Issue link: https://beckershealthcare.uberflip.com/i/422214
56 Executive Briefing: Perioperative Management and OR Productivity Founded in 1986, North American Partners in Anesthesia (NAPA) is the leading single specialty anesthesia and perioperative management company in the United States. NAPA is comprised of the most respected clinical staff, providing thousands of patients with superior and attentive care. The company is known for partnering with hospitals and other health care facilities across the nation to provide anesthesia services and perioperative leadership that maximize operating room performance, enhance revenue, and demonstrate consistent patient and surgeon satisfaction ratings. Patrick Board, President & CEO, Union Health System (Terre Haute, Ind.): We used to have terrible start times in the ASC for a while. We got the surgeons to carve out some money so as to allocate money to those who arrived on time. We jumped from 50 percent on-time starts to 80-something. It was their own money, and they bonused themselves to start on time. Mr. Doerner: What about technology. What are you all doing from a data standpoint to gather data, in the OR and outside of it, to drive discussions of cultural change? John Di Capua, MD, CEO of North American Partners in Anesthesia (Mel- ville, N.Y.): Ultimately, changing culture and getting initiatives to stick is really a big challenge. I've heard people talk about quality issues, customer service issues and throughput issues. And over the years I've not been very impressed with how we've moved the ball on quality outcomes. For example, wrong-site surgeries should not occur. In other industries, they can go 180 days without an accident. We need better data. Our colleagues at North Shore were looking into improving hand-washing compliance in their hospi- tals. They put cameras at the wash stations by every ICU and found the hand-washing compliance rate was 6.5 percent. They used this data and started giving real-time feedback regarding hand-washing compli- ance in the hospital. The compliance rate went up and is now at 95 percent. We decided to apply the same idea to the OR to improve efficiency. We have devel- oped and implemented remote video au- diting technology for the OR. We put cam- eras in the OR with an outside third-party auditor. Through the cameras, you can ob- serve timeouts and sign-outs, OR cleaning and so on. The independent, third-party auditor collects data, thereby eliminating concerns about bias. We push the data out in a number of ways — LED boards, iPhone apps, etc. The auditors also shoot out messages to whoever you want. So if you want to let surgeons know that the OR is almost prepped for their case, the audi- tor can message the surgeon so he or she knows when to head to the OR. You've got to hit the behavior when it oc- curs. Feedback needs to be timely. It is easy to gain buy-in with this data because it is being collected by an unbiased third party and it is also not a sample. We re- cord every case, every day. The results have been dramatic. We are also starting to use remote video auditing in the ICU. Active management and feedback are es- sential for the success of an OR. The dif- ference between a great OR and a not-so- great OR is leadership. That's something we take very seriously. Barry Tanner, President & CEO, Physi- cians Endoscopy (Jamison, Pa.): We've created our own dashboard, accessible to all physicians, so they can look at their own schedules and drill down into individual metrics, whether infection rates or hospital transfers. All the data is available to them and we can decide if there are outliers. We encourage all of our centers to partici- pate in GIQuIC — a central database. The whole idea, around the country, is to have critical mass of data and figure out what is important and what is meaningful. We are also trying to push data out to physi- cians' smartphones. But, at that stage, an extremely limited amount of data is action- able to physicians. So we want to identify two to three pieces of data that may be actionable to them in next 48 hours to fill block time in schedules. Mr. Doerner: We know that as we move from fee-for-value, particularly a bun- dled model, treating surgeons as cus- tomers is important, and it will be more important as we move to a complete value-based model. What are some of the best practices you've found in get- ting your surgeons on board? Tom Mallon, Co-founder and CEO of Regent Surgical Health (Westchester, Ill.): We have 18 [ambulatory] facilities with hospital partners and we've been do- ing this surgeon-as-a-customer [approach] our whole lives. Surgeons are our part- ners, our customers, and everyone else is a secondary customer. The surgeons, and helping them be more efficient, are the only reasons a surgery center exists. The thing we've seen in our partnerships as we move from surgeon-Regent partner- ships to surgeon-hospital-Regent partner- ships is the magic happening in the board- room. When the CEO and/or CFO are part of our boards, they are on the same side of the table. It's the only meeting every month where the CEO and CFO aren't on the hot seat. The surgeons aren't attacking them. What happens before and after that meet- ing is magical — the distrust and dislike melt away and they collaborate. They treat each other as peers and people, and you can see, after three to four months, they are making deals that never existed prior to them meeting. These are things they are doing outside of the surgery center partnership [regarding] other services they want to do together. John Di Capua: Shadow rounding is an- other great idea. It is great customer ser- vice for surgeons. There is a lot of com- petition for surgeons around the country. Also, block schedule utilization is model we have to break in hospitals. Block schedules tend to waste time. There are many more ways to utilize OR time more efficiently. Barry Tanner: The key is empowerment and partnership. Bring physicians into the conversation regarding block schedules. Get together with them and show them how much block time gets wasted. Also show them how much it costs to staff the OR during that time and how much money got wasted. Physicians tend to do the right thing and they will try and fix it. Joanne Urbanski, President & CEO of South Haven (Mich.) Health System: We try to be very transparent with our commu- nications. We are an independent, 82-bed hospital, so market consolidation is on the forefront of many of our meetings. We have physicians on boards so they can hear our bottom line. We also put out, on a daily basis to everybody, our daily rev- enue. Did we hit our daily revenue? That way, everyone is on board and can see our performance. They can get a snapshot of our performance for the month. Com- munication is key to that transparency. [Physicians] would like to remain indepen- dent too, so there is incentive. n