5 Overarching Strategies to Drive Perioperative Performance
Mr. Peters and Dr. Young shared a case study of a hospital's OR that originally had low patient satisfaction, weak management and poor quality and financial outcomes. The department reversed these trends by gaining the support of a new hospital CEO, working with a new anesthesia group, creating a collaborative governance structure, appointing a new OR director, revising block time policies, implementing physician report cards and creating a culture of safety.
1. Anesthesia. The hospital recruited anesthesia providers to drive perioperative performance by granting them leadership positions and aligning incentives. The anesthesiologists received financial rewards for increasing patient volume and a stipend for fulfilling certain service standards, including increasing the availability of regional blocks, accommodating add-ons and participating in the OR's daily huddle, a process in which the OR team discusses issues from recent cases and prepares for the next day's schedule.
2. Collaborative governance. "Many physicians don't get leadership training or mentoring," Dr. Young says. "We taught them how to think beyond their individual specialty to think more collectively — where anesthesia, nursing and surgeons were coming together to think what's best for the hospital." A daily huddle plays a large role in developing a collaborative governance structure. The huddle should include the OR director, the co-medical director and representatives from preadmission testing, central sterile processing, materials management, scheduling and case management/discharge planning.
3. Block time. In the past, the hospital in the case study had variable lengths of block time, did not measure utilization consistently, made all release times 24 hours and had no open rooms. During the perioperative transformation, Surgical Directions helped the hospital focus on eight- or 10-hour blocks, set a goal of 75 percent utilization, vary release time by specialty and keep 20 percent of rooms open for non-block surgeons to operate.
4. Report cards. Physician and anesthesia report cards were created based on efficiency metrics, such as first case on-time starts, turnover time and chart completions prior to the day of surgery.
5. Safety. The hospital adopted Surgical Directions' "10 points for Safer Surgery":
• Create a surgical services executive committee and assign anesthesiologists as co-medical directors.
• Standardize the process/form for surgical scheduling.
• Establish a pre-anesthesia testing center with standardized protocols/hospitalists.
• Implement a document management system for scheduling/PAT.
• Achieve excellence in sterile processing and supply chain management.
• Manage crew resources.
• Implement the World Health Organization checklist/a transparency board.
• Begin a daily huddle.
• Ensure anonymous electronic error reporting.
• Create a just culture.
After these steps, the hospital in the case study became the most improved hospital in its 13-hospital health system for surgeon and patient satisfaction and increased its market share by 3 percent and its volume by 22 percent. The hospital also increased its bottom line from $3 million to $11 million and decreased the average length of stay by 11 percent.
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