For leadership and collaboration in the OR, look to anesthesiologists

As reimbursements continue to decline and expectations for better quality outcomes rise, perioperative services are fundamental to a hospital's success under value-based models. In fact, perioperative services account for more than 68 percent of hospitals' revenue, according to Lee Hedman, senior vice president of Surgical Directions.

"A lot of people don't realize that perioperative services are really the key to a hospital's success," Ms. Hedman said during a webinar sponsored by Surgical Directions and hosted by Becker's Hospital Review. "In today's healthcare world, value equals outcomes divided by cost, so we have to look at the efficiency of the OR, what the staff is doing, what the supplies and costs are, and bring that all together."

The key to improving efficiency, provider and patient satisfaction and lowering costs in the OR is developing strong leaders. According to Ms. Hedman, anesthesiologists can help lead the way in transforming perioperative services.

Set the foundation for collaborative governance
When Surgical Directions, a Chicago-based specialty healthcare consulting firm, works with a hospital client to strengthen perioperative services, the first thing its healthcare experts do is work with hospital administrators and clinicians to strengthen the perioperative governing body. Here, the primary goal is eliminating the silos that prevent constituents from working together seamlessly.

Surgical Directions has developed a perioperative governance model, called the Surgical Services Leadership Committee, to help align incentives and drive improvement efforts in the OR. The SSEC is comprised of surgical, nursing, anesthesia and senior executive hospital leaders, and is chaired by the medical director of perioperative services.

"Part of collaborative governance is bringing all of the constituents to the table and together creating an agenda to make sustainable change," said Ms. Hedman.

Find a gem among your anesthesia providers

An anesthesiologist will fill the role of the medical director in the OR and chair of the SSEC. Hospitals tend to automatically turn to their chief of anesthesia to serve as the medical director, but this can be a mistake, according to Ms. Hedman, because they are already balancing numerous other responsibilities. Instead, she suggested extending the opportunity to other anesthesiologists who are eager to lead.

However, the medical director position should not just be handed over — applicants should be subject to an interview process as scrupulous as one held with external candidates. The ideal medical director is clinically respected; collaborative; trusted by surgeons, nurses and administrators; has strong decision making skills; and is result-oriented.

Once selected, the medical director is responsible for:

  • Setting the SSEC agenda
  • Determining priorities
  • Delegating tasks
  • Monitoring progress on new initiatives
  • Addressing physician-related issues
  • Working with the OR nurses on scheduling, anesthesia deployment and pre-, intra- and post-operative policies. 

Drive performance in the OR
Performance in the OR is predicated upon a few key factors, according to Ms. Hedman. First, it is important to ensure incentives in the OR align with the hospital's overall mission, as well as with the anesthesia group.

"If you're not all moving toward the same goal, then you're just going to be bumping heads, and that makes for a lot of frustration," she said.

Ms. Hedman also noted that regional blocks — a scheduling system in which patients are processed in a parallel fashion to optimize efficiency — could be beneficial to ORs that have not yet implemented them. Additionally, ensuring pre-anesthesia testing is protocol driven is imperative to success in the OR. All of a patient's comorbidities should be addressed, and the care team should work with the patient's primary care physician and cardiologist to ensure he or she will have a positive outcome.

Optimize PAT
When redesigning PAT, the goal is to create a standardized process that can be replicated for each patient and improve the coordination of care among clinicians, according to Yvette Stanley, a project manager with Surgical Directions.

"Pre-anesthesia testing requires support from the administration, anesthesiologist, primary care providers and nurses," said Ms. Stanley. "There must be a standardized pathway to get the patient cleared with anesthesia at the forefront."

Partners such as Surgical Directions can help OR leaders optimize PAT in three main ways. First, optimized PAT improves clinical outcomes by proactively managing patients' comorbidities, which helps prevent post-surgical complications and readmissions. Second, it enhances OR efficiency by improving first case on-time starts and decrease case delays and cancellations, thereby improving patient and provider satisfaction. Finally, it can also help bolster the hospital's financial performance by decreasing the length of stay, readmission rates and surgical site infections. 

Develop a collaborative approach
At Surgical Directions, a collaborative approach is cultivated through the development of performance improvement teams, according to Ms. Stanley.

"It's essential to engage staff and involve them in decision making, or process optimization," said Ms. Stanely. Often, staff don't feel empowered enough to speak up, even when they are not satisfied with the way something is done. With PITs, input from staff about improving efficiency and eliminating waste can be included.

One integral element of collaboration in the OR is the daily huddle. These meetings involve the medical director, anesthesiology, scheduling coordinator, service line coordinators, posting office, central supply manager and perioperative nurse director and manager. By bringing all of these constituents together, the OR can better coordinate resources, reduce inefficiencies, improve real-time decision making, reduce handoffs and make for a more predictable day for both nursing and anesthesia.

Although perioperative care has comprised a significant portion of hospitals' revenue for years, the current transformation in healthcare to value-based care delivery models is accelerating the need to improve efficiency, eliminate waste and enhance collaboration in the OR. Anesthesiologists are poised to take the lead, and with effective partners, OR governance models and protocols can be refined to provide the necessary support. 

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