Issue link: https://beckershealthcare.uberflip.com/i/674245
77 Executive Briefing Sponsored by: Surgical Directions is one of the nation's industry leaders in clinical, operational and financial performance consulting, specializing in perioperative services. We also partner with hospitals to develop and implement organizational strategy, improve supply chain, and review workforce and staffing solutions. For more than 16 years, we have demonstrated our success with hundreds of hospitals nationwide, ranging from community-based hospitals to large academic centers. help lead their process improvement teams. Tension between business-minded hospital administrators and the physicians who treat patients on the front lines commonly prevents the two sides from seeing eye to eye when it comes to making changes to the clinical workflow. However, as the imper- ative to transition to a value-based care delivery system grows, hospital leaders and physicians will need to find ways to work together effectively. Identifying, developing and training physi- cian leaders — who are already respected and deemed credible by their clinical peers — will help mitigate resistance and culti- vate the buy-in necessary to make these changes as swiftly and successfully as possible. Anesthesia's role will also change during an OR transformation. Anesthesiologists should take on more of a leadership role by leading the pre-anesthesia testing process and helping identify and remedy issues that contribute to surgeon outliers who have longer-than-average case times. Governance As with any initiative, governance is critical to the continued suc- cess of an OR transformation. The governing body's overall goal should be to oversee and manage the perioperative service line. Representatives should include medical directors of the OR, surgeons in key specialties, anesthesia, nursing leadership and hospital leadership. Typically, the highest volume surgical specialties of a hospital are general and orthopedic surgery. That said, surgeons special- izing in these areas should be involved in the governing body. Hospitals should also engage surgeons from other major spe- cialties offered at the hospital. Beyond creating a governing body, executives should re-eval- uate how the OR is managed. Traditionally, the OR director led the OR. The individual in this role was responsible for pre-ad- mission testing, the OR and the post-anesthesia care unit. This person was not, however, responsible for the OR floor. Because hospitals are now measured on the overall care experi- ence, it is imperative for the OR director to feel a sense of own- ership and responsibility for patients' entire episode of care. The title of the position is evolving to reflect these changes — vice president of perioperative services. If value is going to be measured along the continuum of care, hospitals need a management structure that follows the contin- uum of care as well. Process Redesign and Improvement In addition to a strong governing infrastructure, hospital leaders should establish process improvement teams to as- sess clinical pathways, pre-admission testing, anesthesia and information technology. Executives should consider redesigning or improving upon the following three areas. Clinical processes. Protocols differ for each procedure. For in- stance, in joint surgeries, the key to driving value is getting pa- tients to ambulate before they are discharged from the PACU. The key to ambulating quickly is being pain free, so the role of the anesthesiologist extends beyond just putting the patient to sleep and waking them up; it includes controlling patients' pain, allowing them to walk. Care redesign. A large share of orthopedic and joint patients have, historically, been discharged to skilled nursing facilities or rehabilitation hospitals, which may or may not have the same quality and infection control standards as acute care hospitals. The last thing a hospital leader wants is for a patient to develop complications at a post-acute facility and end up being read- mitted to the hospital. Not only is this bad for the patient, it's bad for the hospital's bottom line. Instead, the goal should be to discharge patients directly to their home or place of residence. Case time. ORs cost between $40 and $60 per minute, so reduc- ing case time also reduces the cost of a surgery and improves patient satisfaction. One of the most efficient ways to reduce case times is to show surgeons their case time data and how it compares to peers. Armed with that data, the outliers will typi- cally identify ways to improve. Enhancing pre-anesthesia testing is another way to knock case times down. Metrics Surgeons are less inclined to respond to maximizing the hospital's opportunities as they are to respond to how reinventing the OR and the perioperative service line can benefit them and their patients. Based on this observation, metrics that are presented to sur- geons should be personalized — feeding their sense of competi- tion — rather than focusing on the organization as a whole. There are three types of metrics that drive value improvement among surgeons: clinical outcomes (including surgical site in- fections, deep vein thrombosis rates, length of stay, discharges home and readmission rates), financial outcomes (including cost of care per surgeon, joint implant costs, supply costs and lab/im- aging studies) and patient satisfaction measures regarding the surgical episode and functionality after the procedure. Chicago-based Illinois Bone and Joint Institute is one example of a healthcare facility using metrics to drive value. As an am- bulatory surgical center, the Institute is able to perform joint re- placements and has used metrics to help send patients home one hour after their surgery. Doing so has dramatically reduced costs and improved outcomes. The way ASCs operate is the way hospitals are going to need to operate their ORs in the future. In this regard, trying to stick with tradition won't help a hospital survive. n