Swedish Medical Center Case Study

Swedish Medical Center Case Study

Background- Swedish Medical Center is a large medical center located in the Seattle and surrounding suburbs in Washington State. It was founded in 1910 and has merged and acquired other properties, most recently Stevens Hospital in Edmonds, Washington, in 2010. The hospital continually ranks in the top for a number of specialties, including cancer, geriatrics, and orthopedics. Swedish continually outperforms other Puget Sound Institutions in degree of customer satisfaction, and ranks 10 points above the national average in terms of patient satisfaction (U.S.News, 2011). Swedish has nine campuses and several clinics in the Puget Sound area. It has over 1,200 licensed beds, almost 7,000 employees, and 2,300 licensed physicians in every medical and surgical specialty. In 2009 there were almost 110,000 emergency room admissions, 41,000 inpatient admissions, and almost 33,000 surgeries performed. Due to its national prominence, Swedish holds as many as 600 clinical trials (federal and commercial) at any one time. Since Swedish is a not-for-profit medical center, besides focusing on the community, it donates about $15 million per annum in direct charity care to the area. Swedish income was $1.4 billion at the end of 2009, but remains needful of the Swedish Foundation funding to continue to commit to solid medical excellent ((Swedish Medical Center, 2011).

Process-based capabilities- Healthcare organizations now face increasing pressure to improve their operations, provide evidence of their continued quality, and the efficiency of the organization. For the modern organization, this means that managers who have traditionally focused on the quality of care now must now change paradigms in mid-stream and review the overall management practice for the sake of effectiveness, patient safety, and even cutting edge techniques (Kujala & Lillrank, 2006). In fact, this is so critical that reports from the Institute of Medicine suggest that almost 60 per cent of medical errors related to hospital deaths in the United States could have been prevented with a proper safety protocol and change of procedure (Institute of Medicine, 2000).

For Swedish, process improvement became part of the overall strategic planning process as a tool used to solve local problems in the 1990s. Swedish was in an expansion mode, and the concept of process orientation was not just a management tool but more to identify problems in patient flow, resource management, and staff efficiencies. This process has evolved over the years to become a more robust management system that uses the Balanced Scorecard approach, allowing strategic planning to move from an economic discourse to a more balanced approach that used the patient, process and learning perspectives, staff satisfaction, and community relations as a model for continued improvement. In the same vein, greater emphasis was placed on the ability for Swedish managers at all levels to understand, map, and continually improve the important parts of care management within the organization. For Swedish, A Balanced Scorecard approach is often seen as one of the key tools that translate strategy into performance. . The balanced scorecard model is a clear direction outlining what the organization should measure to balance the financial output. The scorecard retains financial measurement as a summary of their business performance. Moreover, the scorecard will highlight an integrated set of measurement that will link customers, processes, resources, and performance to long-term financial success. The balanced scorecard is a tool that provides the company the framework that translates vision and strategy into actionable tasks. The scorecard is a set of performance measures allowing management a dashboard view of their business. These performance measurements are used to aid the company in setting goals and manage the business's strategic plan. The balanced scorecard model will support the strategic plan and implementation by uniting all actions of an organization into a common understanding of the goal; it will provide feedback for both internal processes and the external outcome to improve strategic performances and results continuously (Langabeer & Napiewocki, 2000; Stevens, 2006).

Resources- Swedish has some of the best medical minds in the entire country, as well as a staff of over 1,500 physicians and 4,000 employees. Recent human resource figures indicate that within the non-medical field there are about 25 per cent of the executives have an MBA or are currently working on an advanced degree. Fifty per cent of executives have at least a Bachelor's, and most have hours towards an advanced degree (Crosby, 2011). Additionally, because of its national attention, Swedish has a considerable amount of private and Federal grant money, with much of the private money being used to fund advanced strategic planning research and development. In addition to general medical and surgical care, Swedish is known as a regional referral center, providing specialized treatment in areas such as cardiovascular care, cancer care, neuroscience, orthopedics, high-risk obstetrics, pediatric specialties, organ transplantation and clinical research (www.swedishcare.org).

Technologies -- Being at the forefront of the technological revolution in health care has been a part of Swedish's mission from the beginning. The half-life of technology is such that scientific and technological advances drive a number of business processes at all stages. There are demographic modifiers to this as well -- the number of people over 65 is expected to double by 2030, taxing the healthcare technology paradigm even more. Many believe this is directly in relation to the improvement in medical technology. One of the fortunate factors for Swedish, however, is their proximity to Redmond, Washington-based Microsoft. Microsoft worked with Swedish over the years to develop Amalga -- a database management system that allows disparate data (patient, billing, medication, tests, surgery, office visits, population and resource management) to be stored, accessed and used as a strategic tool across multiple facilities (Tu, 2011). Swedish president and CEO Rod Hochman, M.D. noted, "Healthcare reform requires health systems to do more with less. Amalga is a key technology enabler that will allow us to efficiently combine data stored in disparate IT systems across multiple facilities and use it to uncover opportunities to improve performance and the quality of patient care across the care continuum" (Microsoft News Ceter, 2011). Amalga addresses a common and critical challenge of healthcare providers -- integrating vast amounts of clinical, administrative and financial information that flows in and out of disparate information systems, and tailoring that information for use by physicians, analysts, laboratory technicians, nurses and administrators. Amalga takes advantage of health enterprises' investments in existing health IT solutions, making it possible for the entire organization to gain quick access to data and turn that information into critical knowledge that facilitates better decision-making and improved patient outcomes (MS News Center). In addition, Swedish remains committed to cutting edge new technologies in imaging, cancer care, osteopathic medicine, neurology and of national importance, Hepatitis C and liver disease (Swedish Medical Center, 2011).

Key tactical activities- Tactically, Swedish is set up to provide a broad range of programs that support strategic direction. At present, they have over one hundred medical services that are community based. These include Addiction Recovery, a major institute on Breast Cancer, Childbirth Services and Education, Endoscopy, OB/GYN specialists, Pediatric Neuroscience, Wound Healing and Wellness Works. Each is designed to help fit the specific needs of the Puget Sound Community, as well as a key magnet area for the Pacific NW and especially patients who need to fly in from Alaska. The primary tactical activities for Swedish are:

Cancer Institute -- The Swedish Cancer Institute has been open since 1932 and is a collaborative, multidisciplinary service that focuses on the patient, not the disease. The major difference between Swedish and other hospitals is that besides advanced and aggressive medical care, they offer a wide range of complementary treatments and services designed to work with the holistic side of patient care -- emotional, psychological and spiritual.

Emergency Services -- ER services are available as first line tactical medical care at all seven locations. They use sophisticated technology and patient information and have teams of experts in virtually all specialties. Swedish Emergency Services is dedicated to all patients who need care, regardless of their ability to pay.

Home Care - Home Health Care for people recovering from illness, accidents or surgeries, or those living with a chronic health condition. Hospice and palliative care, which focuses on comfort and quality of life for patients with a life-limiting illness. Infusion Treatments, such as nutrition, antibiotics, fluids and chemotherapy. Telephone access to a registered nurse 24 hours a day, seven days a week

Neuroscience Center -- Besides top-notch neuroscience care, Swedish Neuroscience Institute offers access of its specialists through TeleHealth, programs that use telemedicine computer technology to link Swedish experts to clinics, hospital and emergency department in communities throughout Washington State.

Pediatric Specialty Care -- The Pediatric Care units service about 20,000 families yearly with about 2,500 procedures. Swedish is at the forefront of tactical applications in pediatric epilepsy, infectious disease, cardiology, and most recently, sports medicine.

Surgical Services -- 31,000 surgeries per annum including the latest surgical equipment using robot-assisted surgery and minimally invasive techniques (laser, endoscopy, etc.). Besides serving the Puget Sound, a number of Swedish surgeons accept patients from all over the world, based on need sand specialty.

Women's Health -- Focused on prevention and care for breast health, mammography, etc.

Transplant Programs - Swedish is one of seven kidney transplant centers and one of just four liver transplant centers serving the entire Pacific Northwest. The Organ Transplant Program at Swedish is at the forefront of new advances in transplantation surgery, including pancreas transplants and transplants between unrelated living organ donors and recipients (Swedish Medical Center, 2011).

Service design, operational activities, strategic decisions- Swedish is nothing but on the move -- strategically and tactically. In October, 2011, Swedish opened a new full-care facility with a 550,000 square foot campus in the city of Issaquah, southeast of Seattle city proper. This new facility was designed to be an entirely new hospital experience. Some of the operational innovations include a new Childbirth Center with eight new Labor/Delivery/Recovery rooms that include sleeping areas for partners, iPod access and a hotel room service-style dining program; a new surgical inpatient unit that have pull out couches to accommodate families; and new inpatient care units that are designed to feel like a hotel/resort. In addition, the hospital was designed to meet energy-efficient strategies and sustainability with heat-recovery options, green roofs, and energy saving utilities, and a plan that allows a 60 per cent savings on energy as compared to hospitals of similar size without the new features. "From the beginning, we were confident this new hospital could be a model for the latest innovations in health-care delivery," said Dr. John Milne, vice president for medical affairs at Swedish/Issaquah and an emergency medicine physician. "Our goals were to combine advanced technologies, reduced energy consumption and lower operating costs, while delivering the best health-care services available. The new facility is an innovative example of how this can be done" (Swedish News, 2011).

Quality/variety dimensions of service- Also in Fall of 2011, Swedish entered into an affiliate partnership with Providence Health Services of Seattle to collaborate to better deliver health care to the region. This new agreement will form a new, not-for-profit health-care system that will include all of Swedish's operations in King, Snohomish and Kittitas Counties and all of Providence's operations in King, Snohomish, Thurston and Lewis Counties. Providence will keep the Providence name and its Catholic identity, while Swedish will keep the Swedish name and remain a non-religious organization. "Through this unique operating arrangement, we are able to preserve each organization's heritage and local operations, while providing a better and more affordable level of patient care across both organizations," said John Koster, M.D., Providence Health & Services president and CEO. "Health care in this country is at a crossroads. Having served the community for more than a century, we believe it is our responsibility to lead the region through these challenging times. By sharing the resources, best practices and expertise of two great institutions, we can address the nation's health-care crisis at a local level and create one of the best health-care systems in the country," said Rod Hochman of Swedish (Swedish News, 2011).

Operations management performance objectives- An earlier merger with Steven's Hospital in Edmonds, along with the new location in Issaquah and the affiliation with Providence, allows Swedish to share a common electronic health record for patients almost Puget Sound Wide. By sharing these resources, the operations directive can make it easier to access health care across all of Swedish's services. In addition to growing the patient base and providing new and exemplary standards of care, operationally Providence and Swedish are poised to increase what is already an over $60 million free and discounted care benefit to the community, as well as $205 million in agreed upon community service programs.

While the Puget Sound region has recovered somewhat from the economic downturn of the 2006-2008 years, the economic challenges facing the State are such that innovative operational management decisions and reaching out for more community partnerships are necessary in order for Swedish to survive. There are certain trends that are part of a national healthcare paradigm that operationally, Swedish will need to address. More patients needing treatment without insurance, coupled with an aging population and State budget shortfalls, and a lessening of philanthropic giving all combine to place the squeeze on healthcare budgets. Operationally, Swedish was facing a $19 million dollar budget gap in September, 2011. This resulted in a 3 per cent, or about 300 jobs, being cut or funding for future positions cancelled. Fortunately, the operations goals are such that most of these employees will be redeployed, but the budget shortfall does highlight that, "Despite our best efforts, it is not possible to shield Swedish from the seismic shift that is altering the national economy. To protect our mission and ability to continue meeting the health-care needs of this region, our only option is to face the crisis head on and adjust our operations and cost structure accordingly," said Dr. Hochman. "Swedish has done a lot to reduce expenses already, but the rapidly changing economic climate is requiring us to do more. We believe the next step is a system-wide restructure that will involve a difficult but necessary workforce reduction" (Swedish News, 2011)