3 Keys to a Top Hospital Orthopedic Program

This year Hospital for Special Surgery in New York City was ranked first in the nation in orthopedics by U.S. News & World Report. Thomas Sculco, MD, surgeon-in-chief at the hospital, says one of the reasons for its success in orthopedics is its intense focus on the specialty. "It's a very different place because when you walk in the door, you're really walking into a place where everything, from the security people to maintenance people to nurses and physicians, is focused on orthopedic surgery and rheumatology." The hospital's mission as a specialty hospital allows it to apply more resources to orthopedics than other, non-specialty hospitals. By committing to measuring outcomes, managing costs and recruiting top surgeons, however, any hospital can begin to build a strong orthopedics program.

1. Outcomes. "The success of a service line department comes about when outcomes are outstanding," Dr. Sculco says. To ensure good outcomes, hospitals need to develop metrics that will allow them to compare performance to benchmarks and track progress. Hospital for Special Surgery studies outcomes using registries — a collection of prospective patient outcomes information. The hospital's approximately 30 registries track results for various procedures, enabling hospital leaders to determine what processes are working and which ones need to be changed. Once the hospital identifies current or potential problems, it then takes steps to solve them. In addition, although HSS receives recognition for high quality, it continues measuring outcomes and improving processes, Dr. Sculco says. "Everything we do here is geared toward improving what we do. We never rest on our laurels."

2. Costs. Another important factor in the success of a hospital orthopedics program is cost-effectiveness. Managing costs for orthopedics will be particularly challenging in the future as reimbursement declines, Dr. Sculco says. "To maintain high quality care, a high level of nursing care and cleanliness in an institution — all these things cost money," he says. "You need to be financially sound in order to [maintain quality] in a very difficult economic environment, which may potentially get worse." He says hospitals can manage orthopedic costs by analyzing and constantly reevaluating how funds are allocated.

3. People. Dr. Sculco says HSS' success in orthopedics services is in large part due to the people. The hospital looks for physicians who are "not only good surgeons, but good communicators with patients," he says. "[You need] people who are honest about what they do and are team players [in making] the department stronger and the institution better." HSS recruits top surgeons and staff in three ways. First, the hospital has a very competitive residency program: Approximately 600 applicants vie for eight positions each year, according to Dr. Sculco. After five or six years, the hospital then chooses one or two people from among this select group to work full time. Secondly, the hospital features a large international fellowship program in which 60 fellows who are typically some of the most skilled in orthopedics in their country work at the hospital for one to two years. As with the residents, the hospital can choose among this already-select group people for permanent positions. The third method HSS uses to recruit top physicians is actively recruiting the best person for a newly created program. For example, when the hospital created a hip preservation center, it found and offered the job to one of the experts in hip preservation.   

Learn more about Hospital for Special Surgery.

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