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ED DESIGN: 8 to 12 exam rooms in independent freestanding emergency departments

Architect Jon Huddy, an expert in emergency department planning and design, has written a second edition of his landmark handbook on ED design, which has just been released by the American College of Emergency Physicians.  Here are some of his observations about sizing of emergency departments.

  • 8 to 12 exam rooms is the “sweet spot” for independent freestanding emergency departments
  • Freestanding emergency departments that are part of hospitals tend to have more exam rooms than those that are independent
  • 1,300 to 1,500 patients/room/year has been a typical planning metric for main hospital EDs
  • 1,800 patients/room/year has been a planning metric for main hospital EDs with lower acuity patients and shorter length of stay
  • 1,800 to 2,200 patients/room/year for a new freestanding emergency department — that typically starts operation with lower acuity patients and ramps up to those with more complex, time-consuming problems over time
  • 1,700 to 1,900 patients/room/year for established freestanding emergency departments – he advises clients to go with an average of 1,800 as a starting point for planning discusisons
  • 2,200 to 2,400 patients/room/year might work for urgent care centers

Source: Huddy, J. (2016, Apr.). Emergency department design: A practical guide to planning for the future (2nd ed., pp. 264-265). Dallas: American College of Emergency Physicians. Click here: http://bookstore.acep.org/emergency-department-design-a-practical-guide-to-planning-for-the-future-2nd-ed-516615  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

M&As: How to structure a successful acquisition

Recent peak years for the value of mergers and acquisitions have included 1999, which was surpassed in 2007, which was surpassed in 2015.  The author, a professor at the University of Toronto, states that the vast majority – from 70 percent to 90 percent – of acquisitions are failures.  He actually uses the term “abysmal failures.”  In order to make an acquisition more likely to succeed, Professor Martin maintains that the acquirer should analyze what it is that they have to bring to the entity being acquired.  These factors typically include:

  • Growth capital
  • Managerial oversight
  • Transfer of valuable skills
  • Sharing of valuable capabilities

Analysis of a potential acquisition through a GIVING lens – what can we give to the entity being acquired – is a strong strategic logic and more likely to determine value that can be derived from a deal.

Source: Martin, R.L. (2016, June). M&A: The one thing you need to get right. Harvard Business Review, 94(6), 43-48.  Click here: https://hbr.org/2016/06/ma-the-one-thing-you-need-to-get-right Posted by AHA Resource Center (312) 422-2050, rc@aha.org




TEAMWORK: How to build a successful team

Seminal work in the field of team effectiveness was done in the 1970s by organizational behavior expert J. Richard Hackman – and the authors of this article have validated and expanded this pioneering research.  They discuss conditions that contribute to the success of what they call “4-D teams” – those that are diverse, dispersed, digital, and dynamic – which today increasingly include people based in different locations, including different countries.  The factors that were identified decades ago as enablers include:

  • Compelling direction – a goal that is challenging enough to be inspiring, but not so challenging as to be dispiriting
  • Strong structure – a minimum number of people who together have the requisite skills
  • Supportive context – having the needed resources available

The new knowledge is that a fourth enabler is needed:

  • Shared mindset – common identity and understanding

The authors include a short assessment, “Does Your Team Measure Up,” that can be used periodically to take the temperature of the team.

Source: Haas, M., and Mortensen, M. (2016, June). The secrets of great teamwork: Collaboration has become more complex, but success still depends on the fundamentals. Harvard Business Review, 94(6), 71-76.  Click here: https://hbr.org/2016/06/the-secrets-of-great-teamwork  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

ICU: Wearing gowns and gloves for all ICU patients studied

Caregivers entering patient rooms in intensive care units typically use contact precautions – putting on gowns and gloves – when the patient is known to have antibiotic-resistant bacteria.  This study was a randomized trial of universal gown and glove use for adult patients in intensive care units in 2012.  Data on 1800 patients at different hospitals were studied.  The authors comment that:

  • “The observation that universal glove and gown use may result in fewer adverse events was unanticipated.  Universal glove and gown use could potentially have led to a decrease in HAIs [healthcare-associated infections] by serving as a barrier to acquiring new bacteria both through physical use of gloves and gowns as well as fewer HCW [health care worker] visits and better hand hygiene.”

Source: Croft, L.D., Harris, A.D., Pineles, L., and others. (2015, Aug. 15). The effect of universal glove and gown use on adverse events in intensive care unit patients. Clinical Infectious Diseases, 61(4), 545-553.  Click here for full text: cid.oxfordjournals.org/content/61/4/545.full.pdf  Posted by AHA Resource Center (312) 422-2003, rc@aha.org


Milliman Medical Index: Average Family Spends $25,000 a Year on Health Care

The new 2016 Milliman Medical Index reports the lowest annual increase rate in health care costs since it started tracking them 15 years ago — it’s now down to 4.7%. That said, health care expenses for a typical American family of four now top $25,000 a year, triple the amount from 15 years earlier in 2001. The fastest growing health care expenditure over the past year was for prescription drugs that account for 17% of all family health care costs.

The $25,826 average annual family medical costs are allocated into these three categories:

  1. Employer subsidy to health plan: $14,793 [57%]
  2. Employee contribution to health plan: $6,717 [26%]
  3. Employee out-of-pocket: $4,316 [17%]

Source: Girod C and others. 2016 Milliman medical index. Milliman, 2016. http://www.milliman.com/uploadedFiles/insight/Periodicals/mmi/2016-milliman-medical-index.pdf

Posted by AHA Resource Center (312) 422-2050, rc@aha.org

WORKAHOLICS: Why the “ideal worker” may not be

Sociologists define the “ideal worker” as one who is completely devoted to the job and who is available all the time.  In organizations that value this kind of worker, employees typically develop one of three strategies to cope with the pressure, by:

  • Accepting – and allowing other facets of their lives to wither
  • Passing – and devoting time to other pursuits but under the radar
  • Revealing – and being completely above-board about their outside interests, even to the point of negotiating for formal considerations related to hours and time off

The authors report on their findings based on cross-industry interviews with hundreds of professionals as far as the pervasiveness of the pressure to be an ideal worker and the coping strategies employed.  They then describe ways that organizations can focus more on the quality of work produced than on the sheer hours spent at the office.

Source: Reid, E., and Ramarajan, L. (2016, June). Managing the high intensity workplace. Harvard Business Review, 94(6), 84-90.  Click here: https://hbr.org/2016/06/managing-the-high-intensity-workplace  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

BENCHMARKS: Mortality rate after lung cancer surgery

The Society of Thoracic Surgeons maintains a General Thoracic Surgery Database (GTSD), which keeps track of patients through the first 30 days after surgery.  In this study of records for over 26,000 patients, a link was made with Medicare data for patients aged 65 and older to see what happened over a longer period – 90 days.  The most common lung cancer resection surgery was found to be the lobectomy, which was performed for about two-thirds of the patients who were studied.  The next most common procedure was a wedge resection, which was performed in nearly 20 percent of patients studied.  These were the mortality rates found:

Surgical Mortality for the Lobectomy Cancer Surgery

  • 2.4 percent operative mortality
  • 4.3 percent mortality within 90 days of surgery

The cancer surgery procedure that was found to have the highest mortality at 90 days was pneumonectomy – at nearly 16 percent.  Experts who commented on this study noted the value of having data further out than 30 days, the challenge of having linked the GTSD with the Medicare data, and the fact that these outcomes represent data from the best surgeons at the best centers in the world.

Source: Fernandez, F.G., and others. (2016). Longitudinal follow-up of lung cancer resection from the Society of Thoracic Surgeons General Thoracic Surgery database in patients 65 years and older. Annals of Thoracic Surgery, 101, 2067-2072. Click here: http://www.annalsthoracicsurgery.org/article/S0003-4975%2816%2930136-9/pdf   Posted by AHA Resource Center (312) 422-2050, rc@aha.org


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