How Do You Design Patients And Speciality Services

Health and medical providers operate in an manufacture characterized by perpetual change, the effect of a convergence of multiple influences from both within and exterior of their given establishments. The healthcare manufacture, in and of itself, is immensely complex, and its immersion in and exposure to the greater political, economic, social, and technological environment only adds to associated complexities [1, two].

Successfully navigating such tumultuous environments requires that healthcare providers be expert in myriad areas, including the manner in which they organize and deliver services. Less efficient designs bleed precious resources and hamper efforts to provide the best care possible to patients, making information technology imperative that optimal pathways are identified and pursued. One particular avenue that offers great potential for serving patients well is known as the hub-and-spoke organization design [iii, 4].

Through strategic centralization of the near advanced medical services at a single site and distribution of bones services via secondary sites, the hub-and-spoke model affords unique opportunities to maximize efficiencies and effectiveness. A well-designed hub-and-spoke network satisfies patient care needs fully, yet does so in a manner that fosters resource conservation, render on investment, service excellence, and enhanced market coverage [4,5,6,7]. Benefits abound, but in society to capitalize fully on the hub-and-spoke organization design, healthcare providers must assemble their service delivery networks with great intendance and attention.

To advance awareness, noesis, and use of the hub-and-spoke system pattern, this article profiles Willis-Knighton Health Arrangement's service delivery network which has utilized the model for over three decades. Among other things, the hub-and-spoke organisation design is defined, benefits are stipulated, and applications are discussed, permitting healthcare providers essential insights for the establishment and operation of these networks.

Definition

Formally defined, the hub-and-spoke system blueprint is a model which arranges service delivery avails into a network consisting of an anchor institution (hub) which offers a full assortment of services, complemented by secondary establishments (spokes) which offering more limited service arrays, routing patients needing more intensive services to the hub for treatment [3, 7]. The hub-and-spoke model yields a healthcare network consisting of a main campus and one or more satellite campuses. Information technology is much more efficient than arrangement designs which replicate operations beyond multiple sites [5, seven, 8]. Hub-and-spoke networks are highly scalable, with satellites being added as needed or desired [six, 7]. When geographic distance makes satellite-to-hub access impractical, an additional hub tin can be created, yielding a multi-hub network [iv, five, 9].

The particular mode of centralization varies from institution to institution, depending on the service array provided and size of market addressed, but a mutual approach is as follows: Complex medical services, especially those that are applied science and skills intensive, are centralized at the main campus or hub, as are services that support intendance delivery and lend themselves to centralization, such as human being resources management, marketing, and related operations. Basic healthcare services are broadly distributed across the network, permitting the bulk of healthcare needs of the populace to exist addressed locally. Only when complexities emerge that crave care falling outside of the telescopic of services provided at satellite facilities are patients routed to the main campus or hub for treatment [3, iv, 7].

The hub-and-spoke model has origins in the transportation industry. It is perhaps best known in broad order for its use by air carriers, which due to resource scarcity and intensive demands for profits, operate these networks to achieve more with less [x, 11]. The model has been adopted past and used successfully in many other industries, including retailing, education, and healthcare [12,13,14].

Strategic centralization is the cardinal which unlocks the many benefits of the hub-and-spoke organization design [3,4,v, 7]. Informed decisions regarding service distribution are essential, with the goal being to find an optimal rest between operations efficiency and quick, user-friendly access by patients to associated healthcare services. This is something that simply healthcare providers themselves tin can decide, as service arrays, the markets in which they are offered, and populations served are unique to each entity. However, with firsthand familiarity of an operational hub-and-spoke network, knowledge and awareness of this system blueprint comes to life, making construction of custom networks possible for most whatever interested healthcare provider. Willis-Knighton Wellness System's service commitment network makes apply of the hub-and-spoke model, offering an fantabulous opportunity to gain an understanding of this particular organization design's attributes and performance.

Willis-Knighton Health Organization and its hub-and-spoke network

Headquartered in Shreveport, Louisiana, Willis-Knighton Health System is a nongovernmental, non-for-profit healthcare provider delivering comprehensive health and wellness services through multiple hospitals, numerous general and specialty medical clinics, an spread-out retirement community, and more than. The organisation holds market leadership in its served region, centered in the eye of an area known equally the Ark-La-Tex, where united states of Arkansas, Louisiana, and Texas converge.

Willis-Knighton Health Organization'south origins date to 1924 with the establishment of Tri-Country Sanitarium, founded to address the healthcare needs of the burgeoning population of west Shreveport. Sold in 1929 to Drs. James Willis and Joseph Knighton, the establishment continued operations and, in 1952, it was renamed in honour of Drs. Willis and Knighton.

For the first several decades of its existence, the establishment played an important but relatively minor office in delivering the region's healthcare. In the 1970s, however, Willis-Knighton Health System embarked on a detailed growth campaign to expand its footprint beyond west Shreveport. With funding to support growth initiatives beingness in short supply, executives were forced to economize, with this creating a civilization of efficiency, something that characterizes Willis-Knighton Health Organisation to this day.

Through many years of endeavour and innovation, growth was realized. By the early on 1980s, Willis-Knighton Health System'south sole hospital, located on Greenwood Road in the shadow of downtown Shreveport, had witnessed an exceptional increase in patient volume and loyalty was at an all-time loftier. These successes afforded opportunities to explore avenues for expansion. In doing so, executives noticed that the population of south Shreveport was expanding greatly merely no hospital was serving the area. This represented a natural pathway to increase Willis-Knighton Health Organisation'south footprint and build patient book in a new and growing area of the city. South Shreveport'due south residential developments were increasing rapidly, merely its commercial infrastructure was relatively undeveloped, leading executives to pursue a new construction pathway for realization of the proposed hospital campus.

Although south Shreveport presented the region's most attractive growth prospects, Willis-Knighton Wellness System did not want to abandon its original campus. Prospects for growth remained good in and around the westward Shreveport and downtown areas of the city. Further, a divergence would effectively accept stranded patients in that particular region, a practice that the system has e'er rejected as a not-for-profit, charitable enterprise. Deviation also would have opened the door for competitors to easily enter the w Shreveport/downtown marketplace and capture that market share for themselves. As such, executives decided to operate two hospital campuses, the original ane in west Shreveport and a new one in south Shreveport. Land in south Shreveport was caused and planning ensued.

Among myriad decisions, executives needed to determine the way in which healthcare commitment relationships between the ii establishments would operate. Organization designs which essentially replicated service arrays at each site were popular expansion models at the time, but this pathway went against Willis-Knighton Health System's civilization of efficiency. Seeking a more practical approach, diverse models were explored and the hub-and-spoke organization design was selected due to its reputation for efficient and effective service commitment.

Service array and operations protocols for the proposed facility were determined, architectural designs were adult and approved, and construction began. In 1983, Willis-Knighton Wellness System revealed WK S, its offset satellite hospital, first its journey as a multicampus health system. Through this experience, the efficiency and value of the hub-and-spoke organisation design was confirmed, prompting its connected utilise [15].

Willis-Knighton Health System now operates 1290 licensed beds across five hospital campuses and one retirement community. The main campus, Willis-Knighton Medical Center, serves every bit the hub for each of the satellite campuses, as illustrated in Fig. 1. The system'southward numerous full general and specialty medical clinics, located throughout the region, as well serve as spokes linked to the primary campus hub. Willis-Knighton Wellness System's v hospital campuses and retirement community, their institution dates, and current licensed bed sizes (as of March 2017) are every bit follows.

WK Medical Center (hub, est. 1924): 499 beds
WK South (spoke, est. 1983): 152 beds
WK Bossier Health Center (spoke, est. 1996): 166 beds
WK Pierremont Health Middle (spoke, est. 1999): 200 beds
WK Rehabilitation Constitute (spoke, est. 2017): 65 beds
The Oaks of Louisiana (spoke, est. 2007): 208 beds

Detailed service arrays provided at each location tin be accessed by visiting Willis-Knighton Health System's website (http://www.wkhs.com). With the exception of The Oaks of Louisiana, which involved the acquisition of a small long term care campus that subsequently was developed into a comprehensive retirement community, the spokes in Willis-Knighton Health System's hub-and-spoke network were established entirely past the system. Organization growth experienced over the decades can exist credited in large part to the hub-and-spoke model which permitted the best use of resources to achieve growth ambitions and serve increasing populations of patients well.

Benefits

With over three decades of delivering healthcare services using the hub-and-spoke organization design, Willis-Knighton Health System tin ostend a range of benefits afforded by the model. These benefits, which mirror observations expressed in the literature, are summarized in Tabular array ane and explained as follows.

Table ane Benefits and risks associated with the hub-and-spoke system design

Full size tabular array

Consistency across operations

The hub-and-spoke arrangement design affords meaning control and control across the associated network of healthcare establishments. Policy directives are issued system wide by the primary campus or hub, with administrators at satellite facilities being responsible for implementation in their assigned establishments. This yields consistency beyond operations, something that would be much more difficult to attain in networks consisting of semi-independent or contained facilities [vii, 9].

The hub-and-spoke model effectively creates a hierarchical organization with authority extending from the hub outward to the spokes. This yields a traditional chain of command like to that used by armed forces organizations. Mayhap nearly importantly, from a patient care perspective, the uniformity associated with this particular organization design affords a consequent patient experience across facilities [9].

Courtesy of the hub-and-spoke organization design, despite operating multiple campuses, in that location really is only 1 Willis-Knighton Wellness System and it's composed of the entire collection of establishments. Patients with feel at one Willis-Knighton Health Organization campus volition discover like experiences at whatever of the system's other campuses. Each spoke is managed past an individual holding the championship of Administrator and Vice President who reports directly to the hub-based President and Chief Executive Officer. Medical staff members are credentialed for service system wide; they are coordinated by a hub-based Vice President. A single governing lath is responsible for system oversight. Fundamental command afforded past the hub-and-spoke network allows each of Willis-Knighton Health System's campuses to apace and collectively adapt to environmental changes as directives to modify practices come up from a single source.

Increased efficiencies

By centralizing the nearly advanced medical technologies and skill sets at the main campus or hub of the hub-and-spoke network and routing all patients needing these services to this fundamental site, efficiencies are achieved. Notably, this eliminates the plush duplication of services, increases render on investment, and bolsters economies of scale [4,5,half-dozen,7]. Evidence besides suggests that the toll of intendance delivered by hub-and-spoke networks is reduced, benefiting patients, insurers, and society at big [xvi,17,18].

Willis-Knighton Wellness System follows the practice of centralization without neglect, concentrating leading technologies at its hub. These especially expensive technologies, in fact, are not permitted at Willis-Knighton Health Arrangement's spoke facilities unless patient demand is sufficient at these satellite locations to justify the expenditures. Further, medical staffing, human resources, marketing, materials management, and finance operations are based at the master campus and serve the entire organization from that location. These actions yield tremendous efficiencies which positively impact fiscal performance and beget opportunities to reinvest savings in pursuits that otherwise might not be possible.

The efficiencies generated by the hub-and-spoke organization pattern accept, among other things, permitted Willis-Knighton Health Organization to acquire some of the almost sophisticated medical technologies available, such every bit proton therapy for the treatment of cancer, Visualase MRI-guided laser ablation technology for treating brain tumors, and much more than. The resulting savings also facilitates charity care initiatives, permitting the system to provide healthcare services to a significant percent of the region's uninsured population.

Enhanced quality

Due to its unique structure, pooling resources and expertise strategically, the hub-and-spoke arrangement design offers opportunities to realize quality enhancements [4], with findings in the literature supplying show of the model's power to deliver improved outcomes [19,xx,21,22]. In many regards, the hub of the hub-and-spoke network effectively becomes a system-wide center of excellence, as information technology contains many like attributes, including centralization which concentrates resources at single sites and bolsters patient volume, fostering quality [23,24,25].

Willis-Knighton Health System'south experiences confirm the guidance supplied in the literature pertaining to the quality impact of the hub-and-spoke model. Located at the arrangement hub, its WK Heart and Vascular Found, for example, houses some of the most sophisticated technologies available and it is staffed past the most experienced cardiovascular team in the region. The concentration of leading resources, together with significant volume resulting from organization-broad referrals (597 cardiovascular surgeries were performed in 2016), has afforded a level of quality that would be difficult to achieve otherwise. Quality accomplishments and outcomes experienced on the cardiovascular surgery front end besides have been observed across other clinical fronts in the organisation, demonstrating value and warranting continued use of the hub-and-spoke organization design.

Enhanced market coverage

The hub-and-spoke organization design facilitates expansion initiatives, courtesy of the reduced resources requirements necessary at the satellite facility level. Since service arrays at satellites are more limited in telescopic, less investment is needed to plant new locations, something that also reduces the gamble associated with expanding into new markets. As such, the hub-and-spoke model offers significant opportunities to eternalize market place share and improve access to care [four,5,half-dozen,seven]. This very benefit compelled and permitted Willis-Knighton Health System to begin development of what volition go its 6th hospital, WK Palmetto Eye, which will be located in the fast-growing town of Benton, Louisiana, northward of Bossier City.

The hub-and-spoke model, in fact, has been receiving increasing attention of belatedly as a potential solution to many population health challenges [5, 26]. Logically, resolution of celebrated and ongoing access to intendance dilemmas should be easier if expansion efforts tin be accommodated at less cost and reduced gamble, as made possible by well-planned hub-and-spoke networks. Willis-Knighton Health Organisation'southward own outreach initiatives into medically underserved communities have increased in depth and breadth largely due to the efficiencies and abilities of its hub-and-spoke network.

Improved agility

The synergies associated with operational consistency, efficiencies, and enhanced market coverage combine to yield an especially agile healthcare organization. Change initiation is expedited and enhanced through the central administrative structure and less costly, reduced-hazard expansion opportunities foster expeditious decisions and resulting deportment [3, 4, 7].

The hub-and-spoke model besides enhances an institution'southward power to conform every bit markets evolve. When attractive markets emerge, cost efficient satellites facilitate nimble market entry. Due in large function to the efficiencies of the hub-and-spoke organization design, Willis-Knighton Health Organization was able to address each marketplace in which it placed a satellite infirmary more quickly than did its competitors, a trend which continues with its newest campus development initiative in Benton, Louisiana.

Conversely, in situations where particular markets served by satellites are declining, withdrawal can occur swiftly. Those resources can then be redirected to other establishments in the network or they perhaps can be used to build new establishments in markets with greater potential. Interestingly, this particular facet can also benefit hubs in cases where market decline or failure is experienced at the main campus. In such cases, satellites present opportunities to transfer resources and reestablish the hub in a more promising market place.

Willis-Knighton Health System has been fortunate to accept never experienced the need to close whatever of its campuses, but prudent healthcare executives must always exist mindful that circumstances beyond their control can force painful decisions to be made in order to protect institutional viability. In the event of market downturns beyond levels of tolerance, the hub-and-spoke model offers perhaps the best prospects for ensuring continuity in the face of one or more closures. Flexibility in such situations is an asset and the hub-and-spoke model delivers just that.

Risks

While the hub-and-spoke organization design offers a wealth of benefits, this particular approach to organizing the delivery of healthcare services does comport some hazard, with potential trouble spots existence summarized in Table 1 and explained below. Fortunately, steps can be taken to reduce or eliminate these negative occurrences.

Congestion at hubs

Since patient traffic is routed from one or more spokes to the hub, the potential naturally exists for congestion to occur at the main campus [27, 28]. With proper planning and action, however, such occurrences tin be minimized or possibly eliminated altogether. Quite simply, steps must be taken to ensure that system-wide demand directed toward the hub can be accommodated without hardship or delay. This requires addressing several fronts, including parking access and availability, scheduling practices, infinite requirements, engineering availability and admission, staff coverage, and and so on.

One time once again, centralization delivers benefits, in this instance, pertaining to the supply of intelligence that volition assistance in devising plans to accommodate patient demand. The principal campus, courtesy of the hub-and-spoke design, serves as the organisation-wide data repository, housing the electronic health records system, among other things, for the entire network. This central structure permits historic and real-fourth dimension access to patient volume and flow information, providing an invaluable planning resources. Also, since a nexus of top expertise and equipment exists at the hub, scaling chapters to meet demand is much easier than starting anew.

All the more attempt will be needed in this area in cases where new satellites are constructed or otherwise acquired, as this will crave deportment to ensure that the hub has the capacity to address new volume. Willis-Knighton Health Arrangement engages in intensive planning kickoff early in the development phases of satellite campuses through to construction and commercialization to ensure capability of resource needed to conform demand and ensure positive patient experiences. Proactive planning can greatly reduce or eliminate the potential for congestion, ensuring user-friendly and expeditious access to patient care.

Overextension of spokes

Spoke overextension—placing satellites too distant from the hub to permit adequate service delivery—must be avoided. This invariably will cause service failures that will tarnish the reputations of both the satellite and the main campus [15]. As noted earlier, strategic decisions are required to strike a balance between the desires of institutions for operational efficiency and the desires of patients for receipt of services in shut proximity to their homes.

Optimal decisions can only be made by investigating the particular scenario, with attention being directed toward the type of service, type of patient, distance from hub, country of and access to transportation, and so on in order to decide the nigh prudent pathways. If transit times betwixt the hub and satellite are besides great to let effective care delivery, then efforts should be directed toward establishing a hub in this remotely-located market to ensure continuity of care and allow future satellite growth in the region.

Willis-Knighton Health System's satellite campuses are located in reasonably close proximity to the hub, permitting quick access via personal transportation. The network as well benefits from the system's highly-developed ground and air patient transportation program which ensures the most expeditious spoke-to-hub access possible in life-threatening situations. Expansion into any market begins with a customs needs cess which includes transit time and related analyses, offer helpful guidance to executives as they go about determining the capability of spoke-to-hub access to ensure that overextension is avoided.

Staff dissatisfaction at spokes

Since potency runs from the hub outward to the spokes, satellite facilities operate, past design, nether the auspices of the main campus. This sets the stage for at least some staff members at spoke facilities to exist discontent, resenting the lack of autonomy to operate as they run across fit inside their facilities [fifteen]. They might, for example, wish to schedule work differently, determine services that will and will non be offered, devise their ain advertising campaigns, or develop site-specific personnel policies. Such deportment undermine control and control structures and over time will create patient experiences that are not uniform beyond the system.

Outside of ensuring clear advice betwixt and among all establishments in the hub-and-spoke network, the threat of staff dissent can be reduced by making certain that satellite facilities are led by capable administrators who cover the system's corporate culture and appropriately guide their subordinates. This, of course, places a premium on ensuring that a constructive culture exists within the establishment and that it is conveyed successfully throughout the network. Offering an informative employee orientation and periodic training opportunities which include details regarding the mission, vision, and values of the organisation can further bolster team mindsets that minimize strife.

Willis-Knighton Health Arrangement'southward belief in establishing a positive, productive organizational culture and providing continual learning opportunities prompted it to develop the WK Innovation Center, a site specifically designed for the provision of system-wide didactics initiatives. Personnel from beyond the system visit this item location for their initial onboarding and they return periodically for a wealth of training opportunities throughout their careers with Willis-Knighton Health System. Such initiatives take greatly facilitated the system's efforts to foster cohesion and collaboration across the network.

Ultimately, matters of discontent are highly addressable with numerous remedies beingness available. Proactive steps can help to ensure the presence of positive, collaborative work environments across the hub-and-spoke network, providing mutual benefits that permit the delivery of outstanding care to patients.

Transportation disruptions

Hub-and-spoke healthcare delivery networks, by their very nature, are reliant on transportation systems, with linkages between hubs and satellites beingness disquisitional for patients to realize the entire continuum of intendance offered past providers [27, 29, xxx]. Common options for satellite-to-hub access include personal transportation, patient ship vans, and emergency vehicles and shipping. These modes of transportation, of grade, rely on transit networks and their accessibility. Municipal road construction projects, bridge closures, bad weather condition, and the similar can create pregnant service commitment obstacles, every bit tin can vehicle breakdowns, traffic accidents, insufficient patient transportation systems, and then along. Some of these are beyond the command of healthcare institutions (e.thou., severe conditions which grounds air ambulances), merely others (e.1000., associates of proper patient transportation systems) tin can be managed with concerted effort and attention.

Willis-Knighton Health Organisation'southward patient transportation division provides basis and air transit services which are delivered past personnel defended to ensuring that patient access needs are addressed throughout the network. Proper servicing of vehicles, aircraft, and equipment helps to ensure readiness and effective operation. Rubber training fosters good habits that reduce the potential for accidents. Area roadways are in adept guild and, in the issue of road or bridge closures, alternate routes are readily bachelor. Willis-Knighton Wellness System has never experienced any significant transportation disruption that hampered the operation of its hub-and-spoke network. Still, providers making use of this model of organisation pattern must not neglect their reliance on transportation systems and do their part to reduce the potential for failures to ensure height institutional performance.

Operationalization

Formulating a hub-and-spoke network ultimately requires that healthcare providers acquire an understanding of the tenets of the associated arrangement design and then direct careful thoughts and deportment toward structuring healthcare delivery, accordingly. Similar to the pathway followed past Willis-Knighton Health Organisation to realize its own hub-and-spoke network, a growth-minded healthcare establishment would simply designate a hub of functioning, often its current establishment, and plan to concentrate the bulk of attributes and abilities at this master campus. Growth then is pursued by building or otherwise acquiring spokes, with these satellite facilities offering a express selection of healthcare services, routing cases requiring more than intensive medical interventions to the principal campus or hub for treatment.

Pregnant try must be directed toward structuring relationships between and amidst network establishments. Service arrays, reporting relationships, and other operational protocols should be defined very clearly. Farther, healthcare providers must take great intendance to ensure that operations are designed and managed effectively to prevent hub congestion, avoid spoke overextensions, facilitate organisation-wide staff cohesion, and foster expeditious access via productive transportation systems. Notably, hub-and-spoke networks are highly adaptable, permitting near whatsoever enterprising healthcare establishment, regardless of its size or mission, to make use of the model to enjoy its many benefits. Realization ultimately is a affair of properly designing, structuring, and maintaining organizational relationships.