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55 Executive Briefing: Perioperative Management and OR Productivity Sponsored by P rogress is impossible without change, and those who cannot change their minds cannot change anything, playwright George Bernard Shaw once said. The healthcare industry is discovering this firsthand. Organizations are grappling with the rapid changes brought on by health- care reform, increased consumerism in healthcare and greater emphasis on value. Hospitals, health systems and their leaders are quickly learning that to continue to suc- ceed in this evolving landscape, they must change not only work processes, but also the mindset and culture of the organization. "Changing culture has been talked about a lot," said Peter Doerner, executive vice president and chief development officer at North American Partners in Anesthesia (NAPA), the nation's leading provider of single specialty anesthesia and periopera- tive services. "The healthcare industry is like a car speeding down the highway. We'd love to pull off onto the side of the road to do what we need to do, but if we do that, the rest of the industry will keep going and pass us. So we need to hang out the window, change the tires and anything else that needs changing, while the car is in motion." The transition from fee-for-service to value- based care has already begun, signaling a new era in healthcare. At a recent round- table hosted by NAPA, 13 of the nation's top healthcare leaders discussed how they are handling the transition at their or- ganizations, especially as it relates to the management of the perioperative service line and the operating room — the biggest sources of revenue for hospitals. In other words, how exactly are healthcare leaders managing to balance the shift from one re- imbursement model to another while keep- ing OR productivity and profitability high? Peter Doerner: Describe the cultural changes you are making in your orga- nization to help ensure a smooth shift from fee-for-service to value-based care. Duke Anderson, President & CEO, Hill- sdale (Mich.) Community Health Cen- ter: We have been talking about organi- zational change and what will likely take place. We have been trying to educate our board, management team, medical team and staff. As an organization, we don't like change at all and we are bound by old habits. So what we've tried to do is bring in experts from the outside to discuss these issues. We've organized special meetings for the board with people from outside. We have tried to open up a dialogue. John Ackeret, Growth & Development Manager, Aurora Health Care (Milwau- kee): We have 1,400 doctors employed. At our monthly staff meetings, the phy- sicians see their [patient satisfaction] scores, which are also posted in physician lounges. We've been doing that for more than two years. Some doctors say, 'That can't be right, I can't control patients and how they manage their care.' But we con- tinue to help physicians with peer-to-peer assistance and other opportunities to help with their patient experience. It's an area we're putting a lot of focus on, and we are trying to help them improve. Dean Gruner, President & CEO, Theda- Care (Appleton, Wis.): We're a seven- hospital system and employ about 40 per- cent of our total physicians. We started, in some respects, ahead of some of the conversations. With the primary care phy- sicians, between 20 to 30 percent of their compensation is tied to quality and local financial performance. In 2010, we really worked hard with our board to talk about the future of payment. The board estab- lished the perspective that fee-for-service is the root cause of problems in health- care. We have 24 percent of revenue [now tied to] total cost of care. Our board was really excited about this and wanted us to go faster, and the indepen- dent physicians wanted us to go slower. When we talked to them about forming our own accountable care organization, we thought it would happen in eight months. It took 22 months. We've had independent physicians who are really not excited about moving to the value-based or risk-based approach. They are very hesitant, and I think part of the reason is they are scared and don't know what works. We have had to go slower than we would have liked. You can't force physicians to go faster than they want, so you have to deal with the reality. Peter Doerner: What are some best practices you have implemented in terms of culture change in the OR? Phillip Kambic, President & CEO, River- side Health Care (Kankakee, Ill.): The big- gest change we have made in the operating room is getting nurses certified with special certifications. Our foundation had a fundrais- ing campaign that raised around $1.5 million for scholarships and applications. Having enough nursing staff and opening up the OR schedule on weekends also makes it easier for physicians to practice there. When phy- sicians have access, they will come to our facility versus another facility. The rest sort of falls into place. We've seen a great increase in volume because of that. Patricia Fox, President & CEO, Riv- erview Health (Noblesville, Ind.): We moved our endoscopy department so we can ensure that the preoperative and post- operative nurses are cross-trained, and we have moved the less complicated pro- cedures to the middle of the day so there is constant productivity. Also, we used to have a surgeon run the OR, but now we have an anesthesiologist. It's truly an or- chestration. You need to have a great scheduler and great team communication to ensure the OR runs efficiently. Managing Cultural Change When Moving From Fee to Value: 11 Healthcare Leaders Respond By Anuja Vaidya