Viveka Rydell-Anderson, Esq., serves as Chief Executive Officer at PDI Surgery Center.
On April 2nd, Viveka will speak at Becker's Hospital Review 10th Annual Meeting. As part of an ongoing series, Becker's is talking to healthcare leaders who plan to speak at the conference, which will take place April 1-4, 2019 in Chicago.
To learn more about the conference and Viveka's session, click here.
Question: Healthcare takes a lot of heat for not innovating quickly. What's your take on this?
Viveka Rydell-Anderson: It’s true that new ideas tend to get adopted slowly because there are always ethical, legal, organizational, and financial questions that must be addressed in the healthcare. No-one would like medical teams to rush forward with new ideas that might adversely affect patients. Still, PDI Surgery Center is an example of an organization with a new, and innovative model for treating disadvantaged children in need of oral surgery under anesthesia, and providing case management and oral health education to families, and doing so in a patient-centered and financially sustainable way. Since opening, we have treated over 20,000 children under the age of 7, who were suffering from such severe tooth decay that they require surgery under anesthesia, in a safe manner. Our team has successfully provided this transformation in specialty dental care delivery in Northern California, over a span of about 10 years, in 4 phases:
Planning Phase 2001-2005. It took about three years of planning to: Complete a needs assessment in 3 counties (with input from community clinics and hospitals in the region) Identify and approach investors (in our case, 3 hospital systems in the region who previously carried expensive ER usage burden while not being equipped to treat the patients with abscessed teeth and in pain) Identify size needed, and ideal location, for a site for the surgery center Developing a staffing model for 2 Operatory Room (OR) Ambulatory Surgery Center Completing $1.5M capital campaign through close collaboration with hospitals, clinics, nonprofits, community agencies, foundation, individual investors, and corporations.
Start-Up Phase 2006-2007: Oversee construction Secure accreditation from the American Association of Ambulatory Health Care (AAAHC) and licensing from Center for Medicare Services (CMS), and state licensing. Hire staff, beginning with Administrator, Medical Director and Dental Director. Addressing issues related to professional interests such as buy-in from the dental health community and anesthesiologist and dentist interest and costs Developing a sustainable funding plan and cost analysis
Roll-Out Phase 2008-2013: In January 2008, PDI Surgery Center opened with one OR, and by August 2008, we had secured additional funding to open the second OR, allowing us to care for the 418 children on the waiting list. Treating an average of 2,100 patients/year. Due to demand, parents travel to PDI Surgery Center from 33 Northern California Counties (more than half of California’s counties). Increased efficiency, volume, and decreased turnover times between surgeries.
Expansion Phase 2014-2018: In 2014: developed a comprehensive oral health education and prevention program that reaches over 5,000 families every year In 2016: extended the reach of our services to include special needs patients up to the age of 25, using different equipment and staffing for adults patients, rather than for children. In 2018: Secured funding for a car to transport PDI’s community health workers to community and health-related events, parenting classes, school and after-school programs, and when needed, transport patient families.
Q: Tell us about the last meaningful interaction you had with a patient.
VRA: Gustavo Sanchez, one of our community Health workers/promotor told me about a 12 year-old special needs patient was treated at PDI for severe dental decay. Because 10 teeth had to be extracted, Mr. Sanchez scheduled a follow-up home visit for to check on the patient’s progress and provide assistance on how to prevent further decay (brush the patient’s teeth, eat healthy foods etc.) and help with other possible problems. Mr. Sanchez reported: “The family lives in a disadvantaged neighborhood and their home needs improvement. The front door doesn’t have a door handle and a deadbolt is used to keep it closed. Inside the house is shabby, but clean and comfortable. The patient’s face was still slightly swollen from the surgery two days before, and it seemed that he had not brushed his teeth since then. I asked the mother if she knew how, or if someone had taught her how to brush her son’s teeth, and she replied that no one had ever shown her. (Our oral health educator does show parents how to brush their children’s teeth). I showed her how to brush the teeth using my hand as a model because the boy suffers from severe autism and is tactile sensitive so wouldn’t let me touch him. I recommend that she and her husband use the knee to knee method in order to be able to hold him and brush. I also explain that she needed to start brushing regularly to prevent the loss of more permanent teeth.” After explaining how to take care of her son’s teeth, I helped her to complete an application to the North Bay Regional Center to receive more assistance. We helped schedule a one-month follow-up dental visit at the local community dental clinic.
The family’s problems are mainly lack of good oral health habits, a language barrier (speak a dialect), limited access to resources, financial struggles, and living in a depressed area. The mother will need long-term follow-up and assistance in caring for her son’s health as well as that of the whole family. Outcome: Mr. Sanchez has scheduled a follow-up visit with the mother to assess the outcome of the dental appointment and provide any further assistance necessary. I feel this is a powerful story of some of the social determinants of health and barriers to access facing patient families.
Q: Can you share some praise with us about people you work with? What does greatness look like to you when it comes to your team?
VRA: I believe that PDI is a successful organization because of the passion and innovative ideas of all our staff. Nurse Angela Coffman is an excellent example. She thought of offering children in our pre-op room the choice of walking into the surgery as a super hero or a princess. A simple Superman cape, and a tiara and pink velvet cape, quickly distracts children from what could be scary time as they walk into surgery to start breathing into a bubblegum-scented mask, as they go under general anesthesia. Not only is the child calmed, but so are parents. This simple activity eases everyone’s fears, leading to the patient needing less drugs prior to surgery, and a comfortable awakening in the recovery room.
Another example is when our then case manager, Wendy Lopez, came to me with the concept of an oral health education program. She realized that many of the families we served were totally unaware of good oral health habits or good nutrition and suggested that we should be helping them if we wished to reduce the numbers of children suffering from severe tooth decay. As a result of that suggestion we now have an in-house education program that parents attend while their child is undergoing surgery, and a thriving outreach program with promotores (lay health workers) going into the communities we serve making home visits to at risk families, presenting at community events, schools, and to workers in the wine industry as well as training staff at other agencies who wish to develop a promotores program.
Angela, our lead nurse, and Wendy (now our Outreach and Prevention Education Program Manager) are both typical of all our staff who have a true passion for the families we help, and bring HEART into all aspects of what we do. This enthusiastic buy-in and commitment to PDI’s mission makes for low staff turnover, high employee morale that results in better, more integrated healthcare delivery, and improved health outcomes.