21 July 2022
Hospital operations: why is it clinical’s poor cousin?
Breaking down the complexity of Australian hospitals.
If you’ve ever been to a city emergency room, you know they are incredibly busy places, full of organised chaos.
At any one time, there is often a long list of people waiting – children with fractured arms, grandparents nursing broken bones, men who have tussled with lawnmowers and lost – and those people are all destined to meet at least four or five clinical professionals who will assist them during their visit.
They may be triaged, examined by a doctor, have an x-ray by a radiologist and be checked on by a nurse.
But while they wait for medical attention, they will see an absolute mass of people – hundreds of professionals moving purposefully about rooms, corridors and stations doing their jobs.
And all of this – the multitude of staff they see, occurs in just one relatively short visit, to one section of the hospital.
The fact is, urban hospitals especially, are unimaginably complex machines, and for most of us – even those of us who have worked within them – what we see, is just scratching the surface when it comes to how much it takes to make them work.
The real misconception, however, is exactly ‘who’ it is that enables hospitals to function amidst this complexity – who is behind the scenes, running the show, ensuring everyone is where they are meant to be, doing what they are meant to be doing.
Though it varies by country, in Australia, for every clinical frontline worker you do see, there is often one or more non-clinical professionals, helping run the hospital from places you don’t see.
These people are responsible for everything from switchboard operation and reception, they are biomedical technicians, patient services assistants or porters, among others. Like medical specialists, their fields are vast and various, and without them, the more than 11 million Australian hospitalisations that occur every year, would not have positive outcomes.
Behind this layer – this army of skilled workers and their clinical counterparts – is a complicated array of devices and applications that support patient care and hospital operations: from MRIs and surgical robots to reverse osmosis machines, nurse call and alert systems.
The point is, when all of these pieces are layered on top of each other, there is a level of complexity that is completely unique to hospitals, rarely, if ever seen in any one location, in any other sector.
So, in a world where many hospitals are plagued by a lack of beds; staff shortages and exhaustion are crippling them, and ultimately, healthcare can’t keep up with demand (through no fault of its own!), how does one of the most complex ecosystems of people and machines continue to do what it needs to do?
The answer is technology (no surprise there…) – but finding the right mix between operational and clinical solutions is already proving to be a challenge.
Determining the importance of clinical vs operational
As recently as the 1980s and 90s, computers were first widely introduced into Australian hospital operations. Since then, health tech has come a long way, with hospitals focusing heavily on implementation of Electronic Medical Records (EMR) over recent years.
The mobility of these solutions, their ability to put up-to-date information at the fingertips of doctors, and the ongoing advances in the technology, have meant that ultimately, hospitals are getting very good at empowering clinicians to deliver better care.
But at what cost? In 2018, it was reported Queensland Health paid more than $600 million for an integrated EMR across some of its hospitals (as part of a $1.5 billion project).
NSW started its transition to electronic records more than a decade ago, with an initial $21.7 million committed to piloting the EMR project, a further project (eMR2) completed in 2017, and more than $140 million committed in 2021/22 to unifying medical records.
Since 2011, the US Government has spent $38.4 billion on its EMR project (referred to as EHR) and by 2024, it is predicted to have spent almost $20 billion updating its hospitals – a move seen as crucial in a Covid world that will rely on electronic records and interoperability between systems.
While the dollar figure may be completely justifiable due to the absolute necessity of these platforms, the cost of focusing mainly, or in some cases, only on clinical solutions, is not just a question of money, it is a question of balance.
If so much investment is being made into clinical solutions, is there enough left in an industry so continuously short on funding, to similarly advance the operational side of hospitals?
And if there isn’t, can those hundreds of thousands of non-clinical staff keeping doing what they need to do to ensure patient care and outcomes are acceptable to families and the wider community, under increasingly challenging conditions?
Can the clinical functions run without the operational?
The balance: finding solutions that work together
In short, the answer to that pertinent question, ‘is there enough?’, seems often to be, ‘not right now’. Shortages in funding, can mean hospitals are forced to make a decision between clinical or operational solutions, or to try to reach a compromise on both.
On the bright side for hospitals that can and do invest in both clinical and operational solutions, the opportunity to go beyond EMR integration, into integration and interoperability throughout the hospital, promises to introduce new efficiencies and continue to revolutionise patient care.
While EMR directly addresses some patient data issues, hospitals are filled with distinct, yet vital systems and applications, from pager and duress systems to task and asset management. Each contains expansive data, that when combined, could create a comprehensive operational picture.
Right now, hospitals are achieving but a fraction of that picture, simply because their systems and machines haven’t been enabled to work together optimally.
Some of the right people, are getting some of the right data, some of the time.
Because of this, both operational and clinical staff who are doing different jobs, yet working towards a shared outcome, are not synchronised or organised as meticulously as they could be, and patients are missing out.
Patients linger in much-needed beds, missing out on expedited results, while doctors wait for other hospital services, such as x-ray and labs that have been completed with no notification, due to inefficiencies in process and communication.
These ineffective systems not only impact clinician time with patients, but extend stays unnecessarily, exacerbating sometimes dire capacity issues throughout the hospital, and especially in areas like the emergency department.
Interoperability and optimised communication across hospital systems, really enables both clinical and operational staff to see and know more, with more certainty, and to interact more effectively.
From the perspective of direct patient care, as an example, system interoperability means process improvement that creates a better experience and reduces frustration. It can deliver less or no unnecessary wait time for doctors, nurses or results, or for porters to find a wheelchair, an ambulance to arrive or a bed to be available.
From a hospital perspective, it builds a more capable machine that maximises the time clinicians spend in direct patient care, and optimises the use of limited resources, from simple assets like wheelchairs, to crucial and in-demand diagnostic machines and beds.
A focus purely on clinical technology solutions will have results, it will enable improvements, but alone, it is not enough.
By bringing everything together across operations and clinical, and enabling what are currently disparate systems, machines and people to communicate effectively, some of the challenges hospitals face can be significantly reduced, expenses decreased and productivity maximised.
And the good news for hospitals? Compared to the price of buying and implementing an EMR, most operational systems and platforms that bridge the gap between clinical and operations cost only a fraction of the price, and come with much less risk and complexity.
About David Paré and Olinqua
Built on powerful integration and automation platforms that enable interoperability, Olinqua brings together capabilities across task management, asset and facility management, communication and collaboration, incident management, staff and patient safety to optimise efficiency in healthcare settings.
David Paré is the Chief Technology Officer (CTO) of Olinqua, with over 20 years of experience in HealthTech. He is a strategic product and technology leader focused on building successful Digital SaaS platforms for the health industry.