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Optimizing Patient Flow at Johns Hopkins Hospital

Commentary by
Doug Brooks, Director of Finance, Department of Medicine, Johns Hopkins University
Hetal Rupani, Senior Project Analyst, Johns Hopkins School of Medicine
Murali Padmanaban, IT Manager, Financial Systems Administration, Johns Hopkins University

Optimizing Patient Flow at Johns Hopkins Hospital

Johns Hopkins Hospital wanted to serve more patients while preserving its excellent level of care. In 2012, the hospital was ranked number one in the U.S. in 16 different specialties, according to U.S. News and World Report.

Demand for Johns Hopkins Hospital’s services is strong. The hospital’s outstanding reputation means that many patients across the U.S. choose it for their medical needs. Because of its urban setting, the hospital naturally serves a large population, frequently through its adult and pediatric emergency departments (ED).

Moving patients through the ED effectively is a critical capability for the hospital. A 2010 review of ED figures indicated that 34 percent of all adult patients and more than 50 percent of pediatric patients were admitted through the ED.

A Fractured View Leaves Opportunities for Efficiency

Patient flow, particularly from the ED, was an area the hospital felt had potential to improve. Decreasing time to admittance would require a real-time view of inpatient bed supply and demand and an understanding of barriers to patient discharge across the entire hospital.

Doug Brooks, director of finance for Johns Hopkins Department of Medicine at Johns Hopkins University, notes that teams within the hospital often work independently, making it difficult to gain the necessary holistic view.

“We knew parts,” Brooks said of the view across departments. “We could check out different systems and different data sets to find that information, but it was slow.”

The Department of Medicine used six different data sources to report on patient flow. “It would take a month; it would take a week. Sometimes it would only take a day,” said Brooks. Unfortunately, even the next-day reports didn’t help teams proactively manage patient flow.

Hetal Rupani, senior project analyst at Johns Hopkins School of Medicine, describes the process of running those reports as a real challenge.

“I would be pulling my hair with Microsoft Excel, Microsoft Access, updating my report every month, running the same query again and again and troubleshooting why the query was not running,” she said.

There Has to Be a Better Way

Instead of tinkering with her existing reporting systems, Rupani wanted to get to the root of the problem.

“We were looking for a solution that could actually help us analyze our data more effectively,” said Rupani. “Instead of getting feedback from different users [and putting it into] the reporting format with all the numbers, we wanted to look at the process and fix it right then and there.”

An effective solution would have to be adopted not just by technologists and data analysts, but also by doctors, nurses, administrators, and others on the front lines.

The team knew that mobile access across multiple devices would make a big difference in user adoption of any new solution. Nurses and doctors were unlikely to carry a laptop around, but many were already using tablet devices.

“I think the ease of access and ease of carrying a small device in your hand rather than a big laptop makes a big difference,” said Rupani.

A Trusted Colleague Puts Them on the Right Path

Rupani began experimenting with Tableau Software after receiving a report from another department in the form of a packaged workbook.

She was able to download the free Tableau Reader to open the workbook and interact with the report. The experience piqued her interest. “When I got the report I wanted to know more about Tableau,” Rupani said.

Adding to her desire to learn more, the report was from an esteemed source: the central data warehousing department at Johns Hopkins. “I really respect the senior director of that department and I trust his judgment about the products he purchases,” she said.

The hospital decided to adopt Tableau Server. It has integrated Tableau Server with its custom internal portal so any user with the right credentials can access Tableau dashboards through connected devices, including tablets.

The hospital is blending several data sources for its dashboards. “We bring all of this data into a data repository,” explained Murali Padmanaban, IT manager of the financial systems administration at Johns Hopkins University. “That’s what feeds into our Tableau dashboards.”

Real Time Is the Best Time

Now users across different departments are looking at the same real-time data and making decisions based on facts rather than guesses about patient bed availability and need.

“For example, we’re able to call an emergency meeting at eleven o’clock and everyone is looking at the same data at the same time,” said Brooks. “Nobody has to prepare or publish a report. People are looking at it and we can create a plan of action at that moment.”

Anywhere Access on Users’ Preferred Devices

Because users can view and interact with Tableau visualizations on a variety of mobile devices, caregivers at Johns Hopkins are able to keep up with changes in patient flow through their tablets, devices they were already accustomed to carrying. This has made user adoption much easier for the hospital.

“Almost everyone carries a tablet nowadays, so having an app and making it accessible is just incredible; it makes it easier to access information,” said Padmanaban.

Implementing Tableau has made a difference that has been felt across the hospital. “All of the information so far has been used by everyone, from senior leadership of the hospital itself down to the shift coordinators who are responsible for finding beds for the patients,” said Brooks.

“This dashboard has brought everybody together,” he added. “Everybody is looking at the same data at the same time, and acting in a unified fashion.”

The Eyes Are the Window to the Data

The visual way information is presented in Tableau helps end users key in on important information much faster than they would if they were looking at a collection of numbers in a spreadsheet, said Padmanaban.

“What Tableau does better is visualization. If you look at Tableau, it is meant for eyes,” he said. Through visualization, data trends and outliers are easy to see.

“It’s just implicit. It’s what stands out,” Padmanaban said.

Turning Data into Stories

Converting dry numbers into dashboards and interactive visualizations that allow users to quickly see problems and trends has been a valuable aid to communication for the hospital. “To me, data is data,” said Padmanaban. “But to a front-end user, it’s completely different.”

Brooks noted that Tableau gives data power users the ability to tell the story of the data. “It gives creativity to the people that need it the most,” he said.

Great-Looking Data Makes People Look Good, Too

According to Rupani and Brooks, implementing Tableau has added a bit of sheen to their professional reputations.

“I partially owe it to Tableau for my professional growth in the organization,” said Rupani. “Tableau has helped put me in front of the senior leadership.”

Brooks agreed. “It’s really brought the Department of Medicine to the forefront of hospital leadership’s attention. We have really gained a reputation as being an innovative department.”

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