12 Best Practices for a Successful Hospital Neurosurgery Program

At the neurosurgery department at Northwestern Memorial Hospital in Chicago, surgeons don't try to compete with the physicians in their surrounding communities. Instead, they offer services that complement what these doctors already offer.

At the University of California, San Francisco Medical Center, the surgeons in the hospital's neurosurgery department rely on the latest in new technology, even using surgical instruments that they themselves have designed.

And at Massachusetts General Hospital's Neurosurgical Service, doctors are encouraged to exercise their creativity and entrepreneurial spirit to both deliver better patient care and to improve the department's overall performance.

These are just three examples of how the country's top neurosurgery programs provide the best patient care possible.

Building a top neurosurgery programs isn't easy. But for those hospitals that do it, the rewards, both in service to the community and financially, are immense.

But how is a top neurosurgery department built? Here are 12 suggestions from doctors and administrators at some of the top departments in the country on how to create a top-ranked neurosurgery department.

1. Make patients' needs the top priority. The best neurosurgery programs place the needs of their patients above all other concerns. Providing top patient care, though, isn't as simple as it sounds. It means relying on the latest equipment and technology so that a neurosurgery department provides the best medical care, employing the top surgeons and specialists, and doing the little things that make a patient's stay as pleasant as possible.

At the University of California, San Francisco Medical Center, surgeons in the neurosurgery department not only spend time explaining procedures and recovery times to their patients, they also do the same with these patients' family members.

"We talk to them not only about the disease that they are dealing with, but how they are going to be taken care of from the beginning of the process to the end of their hospitalization," says Mitchel Berger, MD, professor and chair of the hospital's department of neurosurgery. "We are not only talking to the patient, but to the caregiver, too. That is something that we all think is important."

2. Work with all of your hospital's resources. At the Cleveland Clinic, specialists in the neurosurgery department are split into six centers: pediatrics, epilepsy, functional neurosurgery, cerebrovascular, spine and brain tumor.
But that doesn't mean that the surgeons working in these specialties operate as an island. When a neurosurgeon specializing in pediatrics develops a treatment plan for a patient, the physician might meet with a fellow specialist who works in the functional neurosurgery division. That same physician might also meet with hospital physicians outside the neurosurgery department who deal with orthopedics or spinal injuries, depending on the patient's needs.

It's all part of the department's goal to tap into all of its resources to provide the best possible treatment for patients, says Molly Allen, a hospital administrator and manager of the clinic's neurosurgery department.

"When we look at the neurosurgery department as a whole, we acknowledge the differences between each of the specialties," Ms. Allen says. "But we also acknowledge that neurosurgeons are a pretty cohesive group. They work together consistently and cross subspecialty centers when it benefits patient care."

3. Offer a broad range of services. The neurosurgery faculty at Boston's Massachusetts General Hospital boasts a broad range of expertise. The large staff of physicians here treat a wide range of neurological disorders, ranging from those that impact the youngest of infants to those that strike the elderly.

"That is something that you can't find in most other places," says Ron Ash, administrative director of neurosurgery at Massachusetts General. "It allows our faculty to focus in on those areas that they feel they are experts in."

Massachusetts General can do this because it boasts such a sizeable staff. By running a large department, the department can feature physicians that specialize in just about any neurological disorders patients might have, thus broadening the appeal of the facility to its target patient base.

4. Employ the top technology. The field of neurosurgery is constantly evolving. So is the technology that neurosurgeons use to treat their patients. That's why the country's top neurosurgery departments are constantly upgrading their medical technology.

The neurosurgeons at the University of California San Francisco Medical Center rely on intraoperative MRI scanners and image-guided systems to provide for the most precise surgical navigation. Many of the surgeons even use specialized microsurgical instruments that department faculty members themselves have designed.

Department faculty member Michael Lawton, MD, for example, worked with microsurgery tool maker Mizuho to design microsurgical instruments that can be used to perform bypass procedures on patients who have had strokes. This instrument set is known as the Lawton Neurovascular Bypass set, and will soon by released by Mizuho.

"We ask for the absolute best and latest equipment to use in the operating room," Dr. Berger says. "We want every bell and whistle that there is."

5. Encourage creativity. The top neurosurgery departments give their skilled practitioners the opportunity to be creative and develop new ideas and theories.

Neurosurgeons at Massachusetts General Hospital are encouraged to apply an entrepreneurial spirit, Mr. Ash says. Part of their mission is to tap into their own talents to develop new procedures, treatment methods and theories.

One of the physicians at the hospital's neurosurgery department took a one-year endovascular fellowship. This allows him to now work alongside other neurosurgeons and neuroradiologists in the department who also practice endovascular surgery. Taking the fellowship required a serious commitment from the physician, Mr. Ash says. The physician spent a full year traveling to Buffalo, NY, three days a week for the fellowship and then returning to Massachusetts General Hospital for his regular duties.

We encourage our physicians to develop their own skills and techniques and capabilities," Mr. Ash says. "When our surgeons develop their own skills and techniques, it helps us in terms of increasing the breadth and depth of services that we can offer."

6. Encourage specialization. Edward Benzel, MD, chair of neurosurgery at the Cleveland Clinic, seeks the top specialists for his program. Specialists, he says, offer the best possible care for patients.

"Our type of program, with so many people specializing in so many divisions of neurosurgery, makes it more complicated for administrators. But it is much better for the patients," Dr. Benzel says. "The bottom line is that patients are much better served by specialists, by physicians who do what they do arguably better than any other. The bottom line is we do what is best for the patient, and having true specialists as decision-makers and providers is what is truly best for the patient."

The same holds true at the University of California, San Francisco Medical Center, where specialists only concentrate on their own areas of expertise.

"When you are hired into this department, you have to stay in your own domain," Dr. Berger says. "You become an expert. You are not diluted with other things that you have to do."

7. Top care equals more business. A neurosurgery department can't concentrate only on patient care. It must also be strong financially. Fortunately, the top neurosurgery programs have found that the two — patient care and financial success — are related.

Dr. Berger says that because his department has earned a reputation as one of the top centers for neurosurgical treatment, it is never lacking for patients.

"We have established ourselves in this region as the center where patients with complex neurosurgical disorders go," Dr. Berger says. "They know that if they come here they will get the best care they can get."

8. Create a strong residency program. A neurosurgery program is only as good as its talent. That's why administrators at Massachusetts General Hospital work hard at fostering a strong residency program. Such a program attracts the brightest minds to the hospital.

And when Massachusetts General graduates the top doctors from its residency program, this just inspires a further funneling of talent into the program.

"We have a stellar residency program that attracts great candidates," Mr. Ash says. "It's a great starting point for these doctors' careers. And they're here with us for at least seven years. They become well-integrated into the institution. And many of them stay with us."

9. Communication is critical. The administration and medical faculty at Massachusetts General are free to share concerns and ideas with each other at any time, Mr. Ash says. But the communication isn't limited to inside the department. Staffers with the neurosurgery department also discuss patient care and administrative matters with physicians and officials in other hospital departments outside neurosurgery.

As an example, Mr. Ash points to the department's "Grand Rounds." These are weekly meetings that are formal conferences between the neurosurgery department and other hospital departments.

"The communication goes both ways," Mr. Ash says. "It's important to maintain the strong working relationships with other specialists with whom we work. We need those good working relationships to make things work well here."

10. Don't forget about the importance of research. While the focus on most neurosurgery departments is deservedly on the daily care and treatment of patients, the top programs also concentrate on research and education.

Dr. Benzel says he is proud of the research that his physicians do on new techniques and treatments.

"Our goal is to form a tight, cohesive clinical care program," Dr. Benzel says. "Such a program transcends into the research and education arenas, as well, by addressing both research and education in a multidisciplinary and yet focused manner."

11. Work with doctors in your community. When Hunt Batjer, MD, first arrived at Northwestern Memorial Hospital in 1995, the Chicago hospital's neurosurgery program was considered weak, Dr. Batjer says. Dr. Batjer, who is now the chairman of the department of neurological surgery at Northwestern Memorial, had one goal: change this view.

The department now ranks as one of the top in the country. As part of the process of rebuilding the hospital's neurosurgery department, Dr. Batjer reached out to the private physicians in the Chicago neighborhoods surrounding Northwestern Memorial. He wanted to find out exactly what these physicians wanted to see from a top-notch neurological department.

The answers weren't surprising, but they were telling. The physicians Dr. Batjer spoke with wanted quick responses. If they called from the emergency room with a critically ill patient, they wanted to get a physician on the phone from Northwestern's neurology department immediately. And they wanted to arrange a patient transfer immediately, too.

"They didn't want to have to worry about whether that patient had insurance or not … any of that financial nonsense," Dr. Batjer says. "I made sure to tell my faculty to say 'Yes, right away' when these outside physicians called. We still do that."
The physicians also wanted follow-up after they sent patients to Northwestern's neurology department.

"They didn't expect 100 percent success," Dr. Batjer says. "But they did expect 100 percent follow-up."

12. Don't compete with your referring doctors. Dr. Batjer has a theory regarding neurosurgery departments: The bread-and-butter services don't build a department's reputation. It's the highly technical niche services that bolster that reputation, he says, and it's these services that bring in the referral business from outside physicians.

"We are going to have the best people and the best infrastructures to treat the most complex of problems," Dr. Batjer says. "We are not going to go out in the community and try to compete with our referring doctors. We want to be a resource for those practices, not an opponent. We want to offer the services that complement their practices."

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