The Los Angeles County Department of Health Services (DHS) runs the nation’s second-largest municipal health system, annually caring for over 600,000 patients at 19 health centers and four hospitals covering 4,700 square miles. Pressured by broader market forces to both enhance patient care and reduce spending, DHS management is focused on setting up a Command Center to help advance its vision for an integrated system of providers, clinics, hospitals and community, university and health plan partners. For the first time ever, DHS will replace its current hospital-focused approach with one based on the systematic coordination of services.
DHS has strengthened its primary care and preventive medicine services, but it still loses significant funds to out-of-network payments, or to those patients who exit the DHS network. Therefore, an area of focus for greater coordination would be the “repatriation” of those patients by improving communication, collaboration and utilization management of beds and transfer vehicles at a systems level. As a safety-net care provider, there is no financial disincentive for DHS patients to go out of network. Thus, the task at hand is to create an incentive to stay in the network based on the reliability and quality of care. Despite its best intentions, DHS’s current system can result in a lack of coordination with very real consequences for the patient. Each year the cost to the DHS healthcare system related to the lack of coordination is millions of dollars. While cutting network costs is a win for DHS, the greatest win of all would be providing patients with the care they need when they need it.
The plan behind a centralized coordinating group is already underway. With the leadership of the DHS Director of System Operation and Support Services, DHS has collaborated with the UCLA Anderson School of Business MBA program, enlisting a team to conduct an operational assessment and develop process maps (current and future state). The team, through site visits, will complete a comparative analysis of hospital command centers and prioritized recommendations for process improvement, including a feasibility assessment and initial project plan for a DHS Command Center.
Ultimately, a new Command Center would focus on data collection to drive actionable results and improve patient care, eventually evolving to include more predictive forms of data management. DHS believes a new Command Center will have benefits that go beyond patient repatriation, affecting communication and coordination at all operational levels. Moreover, the Command Center will help inculcate a collective sense of pride in DHS as a whole that is currently defined by allegiance to individual hospitals. Finally, a successful DHS Command Center could provide a vitally needed model for efficient and effective health care that serves highly diverse, urban populations. To support this work, Los Angeles County will partner with FUSE Corps to host an executive-level fellow for one year who will assess the outcomes of the UCLA study, codify an initial set of recommendations, manage internal stakeholder buy-in of those recommendations, implement pilot systems and set the stage for full deployment.
Project Summary & Potential deliverables
The following provides a general overview of the proposed fellowship project. This project summary and the potential deliverables that follow will be collaboratively revisited by the host agency, the fellow, and FUSE staff during the first few months of the fellowship, after which a revised scope of work will be developed and agreed upon by the FUSE Fellow and the host agency.
Starting in April, 2019 it is proposed the FUSE Fellow will conduct a current state assessment of DHS, zeroing in on those areas where a lack of internal coordination is most costly, both for patients and the agency itself. Next, the fellow will review the recommendations in the Command Center study by the UCLA team. An internal stakeholder engagement effort will follow in which the fellow will present a plan to install a Command Center, taking in all comments and suggestions from chief medical officers and relevant teams at each facility. After a period of reassessment, in which the best suggestions are incorporated into the plan, a second round of engagement will follow with the goal of achieving consensus on the main functions and goals of the Command Center, starting with implementation of the initial pilot applications. With the pilot programs up and running effectively, the year will conclude with a plan for full deployment of Command Center functions and succession planning to ensure team success after the fellowship year ends.
The fellow’s success in the endeavor will be evaluated based on several factors. Well-developed operations management skills will be necessary from the get-go, both to undertake a current state assessment of DHS functions and to assess the recommendations by the UCLA group. Those skills will include a command of information technology tools in the area of data management, with special attention given to workflow issues to make sure data can be put to use in real-time. Combined with significant operations management experience, the fellow will employ strong communications skills to clearly and persuasively present recommendations to internal stakeholders. Working towards a consensus on the functions of the Command Center might entail resistance, which the fellow will address with the necessary emotional intelligence to bridge differences. The final third of the year will involve implementation of pilot programs, monitoring their progress and preparing a plan for wider deployment along with succession planning to establish continuity beyond the fellowship year.
- Conduct a landscape analysis and assess study recommendations: Get an overview of DHS functions, giving particular attention to those areas in which intra-agency coordination is falling short. Also, review the Command Center study by the UCLA group. Take stock of recommendations made by the UCLA study, select and amend, if necessary, those that will form part of a proposal for a new Command Center.
- Develop proposal and initiate stakeholder engagement: Conduct analysis, develop a proposal and present it to internal stakeholders. Areas of focus and analysis may include:
- Establishing centralized bed capacity and resource management systems to improve coordination and support patient movement.
- Establishing DHS patient transfer guidelines for the inpatient and outpatient settings.
- Incorporating indicators of success including percentage of available revenue captured, average cost savings with repatriation, average length of stay and wait time.
- Collection of data around patient flow, financial and operational metrics.
- Generate stakeholder consensus and buy–in: Maintain close communication with chief medical officers and relevant teams at each facility to develop a consensus around the functions and goals of the Command Center.
- Implement pilot program, plan full deployment and conduct succession planning: With consensus formed around the Command Center and initial programs, undertake implementation and monitor progress, adapting as needed to address challenges. Prepare plan for full deployment of Hub functions and conduct succession planning to ensure continued team success after the fellowship year ends.
- Phillips Franks, Director, System Operations, Los Angeles County Department of Health Services
- Charmaine Dorsey, Director, Patient and Social Support Services, Los Angeles County Department of Health Services
- At least 15 years of professional experience in operations and data management and combined with a strong background in consulting, involving client engagement and presentation.
- Superior critical thinking and analytical skills.
- Ability to synthesize complex information into clear and concise recommendations.
- Ability to relate to a wide variety of diverse audiences with strong emotional intelligence and empathy.
- Excellent stakeholder engagement skills and the ability to use facilitative leadership techniques to coordinate stakeholder activities.
- Self-motivated, goal-oriented, entrepreneurial leader who can also be an independent worker.
- Persistent in obtaining information and creatively resourceful in identifying solutions to complex problems.
- Ability to create direction and movement within bureaucratic environments.
- Exceptional written and verbal communication skills with an ease in public presentations.
- Understands the need for solutions to support all people in a community regardless of race, religion, gender, immigration status, or ethnicity.