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Ballad Health ED Throughput

FY25 Strategic Priority Goal

Isaac B. Mitchell, FACHE, PMP, LSSBB

VP, Project Management and Operational Excellence

Isaac.Mitchell@balladhealth.org

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7/4/25

Ballad Mission & Vision

To honor those we serve by delivering the best possible care.

To build a legacy of superior health by listening to and caring for those we serve.

NorthStar Goal: Become employer of choice

Progress towards Purpose: Obtain 50th percentile performance in “I would recommend this organization as a good place to work” by FY27, and achieve between 50th and 75th percentile thereafter

*Hire & retain permanent staff in critical shortage areas

*Implement Ballad Health Academy

*Reeducate Ballad Health Values

*Optimize limited staffing resources with automation, AI, improved workflows

*Evolve patient flow to match patient demand

*Improve caregiver safety and well-being

*Increase TM childcare access

NorthStar Goal: Consistently deliver value through high quality, low-cost care

Progress towards Purpose: Achieve Top Health System Performance on Ballad Balanced Scorecard by FY30

*Advance Ballad’s High Reliability Organization journey

*Focus on throughput

*Evaluate and implement consumer access strategies

*Accelerate virtual health

*Ensure Ballad’s place as the preferred access point using consumer facing technology

* Utilize advance analytics & intelligence tools to support quality & value-based efforts

NorthStar Goal: Financially thrive as an integrated delivery system

Progress towards Purpose: Reach and maintain Operating Margin of at least 4% by FY30

*Optimize cash flow

*Utilize Capital to invest in growth opportunities

*Pursue inpatient and outpatient growth

*Ensure positive VBC ROI

*Use enhanced data analytics tools & standard work to improve VBC performance

*Increase efficiencies across and access to BHMA

*Increase alignment with provider partners

NorthStar Goal: Become a national model for improving rural health

Progress towards Purpose: By FY35, save 100,000 Years of Life; reduce Infant Mortality by 10%; and reduce YPLL disparities among our counties by 20%

*Target interventions to reduce future Years of Potential Life Lost (YPLL)

*Expand primary care and behavioral health access

*Improve health of the next generation through Strong Starts & childcare capacity

*Streamline care mgmt processes & integrate universal social needs screening

*Promote access Niswonger Children’s Network

Objectives

Strategies

(MAP)

Long-Term

Goals

Vision

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NorthStar Goal: Consistently Deliver Value Through High Quality, Low-Cost Care (Value = Quality + Experience/Cost)

Strategy #2

Executive Convenor/Council 

Key 6-month Tactics 

(by  12/31/24)

Key 12-month Tactics

(by 6/30/25)

FY25 KPIs & Targets

FY26 Tactics

(by 6/30/26)

Focus on Throughput, including ER, surgery and length of stay management

Eric Deaton/Tony Keck (Ops Council)

Lisa Carter/Chad Couch (SVP Convenors)

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  1. Complete OE project focused on admitted patients from the ED at tertiary facilities 
  2. Implement centralized incoming EMS traffic to remaining Ballad facilities
  3. Development of a system wide surgical strategic plan to evaluate sites of service, resource allocation, and costs (focus first on general surgery, ortho surgery, neurosurgery)
  4. Expand enhanced recovery after surgery (ERAS) protocols across additional surgical specialties (focus ortho) and increase adoption across General Surgery as part of the co-management agreement 
  5. Evaluate potential value of hiring ambulation aides (joint effort between finance and clinical leadership)

Process KPIs:

  • Meet targets for the five General Surgery ERAS co-mgmt. agreement metrics (5 of 5)
  • Complete general surgery strategic plan (Y/N)
  • Complete ortho surgery strategic plan (Y/N)
  • Complete neurosurgery strategic plan (Y/N)

Outcome KPIs:

  • SSI Colon (<3.60)
  • DVT rate? 
  • ED decision to admit to departure (170 min)
  • Expand enhanced recovery after surgery (ERAS) protocols across additional surgical specialties – focus on gyn
  • Develop plan to implement early ambulation focus for surgical and non-surgical patients to improve recovery time in FY27

 

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OKRs

Objective: Improving the Median Admit Decision to Admit Time for inpatients including the transport time for the patient to get to room.

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Key Results:

  1. - Decreasing the dispo to bed request time to under 170 minutes for the tertiary hospitals
    • JCMC 371 to 170 minutes
    • HVMC 238 to 170 minutes
    • BRMC from 114 to 170 minutes
  2. Minimize the time it takes to get a patient in an assigned bed to (x) for the tertiary hospitals.
  3. Thoroughly assess the number of hold patients in the Ballad system.

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Smartsheet Dashboard

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Smartsheet Dashboard: Lagging Metrics

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Smartsheet Dashboard: Leading Metrics

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Bristol Regional Medical Center: ED Throughput Dashboard

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Holston Valley Medical Center: ED Throughput Dashboard

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Johnson City Medical Center: ED Throughput Dashboard

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Data Governance Committee

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Epic Source Data

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Ballad Health News Article