
