What Do We Need to Succeed?

Transforming health care services is a year-over-year campaign. For those on the front lines, resources are dwindling and often fewer people are being asked to do more as a result of financial pressures, mergers, and acquisitions.

David C. Capone
CEO & Founder
DCCS Consulting

2018 looks to be another tough year as health systems find geographic limits to growing market share, wages and benefits continue to rise, and operating margins draw downward.   Most will have to adjust labor to maintain financial stability running the risk of further stressing already exhausted management teams to do more with less.

The challenge is to lower operating costs and perform at a higher level.
To succeed you will need a trusted strategic partner that can reinforce the management team by providing new tools, expertise, and assist with delivering important results, as needed.

At DCCS, we have been assisting our clients to add management bandwidth and expertise since our founding.

The success of DCCS is anchored in its design:

  • DCCS works with experienced healthcare executives in leadership and consulting positions.
  • DCCS has a national network of strategic partners and independent specialists that can be enlisted to address any health system related issue.

The value to our clients is that they have a trusted experienced team of healthcare advisors in DCCS, with deep expert resources, who can create flexible options to support the success of their team.

Our experience has proven that a little additional advisory support at the right time can build confidence, trust, and produce breakthrough results.

To learn more about DCCS Services contact us: 

David C. Capone
CEO & Founder
(302) 299-7627

Debbie Linnes
Partner & COO
(814) 777-6179

Are Your Patients Waiting?

Strategies To Improve Emergency Department Patient Flow

By Scott Dillon, VP DCCS Hospital-Based Physician Services

It is often said that the Emergency Department is the Front Door of the Hospital.  The timeliness in which patients receive care and the quality of care they receive in the Emergency Department can impact their overall perception of the hospital. Emergency Department operations are complex and require experienced expertise to guide you in your movement to best practice.

DCCS is focused on Emergency Department Performance Improvement.
Essential patient flow information is readily available in today’s hospitals. When this information is available to both ED Physicians and Hospitalists, and they share incentives to reduce admission times and improve PQRS performance, overall patient flow and satisfaction improve. DCCS helps organizations aggregate and analyze their data and make meaningful improvements in quality, efficiency, outcomes and financial performance.

Comprehensive ED Assessment

DCCS provides an independent assessment of the ED as it relates to provider operational performance, productivity, and coverage. We identify specific opportunities and strategies for improved patient flow and we detail the anticipated financial and operational impact of each opportunity.

This information can lead to:

  • Development of meaningful performance incentives across the ED-Hospitalist continuum to improve PQRS results and avoid penalties
  • Stabilized ED utilization and identify and capture new sources of patient revenue
  • Reduced ED provider costs
  • Improved Patient Satisfaction scores and HCAHPS scores for both ED and Hospitalists
  • Optimized provider scheduling by developing pacing metrics through real-time and predictive patient flow analytics
  • Identification of patterns providing predictive and real-time operational guidance

Can you afford to wait?
As the front door to the hospital, the emergency department, more than any other department, drives community perception. It demands effective strategies to improve patient flow and patient satisfaction.

DCCS ED Advisory Services: 

For over 5-years, we have been improving ED service performance without disrupting staff or physicians with 100% client satisfaction.

If your Emergency Department is underperforming, contact us to learn more about DCCS ED Advisory Services.

Is Your Care Management Department Ready for Value-Based Care?

By: Carol A. Beehler, FACHE, CPHQ, NEA-BC, RN

All hospitals and health systems are in the midst of facing the new world of fee for value in place of fee for volume and services.  Utilization management and length of stay reduction has been the anchor in acute care to control costs but won’t be the only skillsets needed by care management in the future to meet Value-Based Care (VBC) delivery.  With the impending nurse supply shortage and generational changes, new solutions are necessary.  Addressing the entire continuum by using evidenced-based practices and collaboration will drive value for the health systems in the future.

As early as 2015, the then Secretary of Health and Human Services, Sylvia M Burwell announced a target of having 30 percent of Medicare payments tied to quality or value by the end of 2016 and 50 percent by the end of 2018.  The 30 percent goal was met by the end of 2015, a year early.  VBC is well on its way while the American Nurses Association reported new graduate nurse turnover being 30 percent in their first year of practice and up to 57 percent by the second year.  Combining these two shifts along with most baby boomers retiring by the year 2020, the demand and supply curve will be in turmoil.  What does that say? 

Care Management services are pervasive in high-risk patients as this increased from 23 percent in 2015 to 32 percent by 2017.  And in 2017 alone, 43 percent of responders to the Becker’s Hospital Review report said they hired a care management coordinator.

Without a strong care management program and engaged nursing and multidisciplinary healthcare professionals, organizations will continue to struggle financially and not be able to meet the new world of VBC.  The patient-centered medical home (PCMH), health value management (HVM), VBC, care coordination and transitions of care all can be accomplished with a strong care management program.

A strategy and plan for the immediate future of your care management department is imperative:

  • Use foresight by integrating pre-hospital and post-hospital care transitions and relationships among providers and care managers. This will result in outcomes data that demonstrate the value of healthcare delivered at a lower cost. 
  • Evaluate and address the Care Management Department’s current leadership strengths/weaknesses and capacity for change. 
  •  Integrate the continuum by working with internal and external stakeholders across disciplines and settings.
  •  Consider the use of interim leadership to determine needed changes with an objective viewpoint.

Utilizing these methods, an 800-bed medical center demonstrated the ability to successfully engage care managers, eliminate open positions and subsequent turnover and established a strong leadership strategy for the department.  Care managers were empowered to identify evidenced-based practices with physicians to come up with solutions across the continuum and played a major role in leading success by improving and accelerating transitions of care to impact patient outcomes and compliance.

Without the integration of evidence-based practices, new delivery models, and engaged leadership, you cannot manage the continuum and those care transitions to drive value.  DCCS- a leader in healthcare transformation, offers clients these services and can establish effective care management systems that achieve quality, financial, and patient and caregiver satisfaction outcomes.  Contact us to learn more. 

Preventing Conflict in Healthcare – A Missed Opportunity!

In May of 2008, the Joint Commission released its Leadership Standards for 2009 with the goal of creating a Culture of Safety. A key element of the new standards was the prevention of workplace conflict that the JCAHO determined was disrupting communication between practitioners, which their research confirmed was compromising patient care.

In response, Healthcare Organizations developed and attempted to rigorously enforce Codes of Conduct among their Medical and Nursing Staffs.  Despite that considerable effort, conflict in the Healthcare Environment remains as prevalent as ever.  So what went wrong?

A Broken System

Most organizations decided that reports of violations had to be dealt with in secret and the resolution decreed by leadership fiat.  Concerns about confidentiality and Peer Review Privilege meant that those individuals that were on the receiving end of the disruptive behavior, the ones who filed the complaints, were completely ignored in the process.

The complainants were seldom told about actions taken in response to their reports of Code Violations. Equally counterproductive, they were never asked whether they believed the remedies decreed were suitable or appropriate. In a painful irony, the only “update” many of the complainants received were when they were confronted by the person they’d reported.

The Rules of Engagement

The commitment and resolve of executive and Medical Staff leadership are essential to the success of any effective campaign to address workplace conflict but their opinions as to what constitutes an effective resolution aren’t the ones that really matter!  We need to remember that JCAHO’s belief was that quality patient care was being impaired as result of poor communication.  That can only be corrected by those whose communication and relationships have been impacted.

That requires that the parties to the disruptive event find a way to begin trusting and respecting one another again. This won’t happen unless they are allowed to speak candidly with one another about the event and their actions/reactions. Any conversation they might initiate on their own isn’t likely to be productive if it’s not conducted in a safe and constructive setting!

That setting is best created in Mediation because facilitating the parties’ journey through this emotionally charged minefield require the skills of an educated, experienced and objective 3rd party neutral.  It shouldn’t the sort of hard-nosed, distributive bargaining many have encountered in malpractice or employment-related litigation because resolution isn’t based on legal integration or a monetary settlement.

Instead, it should be facilitative or transformative model of mediation, the satisfactory outcome of which is the restoration of the relationship among members of the clinical care team.

Resolve the Differences

Conflict in the workplace doesn’t have to be a disaster—it can be an opportunity for transformation. Too often conflicts in healthcare environments are avoided, handled inadequately, and allowed to escalate into major disputes. Robert Fielder provides coaching and resources to effectively deal with stressful situations without damaging the team or jeopardizing medical care.  If you are ready to minimize workplace conflict contact us today.

With flu season approaching, you can’t afford to wait.

Are patients feeling trapped in the Emergency Department?

Is your ED staff frustrated?   Is patient satisfaction declining?

Have you become too busy to change?

The Emergency Department is the front door to a Hospital, and for patients and families often is their first step in care.   It is critical the ED runs efficiently and in sync with the Hospital.

DCCS transforms EDs with a full suite of solutions including:

  • Patient Flow and Process Redesign
  • Operational, Clinical, Physician Practice Optimization
  • Quality and Safety Expertise
  • Strengthening Financial Performance

DCCS ED Advisory Services:

For over 5-years, we have been improving ED service performance without disrupting staff or physicians with 100% client satisfaction.

[Click to see our success stories.]

If your Emergency Department is underperforming, contact us to learn more about DCCS ED Advisory Services.

David Capone, President & Founder
DCCS Consulting | (302) 299-7627

Scott Dillon, Senior Consultant
Hospital-Based Physician Services


IT is Disrupting Healthcare: HERE IS HOW

IT is rapidly disrupting healthcare.

By Jorge E. Galva, JD, MHA, Healthcare Operations Executive

Disruption is a process by which a product or service takes root initially in simple applications at the bottom of a market and then relentlessly moves up market, eventually displacing established competitors (Carnegie Mellon University, 2017).  Healthcare had been relatively isolated from technological disruption by a convoluted set of operational, financial, professional and regulatory barriers. These barriers are falling in the face of relentless technological advance.

There are three areas where IT disruption is more incisive:

Remote healthcare: IT enables a broad variety of delivery modes away from the physical visit to a facility.  These include virtual doctor appointments, at-home tools capturing vital signs, cloud-based medical records accessible to physicians, diagnosticians and patients, and broadly enhanced telemedicine resources (Libert at al., 2017).  Remote healthcare improves efficiencies as duplication and siloing of patient care are reduced, downtime wasted for office visits disappears, and follow up is achieved through continuous sharing of information (van Hooijdonk, 2015).  Healthcare leaders must plan for a future where brick and mortar investment will be downsized by the growth of virtual healthcare.

Artificial Intelligence: Artificial Intelligence (AI) is defined as the science of creating intelligent computer systems able to perform tasks without receiving instructions from humans. (Chouffani, 2016). AI allows diagnosing conditions, designing treatment for individual patients, medication management and virtual nursing, among others (Novatio, 2017).  AI boosts the capabilities of providers by removing guesswork and time-consuming analyses from the care process.  The use of AI may soon become the new standard for medical care as more providers adopt it. Healthcare leaders must be prepared to acquire and utilize AI to maintain competitive parity and avoid potential legal consequences.

Health data security: Healthcare IT enables the acquisition, storage, and transmition of huge amounts of data.  This capability is subject to a high risk of unlawful breach. More patient and health plan member records were exposed or stolen in 2015 than in the previous 6 years combined; 2016 saw more healthcare data breaches reported than any other year, with 2017 set on becoming a record breaker (HIPAA Journal, 2017).  As healthcare systems expand their IT capabilities, disruptive changes are affecting data security.

Systems must strengthen their encryption protocols, improve firewall protection, and experiment with biometric and blockchain technologies (Weintraub and Borenstein, 2017). The adoption of these technologies will disrupt established administrative practices, along with payer, provider and patient relations. Leaders implementing an aggressive plan to protect data will be faced with elevated expenses and difficult operational changes going forward.

IT disruption of healthcare will only accelerate. Leadership must face it with strategies leading to proactive exploration and experimentation. These include external focus, internal incubation, and capability development; disruption is external, but must be embraced internally in order to succeed (Kaplan, 2017). Healthcare must learn to love the problem and guide the solutions. This is the road to success in a disrupted world.


Carnegie Mellon University, Disruptive Health Technology Institute, What Is Disruptive Health Technology, 2017, retrieved 11/8/17

Barry Libert, John C. Grady Benson, Steve Schutzer, Megan Beck, Why Healthcare is Ready for Digital Disruption, Wharton, University of Pennsylvania, 2017, retrieved November 6, 2017 http://knowledge.wharton.upenn.edu/article/why-health-care-is-ripe-for-digital-disruption/

Richard van Hooijdonk, Disruptive healthcare innovations that will bring the hospital to your bedroom, 2015, retrieved 11/7/17, https://www.richardvanhooijdonk.com/en/7-healthcare-innovations/

Reda Chouffani, Biz Technology Solutions, Four Uses for Artificial Intelligence in Healthcare, 2016, retrieved 11/8/17 http://searchhealthit.techtarget.com/tip/Four-uses-for-artificial-intelligence-in-healthcare

Novatio, Novatio Solutions, 2017, retrieved 11/6/17 http://novatiosolutions.com/10-common-applications-artificial-intelligence-healthcare/

HIPAA Journal, 2017, retrieved 11/8/17

Rebecca Weintraub and Joram Borenstein, Business Harvard Review, 2017, retrieved 11/7/17

Soren Kaplan, 5 Ways to Drive Disruptive Innovation in Healthcare, Inc., 2017, retrieved 11/6/17 https://www.inc.com/soren-kaplan/5-ways-to-drive-disruptive-innovation-in-healthcar.html


Are Your Hospital-Based Physicians Rowing in the Same Direction?

Hospitals and clinical services are challenged to improve quality outcomes, patient safety, and the patient experience.  Aligning hospital-based Emergency Medicine and Hospitalist Medicine physicians to move patients efficiently through the emergency department can significantly impact the care your hospital delivers and improve its financial health.

Multiple studies suggest that inefficient  ED patient flow contributes to:

  • Poorer clinical performance and patient outcomes
  • Delays in pain assessments and medications
  • Decreased likelihood of receiving evidence-based interventions
  • Increased patient and family distress

A negative correlation between wait times and patient satisfaction
It is no surprise that industry leaders like The Joint Commission, the Institute for Healthcare Improvement and the Institute of Medicine all champion ED throughput as a key quality initiative.  ED throughput metrics remain a key component of the Center for Medicare and Medicaid Services Hospital Inpatient Quality Reporting Program.

Improving ED throughput is challenging particularly when adding staff, ED beds or facility upgrades isn’t possible.  For most hospitals, the only option to improve efficiency is process improvement.

We are the Rowing Coaches of Emergency Medicine and Hospitalist Practices.

At DCCS, we use a collaborative process to identify opportunities that will improve the process of care, contain costs and align providers to drive engagement and effectively utilize resources.

  • Putting providers and facilities on the same trajectory pointed at the same target.
  • “Aligning” emergency physicians and hospitalists as partners to produce solutions that are consistent with the facilities’ strategic direction is our expertise.
  • Building an infrastructure that supports sustainable models of emergency physician and hospitalist engagement driving excellence in care.

Our focus is on helping to align EM and HM clinical services with the quality and performance requirements health systems must meet to maximize performance and financial reimbursement all while providing the feedback systems to ensure practices are getting the information they need to support excellent patient outcomes.

Healthcare is a Team Sport

By: Patti S. McCue, Sc.D., MSN, RN

Fall ushers in a welcome change – colorful foliage, crisp weather, and the excitement of college football.  As I enjoy watching my favorite teams play each week, I can’t help but notice the similarities between team sports and healthcare.  Perhaps more importantly, I notice where healthcare often falls short in the team aspect and has the opportunity to gain considerable yardage.

The professions of modern day medicine have a history and culture deeply rooted in hierarchy, rank, and social norms. Healthcare remains very much a team sport; however, the ability of each professional to practice as a team member is not yet a given.  Only in recent years has academia begun to educate future healthcare professionals together in an effort to promote a culture of inter-professional collaboration.  Unfortunately, newly graduated professionals are often thrust into the traditional settings that undermine the very constructs of collaborative, team-based practice.

The shift in our current healthcare system from volume to a value-based paradigm requires a new approach to care delivery.  Inter-professional Collaborative Practice is the cornerstone of the new practice and delivery models.  Reimbursement methods are increasingly geared towards improving outcomes in quality, safety, and patient satisfaction.   An Inter-professional team based care delivery model is critical to achieving the best possible outcomes for the patient and to also achieve the organization’s goals.

So, what does this Inter-professional Collaborative Team (IPCT) Based care delivery model look like?  Here’s a brief outline of the basics and required elements:

A Designated Leader

  • Builds a collaborative culture based on common ethics and values
  • Provides direction, support, and promotes transparent communication
  • Ensures clarity of goals and alignment of the team
  • May or may not be a physician dependent upon practice setting

Roles and Responsibilities

  • Clearly delineated roles and responsibilities for each member of the team
  • Consensus building
  • Advanced communication skills – conflict management, negotiation
  • Forge interdependent relationships with other professions to improve care

The Team

  • Includes various clinical disciplines – physicians, nurses, pharmacists, physical therapists, etc.
  • Mutual respect for diversity of expertise and professional boundaries of each team member
  • Learns to relinquish some professional autonomy to work together to achieve better outcomes
  • Systematic use of evidence and data to drive improvement
  • The patient and family are members of the team

Developing an IPCT takes time, yet this model is proving its worth in improved patient outcomes while achieving organizational goals.  A different healthcare system reality requires a different approach to the delivery and management of care and population health.  Inter-professional collaborative practice is not the multidisciplinary or interdisciplinary teams of yesteryear.  Rather, the IPCT is a modern revolution in professional practice with the hallmark of shared ownership, shared decision making, and shared accountability for outcomes.

The Quality Improvement Journey: Next Stop, High-Reliability

None of us would fly today if airlines had the same outcomes as healthcare.

Airlines, like other high-reliability organizations far along the journey, are organizations that operate in complex, high-hazard domains for extended periods without serious accidents or catastrophic failures. So where is healthcare on this HRO journey?

Becoming a High-Reliability Organization

The journey toward becoming a high-reliability organization focuses on improving reliability through better process design, building a culture of reliability, and leveraging human factors that help people do the right thing. Though the drive to become an HRO originated with safety, healthcare has come to realize this work will improve performance in every area.

High-Reliability organizations cultivate resilience by relentlessly prioritizing safety over other performance pressures.

Where to Begin: Assess your Readiness

Begin with a high-level assessment that focuses on the strengths and opportunities for your organization in the High-Reliability Elements areas. The assessment should sample key elements and services most important to your organization.

This assessment will help speed your journey to High-Reliability by directing your focus on improving processes that result in poor reliability.

The final report should include:

  • Strengths in HRO Elements
  • HRO Elements to enhance. These elements of focus will most improve clinical outcomes safely
  • Key processes to strengthen in the identified HRO Elements. These processes should be the focus to improve the identified HRO Element
  • A Roadmap to High-Reliability and suggested milestones along the way
  • Sample process templates
  • A definition of High-Reliability for your organization.

Your Roadmap to High-Reliability

Our complete Roadmap to High-Reliability includes a high-level assessment of organizational readiness, tools including easy-to-use templates teams can use in improving reliability, and a Roadmap to High-Reliability to support your journey. We will also include ideas for rapid improvement quick wins.

Our passion at DCCS is to create High-Reliability Organizations and we freely share information throughout the engagement. We are ready to serve as your advisor and help you on your journey.

Ready to take the next step?

A Shortage Like No Other

By 2020, nearly half of RNs will be at traditional retirement age, the U.S. Department of Labor reports. As these seasoned professionals retire, their experience, knowledge, and skills, which are essential to achieving the goals and outcomes of an increasingly value-based healthcare industry, will go with them.

What Makes This Nursing Shortage Different

The U.S. has been dealing with a nursing deficit of varying degrees for decades. However today, due to an aging population, the rising incidence of chronic disease, an aging nursing workforce, requirements for BSN staff and the limited capacity of nursing schools, this shortage is on the cusp of becoming a crisis, one with significant implications for patients and health-care providers alike.

The Bureau of Labor Statistics estimates there will be more than a million registered nurse openings by 2024, twice the rate seen in previous shortages.

Add to the mix a multitude of new nursing opportunities created by changing care delivery models, and the career philosophies of younger nurses who crave change and typically move on to new opportunities every one to three years, and there is cause for concern.

A Different Shortage Requires Different Solutions

Successful organizations see effective Nursing recruitment and retention strategies as a strategic priority. The strategies to address this new shortage require breakthrough concepts and vision to respond to the changing Millennial workforce.

For example, nursing staff today are looking for employers who recognize, support and help plan for their career advancement. Setting up pathways for career development allows nurses to advance within the health system and not have to leave for opportunities.

How are you positioning for success in this new shortage era?
If you are interested in a new perspective regarding your Nursing Recruitment and Retention Strategies:  Contact DCCS Consulting