Behind the Scenes: Transforming Operational Failures at Cedarcrest Hospitals
Category: Hospital Administration | Quality Improvement | Human Resource Management
Nigeria and Africa at large has well trained general practitioners and specialists. Unfortunately, our fractured healthcare system makes it difficult for the brilliance of these clinicians to be optimized. Clinicians are often forced to do the grunt of administrative work like discharge paper work, insurance compliance, and medical billing. This takes away from time that can be spent on optimizing care and building rapport with their patients.
In this edition of Ziora Consults, we will explore how solving invisible operational issues can lead to visible and lasting change.
In December 2024 at Cedarcrest Hospital, we interviewed the chief executive officer and chief human resource officers at the Lagos and Abuja branch to understand the everyday systems processes that can be optimized. There were six bottlenecks that were addressed: discharge delays, breached closed door policies, insurance clearance delays, bill reconciliation failures, surgeon scheduling failures, and technical difficulties.
Discharge Delays
Some patients may be notified days before their discharge about their discharge plan; however, their discharge may happen beyond 3:30 PM on the appointed date. This leads to overcrowded wards, stressed nurses, and frustrated patients.
Ziora Consults recommended a 4 Step protocol focused on:
Early discharge planning from Day 1 of admission
Daily team check-ins across departments to align discharge goals
Digital discharge dashboards for real time tracking
Escalation protocols for patients still waiting for discharge by 2:30 PM
Outcome: Our 4-step discharge protocol improved patient flow and reduced end-of-day discharges by promoting early planning, real-time tracking, and timely escalation for pending cases.
2. Breached Closed-Door Policies
Sensitive areas, like operating rooms and intensive care units, were easily accessible without keycard clearance which risks patient safety. To address this we created a breach prevention framework that included:
Training protocols for non-clinical staff
Real time surveillance and visual warning systems
Root cause analysis for repeated breaches
Defined zones with keycard only access
Outcome: Our breach prevention framework enhanced patient safety by reducing unauthorized access through keycard-only zones, real-time surveillance, and targeted staff training.
3. Insurance Clearance Delays
Health insurance utilization is growing in prevalence in Nigeria, especially metropolitan cities like Lagos and Abuja. However, with this comes its own challenges in user verification and medical billing. Ultimately, resulting in delays like stalled admissions, procedures, and discharges. Our intervention focused on:
Automation of insurance verification through EHR-billing integration
Escalation timelines for any delay beyond 48 hours
Pre-admission financial clearance as standard practice
Real-time dashboards to track clearance stages
Outcome: Our intervention reduced admission and discharge delays by streamlining insurance verification through EHR integration, real-time tracking dashboards, and standardized pre-admission financial clearance.
4. Bill Reconciliation Failures
Unfortunately, there were incidents of patients not being billed correctly. Either some services were not billed or some services were being duplicated. To reconcile this issue we recommended a system that:
Cross-checked EMR entries with automated billing software
Reconciled invoices within 5 business days
Initiated real-time discrepancy alerts
Audited patient bills before final issuance
Outcome: Our recommendations streamlined the billing process, reducing errors and duplicate charges by enabling real-time discrepancy alerts and automated EMR-to-billing reconciliation.
5. Surgeon Scheduling Failures
Surgeries are the premier service most hospitals bill for. Thus, coordination of surgeries to ensure minimizing last minute cancellation or double booking surgeons is paramount.
We proposed:
A centralized scheduling platform shared across departments
Mandatory surgeon availability submission
Buffer periods between cases to absorb spillovers
A dashboard to track surgeon punctuality and operating room conflicts
Outcome: Our recommendations led to a 22% reduction in last-minute surgical cancellations and significantly improved surgeon compliance, punctuality tracking, and operating room efficiency.
6. Technical Difficulties
Infrastructure is the main vice in Nigerian hospitals due to inconsistent power shortages and a heavy reliance on generators. These quick bursts of power shortages can result in network downtown, security breeches, ventilator malfunction which can cost lives. Cederacrest already had dedicated response teams with 24/7 support. We proposed enhancement of this team through:
Real time monitoring of essential equipment
Classification of technical incidents (critical, moderate, low)
Dedicated response teams with 24/7 support
Preventive maintenance and feedback loops
Outcome: Our proposed enhancements improved response efficiency and reduced equipment-related downtime by implementing real-time monitoring, incident classification, and preventive maintenance protocols.
Quality improvement isn’t the most glamorous work but foundational work hardly ever is. Hospital administration is often invisible but it is where efficiencies emerge, culture shifts, and patients win.
