This content is sponsored by Sheridan Healthcare.
As the healthcare industry works to reinvent itself to contain skyrocketing costs while improving quality of care, providers must grapple with a significant degree of uncertainty about the future. Not knowing what lies in store can be frightening. However, Adam Blomberg, MD, national educational director of the anesthesiology division at Sunrise, Fla.-based outsourcing services provider Sheridan Healthcare, prefers not to look at this as a time of trepidation.
"I really believe that this is a time for opportunity," he says. "It's really a time to make a mark."
He says hospital-physician alignment is a crucial part of taking advantage of that chance to shape the future of healthcare. While hospitals and physicians have historically acted as separate entities, Dr. Blomberg says it's important to establish "one solid voice" moving forward for the sake of the patients.
As hospitals and physicians come together, physicians can make a positive impact by championing hospital initiatives to deliver better, more efficient care at a lower cost. Dr. Blomberg has experienced this through his work as vice chief of anesthesiology at Memorial Regional Hospital in Hollywood, Fla.
The value of physician leaders is only going to increase, says Joseph Loskove, MD, Sheridan regional medical director and chief of anesthesia for Memorial Healthcare System in Hollywood, Fla. Physician leaders can bridge the gap between the different ways physicians and hospital administrators approach healthcare delivery.
"The role of the physician leader is to understand both sides of the approach and serve as a mediator between the physicians and administrators," he says.
Dr. Blomberg says the hospital and physician can only succeed if they join forces, since the hospital knows how to run the business while physicians understand what the patients need.
"You need to have physicians championing initiatives within a hospital setting, but you need the hospital administration to be involved to understand the budgeting and the financing," he says.
Dr. Edward Abraham, chief of anesthesiology at Baptist Hospital of Miami, agrees that alignment between healthcare providers is crucial to improving care delivery.
"Collaboration between the hospital staff and the physicians and the nurses and the hospital is vital," he says.
Better outcomes, lower costs: How physicians can make a difference
Dr. Blomberg had a chance to drive change at Memorial Regional in his role as a member of the surgical services executive committee, which is made up of hospital executives as well as anesthesiologists and surgeons.
He says that in response to the changing industry landscape, the committee decided to align surgeons, anesthesiologists, physicians and others to increase volume, maximize efficiency and increase surgeon and patient satisfaction. To accomplish that, he says they completely revamped the operating room.
He and the other members of the committee put together other committees and a task force. After examining volume, efficiency and materials management, they redesigned block time and reengineered patient flow, among other changes. He says the results have been "wonderful for the hospital."
"Volume has increased," he says. "Surgeon satisfaction and patient satisfaction is extremely high. Efficiency is better than ever. And the reason that this happened is we all got together with one common goal."
Dr. Loskove has also championed initiatives that require multi-disciplinary teams to collaborate and solve problems. In one case, Dr. Loskove and team members from nursing, IT, purchasing and respiratory therapy, as well as physicians from the emergency department, ICU, and trauma surgery, came together to create a process that would increase safety and outcomes for patients with difficult airways.
Since a nationwide search for best practices was not fruitful, the team collaborated to develop a "difficult airway notification system" ensuring a patient's airway status was communicated to the entire healthcare team and that the necessary intubation equipment was readily available in all of the health system's six hospitals. The new protocol went live in February 2012.It focused on three key factors: identifying a patient as difficult to intubate, communicating a patient’s DTI status to all medical staff via blue wrist band and medical chart notation and ensuring equipment was standardized throughout the six hospitals in a manner identical to a "code" cart.
"The medical staff's teamwork has greatly benefited our patients who have tenuous airways," says Dr. Loskove. "It is this type of leadership, collaboration and alignment with hospital goals that is central to the success of any initiative."
At Baptist Hospital, Dr. Abraham has also spearheaded initiatives to produce better outcomes. One of those projects involves improving blood management and reducing blood transfusions. He says anesthesiologists, oncologists, gastroenterologists and other specialists have collaborated with the hospital and physicians on the medical staff to make patient outcomes better while simultaneously reducing costs.
They have worked to lower transfusion triggers and increase blood conservation. They have also started looking to test patients scheduled for elective surgery for anemia and self-salvaging, or collecting the patient's own blood with machines during procedures and giving it back to them.
"I think we've done a good job with reducing transfusions, and our outcomes are better because our patients are having fewer complications with transfusions," he says. "And we've also been able to shorten our length of stay."
Learning to trust and accept change: Challenges for physician-led initiatives
Despite the positive outcome, Dr. Blomberg says hospital employees and administrators weren't necessarily comfortable with the OR revamping initiative at first, even though they weren't happy with the existing protocols at that time.
"Everybody's scared of change," he says. "They're scared of uncertainty."
Dr. Blomberg says he and the other committee members were able to get people on board by making sure everyone was involved in the initiative.
"We didn't just use physician leaders, nursing leaders and hospital leaders," he says. "We had the "front line" staff become involved in task forces as well. By getting all of these individuals on the task forces, the individuals on the ground and not just the leaders, we really had motivation. We really had buy-in."
In spearheading the airway status notification system, Dr. Loskove found that a lack of trust between physicians and hospital administrators posed a challenge. He says physicians will say administrators don't understand what clinicians are trying to do, while administrators can be skeptical of whether the resources physicians request are truly necessary.
That's where physician leaders come in. "Look at my role as an anesthesiologist," he says. "If we're going to change the OR model to be more cost effective…there's certainly going to be some growing pains along the way. The surgeons trust me that we're doing all this for the patients' best interests and [their] best interests. It's just going to take a little bit to get there. To hear that from an administrator, I'm not so sure that would work."
Conclusion
Ultimately, Dr. Blomberg says hospitals and physicians need to work together to benefit their patients.
"Physicians and hospitals have to align first and foremost for the patients," he says. "You have to have everybody at the table and try to align their interests as best as possible. They have to be on the same page, because patients suffer if they're not."
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