39 Playbook to improve workforce well-being and reduce inpatient length of stay (LOS) at an Urban medical center

<h3>Description</h3> The pandemic, staffing issues, increasing disease complexity and social drivers of health have contributed to major capacity and access constraints (full beds) and concerns about workforce well-being in most hospitals. UChicago Medicine launched a multi-year plan to identify barriers and sources of workforce stress causing delays in care of hospitalized patients and develop interventions that provided resources and support to our inpatient care teams with a goal of reducing Length of Stay (LOS), improving access to care, and improving clinician wellness. A team of hospital leaders, experienced clinicians, process improvement specialists, and data analysts evaluated local drivers of workforce stress leading to inpatient care delays by reviewing best practices, stakeholder meetings, and effort/impact assessments and identified three targets for intervention: 1) Ineffective communication workflows between providers, care coordinators, and patients, 2) Frequent bottlenecks in routine care processes, and 3) Limited escalation and feedback pathways for frontline staff in difficult social/clinical situations. We developed the following key interventions: 1) Development of an expert physician leader team to identify and resolve real-time clinical bottlenecks; 2) Establishing a plan to co-locate patients and workspaces by clinical service to improve communication through multi-disciplinary rounds; 3) redesign of Care Coordination infrastructure; 4) creating a complex case review process to improve the coordination of care in these cases that often have extended LOS. The implementation of these strategies over 3 years (see figure 1) has resulted in significant improvement in Vizient data with LOS Index decreasing from 1.15 to 0.87 and improvement from the 60th to the 90th percentile of peers. Clinical teams report enhanced sense of team-based care, reduced rounding time, support to solve complex issues, and more interactions with patients. Targeting specific sources of stress and barriers faced by our clinical teams allowed us to create a “win-win” intervention that supported workforce well-being and reduced LOS.