The Integrated Respiratory Therapy Enterprise

By Madhu Sasidhar, MD

As healthcare systems consolidate to achieve efficiencies of scale, care integration is vital to improving the patient experience, ensuring quality and reducing costs. Recently, Cleveland Clinic health system integrated the respiratory care services provided by over 500 therapists at 13 locations in the Cleveland metropolitan area.

Moving from a Fragmented Care Experience

Respiratory therapy (RT) services within our health system in Northeast Ohio previously consisted of 12 business units at nine acute care facilities, one pediatric rehabilitation hospital and three freestanding emergency departments. Each unit created independent clinical protocols, policies and standards. Human resource management, education, research and quality improvement were integrated into the activities of individual units without coordination across units.

Owning only parts of our care continuum was inadequate, and the health system recognized the need for a deliberate strategy of integration for an optimized patient experience.

A Framework for the Integrated RT Enterprise

Integration efforts are critically dependent on support from senior leadership. During the early stages of planning, we sought participation from various stakeholders, including leaders of clinical institutes, regional hospital presidents, chief operating officers, operations, nursing and human resources. We identified barriers to success, including the need to have a local respiratory therapy leadership presence for daily operations. Many local leaders of respiratory care were in cross-functional roles that included oversight of services such as echocardiography and outpatient clinics. To provide a seamless transition, these expanded roles were preserved and supported following RT integration.

To support enterprise-level activities, existing roles were redefined and their scope of authority expanded. The RT director is a system-level role with responsibility for strategic planning and helping align goals of each unit with the organization’s priorities. Two regional managers, with responsibility for four hospitals each, serve as cross-continuum leaders while providing operational support to local RT leaders. A lead RT supervisor or manager at each hospital is responsible for day-to-day operations and also serves as the main RT contact for other services at the hospital. Information technology, education, research and quality were each assigned coordinator positions with enterprise-wide scope of activity.

Impacting Quality and Value

Integrating RT services across our health system uniquely positions us to implement projects that impact quality and value. We have changed our RT productivity measurement system to better align with value-based care. System-wide scheduling software will enable us to fully leverage a flexible staffing pool to meet staffing needs across multiple sites.

Enterprise quality improvement utilizes a monthly business review and scorecard to track and compare more than 70 clinical and operational metrics applicable to respiratory care. Our processes for regulatory compliance are being standardized along with enterprise-level RT policies and standard operating procedures.

Our integrated respiratory care service is continuously identifying opportunities for an expanded RT scope of practice that allows therapists to function at the highest level of their license. Specialized RT consult services, chronic disease management for COPD and emergency airway management are some of the areas we have identified and developed using our enterprise resources for education.

The integrated RT enterprise is one example of our health system’s adaptation to provide a fully integrated care experience that continuously evolves and is optimized for value.

Dr. Sasidhar is Head of Respiratory Therapy and staff in the Respiratory Institute.