Becker's Hospital Review

March 2017 Issue of Becker's Hospital Review

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20 Executive Briefing 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. 4. Implement "Management by Huddle" New PTC and scheduling systems helped GBMC capture complete patient and proce- dure information ahead of surgery. The next step was to create a management system for leveraging this information. The SSEC's solution was to institute a "daily huddle." The daily huddle is a brief operational meeting that takes place every afternoon. Participants include representatives from anesthesia, OR nursing, sterile processing and other key departments. During each 20-minute huddle, the team examines upcoming surgery patients using a rolling 4-, 3-, 2- and 1-day system. They ensure all labs are complete, comorbidities are under control and medication manage- ment is on track. They also scrutinize the schedule for any issues that could slow down patient flow. For instance, they might move diabetic patients to earlier time slots to facilitate glucose control. Or they might schedule all left-side knee replacements to follow each other in the same room, minimizing turnover time. Stronger PTC processes, coupled with careful management by the daily huddle, have helped ensure patients arrive at the OR completely prepared for their surgery. Minimizing last-minute problems has helped create a smoother daily schedule that supports higher utilization. 5. Tap the Power of Anesthesia Lead- ership Anesthesiologists offer significant ex- pertise in OR quality and efficiency. But in most ORs, this expertise goes largely untapped. Hospital executives at GBMC changed this dynamic by inviting the an- esthesia department to take a larger role in OR leadership. The SSEC began by appointing an anes- thesiologist to serve as medical director of perioperative services. This physician provided critical leadership on sever- al efforts to redesign OR processes. As described above, anesthesia led the de- velopment of pre-surgical pathways and standards for testing and patient man- agement. The department also guided ef- forts to standardize hand-offs, strengthen safety checklists, institute pre-operative screening for obstructive sleep apnea, and establish real-time data reporting. These initiatives not only increased safety, they improved overall efficiency by con- trolling the factors that lead to case can- cellations and delays. 6. Use Manufacturing Techniques to Cre- ate a "Future State" OR Most ORs struggle with poorly de- signed processes and staff structures that waste time. At GBMC, inefficient processes created long average down- times between procedures — up to 53 minutes for inpatient surgery. Performance improvement teams com- posed of managers and frontline staff rede- signed room processes and workflows. To do this, they borrowed efficiency principles perfected by manufacturers such as Toyota. For instance, they cut minutes out of turn- over by replacing sequential tasks with parallel processes. Some room tear-down steps can be initiated while the surgeon is closing. That lets clean-up start earlier, allowing staff to set up for the next case in a timelier manner. Supply management was another focus. Previously, the circulating nurse might leave the OR multiple times to retrieve supplies. Redesigning in-room storage and other inventory areas saved time and improved service for surgeons. Designing and implementing a "future state" process map for the OR helped cases run more smoothly. Within months, the average turnover time for all proce- dures (inpatient and outpatient) was re- duced to 31 minutes. 7. Understand the Critical Role of Ster- ile Processing Effective sterile processing standards are critical to OR efficiency and safety — for patients as well as for hospital employees. In most hospitals, however, central ster- ile processing receives little leadership attention. At GBMC, sterile processing workflows and management processes needed improvement. The SSEC addressed these issues by sponsoring a reorganization of the sterile processing department. The first step was to bring in interim leadership to identify department problems and establish ef- fective systems. Over several months, the interim leader realigned SPD processes — from decon- tamination and sterilization to tray assem- bly and storage. This involved improving SPD guidelines, enhancing staff educa- tion, hiring additional team members, es- tablishing accountability and putting a new management structure in place. Spe- cific interventions included establishing oversight for endoscope reprocessing and better systems for monitoring quality events. Overall, the initiatives have helped SPD develop into an efficient and effective team. As a result, instrument set reliability has increased in terms of both accuracy and readiness for surgery. Results: Greater Efficiency, Dramatic Turnaround in Volume These seven strategies — from multidisci- plinary governance to process redesign and enhanced management systems — had a measurable impact on OR efficiency. In less than six months the first-case on-time start rate increased from 67 percent to 75 percent. Together with improvements in turnover time and other measures, these efficiency gains increased OR utilization from 62 percent to 73 percent. Greater efficiency has also had a strong impact on surgeon satisfaction. Thanks to the new block time system, surgeons have reported little trouble scheduling cases. In addition, better schedule flow means they are more able to have highly productive days in the OR. And as pay- ers increasingly watch postsurgical out- comes, GBMC's enhanced pre-surgical optimization and quality initiatives are setting the stage for strong performance under value-based payment. Overall, improvements in efficiency and surgeon satisfaction have driven strong gains in case volume at GBMC. Between 2015 and 2016, OR volume increased 26 percent. This robust growth in surgical services is helping to drive stronger finan- cial results for the entire organization. Lee Hedman is executive vice president of Surgical Directions. Ms. Hedman and col- league Jeffrey Peters will detail more OR turnaround tactics during a "Lunch and Learn" session at the Becker's Hospital Re- view 8th Annual Meeting. Join us April 19th at 7a.m. for "Improving the Performance of Your Hospital's Most Important Service Line: Perioperative Services." Register to- day to reserve your seat - http://www.beck- n

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