Innovation and management control for healthier hospital governance with SAS® Activity-Based Management
In Genoa, Italy, the people say "a good reputation is worth more than a million." That sentiment is reflected in the philosophy at San Martino Regional Hospital, a leading provider of comprehensive health-care services for metropolitan Genoa and Liguria.
Since 1422, San Martino Regional Hospital has drawn patients from all over Italy and around the world. A prominent center of excellence for cardiac and neurologic surgery and care, hematology, transplants, and emergency care, the hospital averages 80,000 inpatient admissions, 8 million outpatient cases, and 100,000 emergency-ward visits a year.
So it's no surprise that managing clinical risk is a critical component of San Martino's mission. Without reliable risk models for each department and operational unit, the hospital corporation would see enormous increases in insurance costs.
Extensive process redesign reduces the risk and cost of errors related to the preparation and delivery of care and prescription medications. IT systems, therefore, represent a point of strength for the company, and the choice of advanced technologies has positioned the hospital as a beacon of excellence in health care.
In the Q&A that follows, Francesco Copello, the hospital corporation's Health Care Director and a former physician and Management Control Director at the hospital, explains how San Martino uses IT to control costs and ensure an even greater quality of patient care.
How does one reduce risk in an enterprise of this size?
Are you referring to management control?
All this before the creation of the role – what happened after?
Previously, we implemented reporting systems and adopted a balanced scorecard. This was followed by cost analysis. Initially, on the basis of the current system for the classification of admissions based on Diagnostic Related Groups (DRGs), we analyzed costs for a standard admission.
But we lacked a good analysis of costs relating to individual processes, from hospitalization to drugs to diagnosis. Day admissions, outpatient care and emergency care remained uncovered and lacked in-depth analyses. It was urgent, therefore, to get specific data on the costs of individual activities, products, and drugs. In essence, if the cost of an appendectomy was evident, we wanted to break down those costs into individual processes.
In which sectors do you want to improve knowledge of costs?
How does activity monitoring figure into this picture?
In this way, each manager can assess how we consume our available resources. Currently, the information and analyses produced through SAS are published on our intranet to the executive board, department directors and directors of the operational units. We can drill down to granular detail – down to individual aspirin tablets.
Is there a system for classifying admissions?
Since DRGs didn't perfectly respond to our needs, we were motivated to improve. We rationalized expenses and standardized behaviors in each operational unit. We also did all of this with SAS, because it perfectly supports clinical management processes.
What are the cornerstones of the activity that SAS supports?
In particular, we recognize that the most dangerous risks are inherent to routine, daily activities. We have procedures for risk assessment and incident reporting: the first assesses activities to identify possible risks. The second defines the event at the moment it occurs and provides possible interventions.
Another key point is our project to determine how much it costs per hospital bed for a single dose of a drug. Drugs are barcoded and tracked along their entire journey from the cabinet to the intelligent cart all the way to the patient.
Have you quantified the benefits?
In practice, we have improved occupancy rates, which today is about 85 percent, keeping the standards unaltered, and reduced the average stay from 12 days to 10.
The results illustrated in this article are specific to the particular situations, business models, data input, and computing environments described herein. Each SAS customer’s experience is unique based on business and technical variables and all statements must be considered non-typical. Actual savings, results, and performance characteristics will vary depending on individual customer configurations and conditions. SAS does not guarantee or represent that every customer will achieve similar results. The only warranties for SAS products and services are those that are set forth in the express warranty statements in the written agreement for such products and services. Nothing herein should be construed as constituting an additional warranty. Customers have shared their successes with SAS as part of an agreed-upon contractual exchange or project success summarization following a successful implementation of SAS software. Brand and product names are trademarks of their respective companies.
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San Martino Regional Hospital
Support management control by assessing the individual cost of each activity that occurs in departments throughout the hospital
SAS Activity-Based Management
Occupancy rate improved to 85 percent, average length of stay down from 12 days to 10
“We use SAS on a daily basis to carry out analyses that verify department activities and establish budgets with great results. One medical department has saved €1 million in one year.”
Health Care Director
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