As South Carolina's largest private, nonprofit health system, Prisma Health grappled with several pressing challenges common to the modern healthcare industry: resource constraints, financial pressures and widespread provider burnout.

THE PROBLEM

These problems were exacerbated by the scale of the organization – a network of 18 hospitals serving more than 1.5 million patients annually with 30,000 team members.

One of the main struggles was efficiently managing patient care and staff engagement on such a large scale. Tracking essential metrics like patient safety, care quality and staff performance in real time was difficult for the leadership teams.

"Without the right tools, it became nearly impossible to ensure that key leadership behaviors, like patient/leader rounding and purposeful rounding, were happening consistently across all of our hospitals," said Tina Hunter, executive director of patient experience in the department of clinical care experience at Prisma Health.

"On top of that, our emergence from the merger of two large organizations brought its own set of complexities when it came to unifying processes and workflows," she added. "Staffing shortages and the increasing demands of caring for a diverse patient population only made oversight more difficult."

Prisma Health also had trouble maximizing the impact of its workforce. Team leaders and nurse managers often had limited time and resources to ensure they were focusing on the highest-priority tasks.

"With so many responsibilities and not enough visibility into performance data, crucial tasks could easily be overlooked or delayed," Hunter explained. "This lack of structure and real-time insight contributed to inefficiencies in care delivery, making it harder to maintain high-quality care amid mounting financial pressures and increasing patient demands.

"It became clear that technology could offer a solution to help close some of these operational gaps and optimize our existing structures, which would be key to improving our systems, enhancing accountability and driving better outcomes," she added.

PROPOSAL

Prisma Health's core idea behind turning to vendor CipherHealth was that rounding – whether patient-facing or team member-facing, in both acute and ambulatory settings – had to become a fundamental part of workflow.

"By moving to a structured rounding framework, we aimed to create a culture of continuous improvement and accountability throughout the organization," Hunter noted. "The system didn't just need to track key metrics like patient safety concerns or learnings from patient/leader rounding; it also had to empower our frontline teams with real-time data, helping them to make informed decisions to improve care quality.

"We wanted to ensure leaders at every level of the organization, from C-suite executives to frontline team members, were involved early in the development process," she continued. "This top-down and bottom-up approach helped everyone in the organization align on the importance of rounding and tracking care metrics and made it easier to incorporate Pulse, our clinical operating system, into our daily operations."

Prisma Health also wanted to ensure one of the key strengths of this technology was flexibility and an emphasis on continuous improvement. Rather than creating a rigid system, the health system encouraged feedback from both staff and leaders to refine the platform as it implemented the tech.

"As we began using the system, we allowed real-world experiences to guide further enhancements," Hunter explained. "This iterative process ensured this element of the Pulse OS was a collaboratively established unifying model aimed at eliminating variability in care and tailored to our specific challenges over time."

MEETING THE CHALLENGE

Prisma Health integrated CipherHealth's rounding systems into the Pulse OS for its rounding system. By integrating CipherRounds, the health system has been able to track those critical activities like patient/leader rounding and purposeful rounding as well as monitor correlations with improvements in patient outcomes.

"We've observed a nearly perfect alignment between rounding activities and key performance metrics, demonstrating the tangible impact on care quality," Hunter said.

"CipherRounds has worked with us to enhance patient safety by flagging high-risk patients, helping leaders prioritize them during rounds and allowing staff to focus on those at risk for infections or falls," she continued. "This system enables quick, informed decisions, improving rounding efficiency and effectiveness."

Additionally, the vendor's rounding technology helps Prisma Health leaders integrate real-time service recovery and escalation processes, enabling prompt issue resolution and uncovering hidden concerns. This visibility has boosted both patient satisfaction and operational efficiency across the 18 hospitals.

"Beyond data collection, the rounding platform has become a powerful tool for driving organizational improvements," Hunter noted. "We also introduced CipherHealth's Self-Service Rounding to Pulse, starting in our busiest mammography clinics.

"Self-Service Rounding gathers real-time feedback via SMS or QR code, facilitating immediate service recovery and addressing safety issues swiftly," she added. "It also recognizes staff achievements, and we plan to expand Self-Service Rounding to all imaging centers and our entire medical group this month. Future expansion of this tool will be to our medical group practices and then into the acute space."

RESULTS

The rounding technology from the vendor has enabled Prisma Health to think differently about how it continues to improve. The health system has shifted from a reactive, "error-found" to a true learning organization where it considers finding gaps a good thing.

"Once a gap is found, we can systematically improve processes to better care for our patients and to support our teams," Hunter said. "The impact of this learning and improvement focus has been monumental in moving the needle on both quality of care, the patient experience and team member engagement. An example of the improvement realized as a result of the implementation of CipherRounds is seen in our emergency departments over the past year.

"Systemwide, our emergency departments have improved by 17 percentile rank points in overall 'Likely to Recommend,'" she continued. "Our largest emergency department (a level 1 trauma center, comprehensive stroke center, with an average daily census of more than 300 a day) has improved by 35 percentile rank points over the last two years in overall likelihood to recommend – despite the negative challenges that faced them post pandemic."

These improvements can be correlated to the collaborative approach and the process improvements put into place as a result of learning from patients. The vendor tool has been instrumental in helping Prisma Health track and trend opportunities as well as leading metrics when a new process is put into place, she added.

ADVICE FOR OTHERS

"Healthcare organizations dealing with resource constraints and staffing challenges should fully embrace technology as a critical tool for bridging operational gaps," Hunter advised. "In today's healthcare landscape, no single technology is perfect, and many systems aim to address multiple issues simultaneously.

"The real challenge is finding the right balance – using technology to enhance efficiency without overwhelming staff or compromising patient care," she continued. "It's crucial to adopt systems that can be tailored to your specific needs and empower your team, rather than seeking a one-size-fits-all system that might not fit every scenario perfectly."

Tech-enabled workflows should aim to help leaders be more efficient and pull in multiple functions to help them accomplish that – it should always complement, not be an additional step to complete, she added.

"Don't be afraid of technology," she said. "Instead, focus on how your staff can support technology for operational workflows while allowing the space to also provide that essential human connection that patients need when needed. Technology should complement, not replace, the interaction between healthcare providers and patients. It should also provide insights inside of workflow to truly maximize interactions in a concise format.

"It's also crucial to have buy-in from leadership and frontline staff early in the adoption of technology to ensure the systems align with all the organization's needs," she concluded. "Embracing continuous improvement and flexibility will help the technology evolve and remain effective in addressing challenges such as staffing shortages and financial pressures."

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