Hospital readmission is a recent epidemic in the U.S. healthcare system, a problem too big to fix without using new and creative solutions that “THINQ” outside of the box. A new program at UCLA called THINQ uses disciplines from various fields such as business and engineering to implement innovative methods to improve the healthcare workflow at Ronald Reagan Medical Center. THINQ aims to make the hospital more efficient and effective in delivering quality patient care.
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BHARIL: When we think about medicine what comes to mind? Usually a doctor in a white coat right? But that’s only a small piece in the big puzzle that makes up healthcare. Healthcare is an ever evolving field facing new challenges such as high costs, impersonal care, and increasing patient dissatisfaction; Finding the solution to these problems is no small task and might require some “THINQing”, outside of the box.
THINQ, is a new program at UCLA that was co-founded in May 2014 by Dr. Nasim Afsarmanesh, the Executive Director of Quality and Safety for the Department of Medicine at Ronald Reagan and Aram Namavar, a graduate of UCLA and a current medical student at Loyola University of Chicago.The program aims to use interdisciplinary approaches to find new ways to address medicine’s biggest problems.
NAMAVAR: One of the main reasons we founded the program was to radically shape care delivery and something that was very important to me that I noticed within UCLA, as well as nationally was that there were not too many programs at the undergraduate level to allow their students to get meaningful experience in the hospital in an interdisciplinary setting.
Something we try to encourage is having our students go out there on the floor and be eyes and ears for the patient so they can identify some of these lapses in the healthcare system.
BHARIL: What’s unique about THINQ is the way it brings together students from all walks of life such as Economics, Political Science, Statistics and Engineering to learn and collaborate with each other in order to come up with new effective ways to reform health care.
The program gives students clinical experience, patient interaction and also hosts collaborative sessions called THINQ tanks, where students can come together and brainstorm intervention ideas.
NAMAVAR: With the changing landscape of healthcare it’s becoming increasingly interdisciplinary where the doctor is not the sole person in charge of care of the patients it’s a team you have your case management, social workers, nursing staff and other allied healthcare professionals.
BHARIL: By using this interdisciplinary lense, THINQ focuses on applying something called lean methodology to medicine, an organizational method that spun out of Toyota.
NAMAVAR: Lean has been around awhile in the business industry..Toyota developed this system based on lean methodology to change their culture which allowed them to reduce waste, synchronize workflow, and most importantly max value for the customer. So after implementation of this lean thinking they were able to reduce costs and improve the quality of their produce being produced.
BHARIL: In essence, lean methodology is a way of streamlining a process and when applied to medicine, it means finding more efficient ways to improve quality care. This method has only recently been used in the healthcare system, and when used, it’s mostly to improve wait times. UCLA, along with a few other institutions, is one of the first to start using this method to improve clinical operations such as reducing blood infection rates and hospital readmission rates.
Specifically, hospital readmission is the process in which a patient is discharged from a hospital but come back and get “readmitted” within 30 days. This leads to increased costs for the healthcare system as there are already a finite amount of resources available to treat patients. In this case cost can mean anything from time, money or health. UCLA has made readmission it’s top priority because 20% of its general medicine patient population is readmitted within 30 days. And according to the New England Journal of Medicine, on average 34% are readmitted in 90 days across the nation.
NAMAVAR: And the cost for those readmissions is 18 billion, b dollars.
BHARIL: Reasons for readmission vary from hospital to hospital. Specifically at UCLA, some causes include patients missing required follow up appointments after being discharge and the varying quality of skilled nursing.
NAMAVAR: For example, this past year I was in a meeting and one of the patients was readmitted because one of the nurse could not but a central line in which is a very simple procedure…and UCLA was penalized for that readmission.
BHARIL: THINQ has many projects that aim to lower hospital readmission rates at UCLA some including the enhanced transition initiative which focuses on the issue of patients feeling unprepared or discontent when they leave the hospital. THINQ made a video and a checklist on discharged preparedness and found that with these interventions patients felt more emotionally and physically prepared to leave the hospital.
Another project being implemented is called decisional conflict which examines how the certainty of a patient’s decision making affects readmission rates. THINQ has found that patients who are less confident in their decision making, or scored positive on their tests, are more likely to be readmitted.
NAMAVAR: The patients that had tested positive for our decisional conflict were more likely to seek the emergency department post hospitalization care compared to those that were not conflicted.
BHARIL: By seeking out the emergency department instead of a primary physician or specialist, patients are driving up not only readmission rates but also costs. This projects works on educating patients on what resources and options are open to patients after leaving the hospital.
Students who work on THINQ project such as these, such as Lushin Huey a graduated alumni of UCLA, believe they have gained valuable experiences from the program.
HUEY: I am a project manager of this specific project called patient centered readmissions. It’s a clinical project so as a project manager I would be managing the workflow as well as looking at the data and how we can improve the project itself.
BHARIL: These experiences have influenced student’s perception and understanding of issues prevalent in the healthcare field today. For example, Jae Kim a 3rd year Human Biology and Society major realized the medical system isn’t perfect.
KIM: I realized what a significant gap there is in patient knowledge or in general anyone’s knowledge about their resources for getting medical attention and how the healthcare system in general can be more efficient.
BHARIL: For Lushin, her experience enhanced her understanding of healthcare.
HUEY: I never realized it was so hard to do things in the healthcare system. When I was younger you always think oh, a doctor just goes in and fixes the person and they leave all happy but no I’ve realized that there are a lot flaws in the healthcare system.
We need different modes of thinking. I really think having different types of people can bring new things to the table and generate bigger and better ideas. A hospital in itself isn’t run by scientist, or run by doctors. They’re run by people and we are trying to help people. People need different things sometimes.
BHARIL: Healthcare is a team comprised of different people whose common goal is to better the patient experience and THINQ provides a way for students to experience what the field of medicine is and will be in the future. With bigger and badder problems popping up it seems that “THINQing” out of the box might be the only way to tackle these issues head on.
For the Daily Bruin, this is Sarika Bharil.