At Sacred Heart Hospital, a 344-bed hospital in Eau Claire, Wis., that is part of Hospital Sisters Health System, in addition to these techniques, an additional strategic lever is being pulled and producing impressive results. Revolutionary technological advancement within the Hospital’s Brain and Spine Institute has not only redefined the neurosurgery service line, but transformed the entire organization. The service line has grown by leaps and bounds, its clinical quality has never been greater, and its financial performance has gone from indifferent to indispensible. The impact on the Hospital as a whole? It has evolved from a community hospital serving a relatively small, local patient population into a vibrant medical care destination center for patients throughout Western Wisconsin.
Sacred Heart Hospital and The Brain and Spine Institute
By using state of the art technology acquisition and integration as the driver to establish the Brain and Spine Institute, Sacred Heart Hospital has created a world-class neurosurgery program and simultaneously paved the foundation for a pathway to tertiary care development throughout the institution.
The Brain & Spine Institute has evolved from a focused program reliant on a single neurosurgeon to a comprehensive institute providing the complete spectrum of neurosurgical care. Today, the institute’s three neurosurgeons provide neurosurgical care to address the full spectrum of brain and spine disorders:
Technology as a strategic lever
Technology as an enabler for visionary clinical leadership
In 2000, as the hospital’s CEO assessed the changes in the local and national health care markets, it became clear that Sacred Heart Hospital could no longer afford to only be recognized as a very good community hospital that delivered compassionate, mission-driven care. In order to compete and thrive in the 21st century, the Hospital needed to evolve into a tertiary care medical center known for delivering state of the art medical care. Sacred Heart Hospital had the resources and System support necessary to make this leap; however, one vital ingredient was missing — a visionary physician leader to define and drive the clinical practice of the future.
How could Sacred Heart Hospital recruit and retain the very best and brightest physician talent? By combining a passion for patient care excellence with a commitment to investing in the technology of the future, the hospital was able to recruit the physician talent and leadership required to redefine the future of the neurosurgery service line and ultimately that of the entire hospital. Two neurosurgeons agreed to join the neurosurgical program, with Kamal Thapar, MD, PhD, a Marshfield Clinic physician, agreeing to serve as the medical director responsible for the development of a world-class neurosurgical program.
Dr. Thapar partnered with the hospital’s administrative leadership team to chart a deliberate course to fundamentally redefine the depth and breadth of neurosurgical services. As expected, this plan clearly outlined specific, measurable goals related to maximizing quality, service and growth outcomes while optimizing financial efficiency. The unique and differentiating factor in the approach to this plan was that the cornerstone for it, and most pivotal aspect of future success, would be repeated, deliberate investment in game-changing technological advancements.
Establishing the operational/clinical foundation
Before the Hospital invested in leading edge technology, it recognized that a solid and safe operational and clinical foundation needed to be established throughout the neurosurgical service line. This required a comprehensive approach to reconstructing the program from the bottom up:
- Dr. Thapar, as medical director, was provided the time and had the authority to lead the program strategically, clinically and operationally. An administrative dyad structure was employed to assure alignment and accountability for the hospital’s ability to achieve the required results within the neurosurgery service and across all supporting departmental lines.
- The neurosurgeons collectively agreed to provide 24/7 coverage for emergency services, participate in outreach, and accept all cases regardless of ability to pay.
- Establishment of a new procedure for clinical grand rounds that included weekly interdisciplinary case reviews to fully engage the medical staff and provide ongoing education as an accredited continuing medical education program.
- Building a dedicated team of expert neurosurgical clinicians:
- Dedicated operating room team and operating rooms.
- Just-in-time training on technology and procedures for all clinical staff
- An expert trainer to validate staff competence, support training and facilitate problem resolution.
- Formal team communication structures; reward and recognition for employees.
- Maximizing utilization of all clinician skill sets within the full purview of their license — e.g. a clinical nurse specialist to coordinate patient care and maximize the time of a neurosurgeon. This allows for effective delegation and time management to occur, which is pivotal to the success of the physician leader who requires time to globally think and plan as well as practice surgery.
Sacred Heart Hospital Brain and Spine technology investments over time
With the operational and clinical foundation coming together, the hospital was in a position to begin to lever leading-edge technology within the neurosurgery service line to create marked differentiation from its competitors. During the years 2003 – 2007, the following incremental investments in technological advancement played a key role in advancing the service line:
- BrainLAB neuronavigational system for image guided surgery (2002-2003)
- Interventional neurosurgical laboratory – Biplane Angiography Suite (2003)
- Siemen’s surgical c-arm – ISO-C-ORBIS (2004)
- Siemen’s surgical c-arm – ISO-C-ARCADIS (2006)
As the data in following section of this paper details, there is no doubt that this incremental investment strategy delivered tremendous dividends in repositioning the neurosurgery program as the market leader, resulting in impressive volume growth and strong financial returns. Despite how well the strategy was playing out, in the years 2008 – 2010 the hospital and Dr. Thapar decided it was time to shift from the incremental investment approach that served the neurosurgery program so well, to a quantum leap investment strategy designed to not only redefine neurosurgery, but to redefine an entire hospital.
Not surprisingly, this quantum leap in technology advancement required a commensurate leap in the amount of capital resources required. The traditional capital investment analyses that focused on the clinical and financial returns associated with the utilization and pricing structure for a singular piece of equipment needed to be replaced by a systems thinking approach that could predict and quantify the impact not only within the neurosurgery program, but on the overall hospital and other developing tertiary care service lines. This paradigm shift in capital planning requires extensive analysis and modeling of downstream strategic value and spinoff revenues. This was Sacred Heart Hospital’s experience as it transformed its neurosurgical operating rooms into two Smart ORs — a level of technology investment and innovation that is rivaled only by a handful of hospitals in the world.
Technology Investment impact at Sacred Heart Hospital
Service line specific impact
The incremental technology investment strategy, coupled with the bold investment strategy that resulted in the acquisition and creation of the Smart ORs, has without question delivered enormous strategic, financial and clinical benefit to the neurosurgery service line.
Patient volume in neurosurgery has risen dramatically since the beginning of the decade (Figure 1) and the program’s market share correspondingly increased to become the market leader for the past three years (Figure 2). The volume growth and technology advancements drove significant improvements in financial performance. By the middle of the decade, neurosurgical contribution to overhead had risen from break-even performance to better than $3 million a year. After the Smart OR opened in 2008, financial performance catapulted to nearly $6 million in 2009, despite volume remaining essentially stable. Moreover, 24/7 coverage and support of the emergency department led to improved contribution to overhead for neuro-related patients that entered through the ER (Figure 3).
Importantly, at the same time the neurosurgery program’s patient volume and financial performance improved, neurosurgery patient satisfaction scores increased (most recent three years is only data available) (Figure 4).
Finally, and the most meaningful outcome of the philosophy to marry technological innovation with Sacred Heart Hospital’s Franciscan mission, has been the positive impact on patient results. Preliminary studies of the iMRI Smart OR have demonstrated that in 15 out of 47 cases, surgeons at the Brain & Spine Institute were able to remove residual tumor/suspicious tissue before completing the surgery. Prior to the Smart OR, these patients would have required subsequent surgeries to try and remove the residual or suspicious tissue (Figure 5).
The “Halo-Effect” – Hospital-wide impact
The development of the neurosurgery program at Sacred Heart Hospital over the past eight years offers an important lesson in understanding how redefining a key clinical service can elevate an entire organization and numerous other tertiary care programs. This “halo-effect” that can result in the bolstering of other service lines occurred at Sacred Heart. From 2005 – 2010, the hospital’s other three key service lines, orthopedics, cancer and cardiology, all experienced steady growth in contribution to overhead — fueled by higher acuity cases in each service line resulting from the halo-effect that enabled them to develop the full spectrum of services. Despite the improvements in these services and their ability to care for high acuity patients, during this same time period patient volume declined overall. This is entirely consistent with national trends where more and more of the less acute, outpatient services have transitioned to free-standing or physician owned facilities.
Beyond the neurosurgery and other tertiary care service lines noted above, it is not surprising that Sacred Heart Hospital’s operating margin in total has followed a similar upward trajectory as the investment in technology has uniformly maximized volume, quality and operating performance. The opening of the Smart OR, in concert with a hospital-wide initiative to reduce discretionary operating expenses, has elevated the financial performance of the institution to levels heretofore not experienced in the past 15 years. Presently, the hospital’s total operating margin is increasing by nearly two percent per year since 2008 and is projected to increase again in 2010. Furthermore, after an initial investment of $8.9 million for the iMRI and iCT Smart ORs, neurosurgery alone has contributed to the bottom line by nearly $2 million in the first 18 months of operation.
Community impact
The strategic, clinical and financial benefit across tertiary care service lines to the hospital is well documented in the improved margins, clinical capabilities and acquisition and retention of physician talent. The technological revolution that the Brain and Spine Institute has driven at Sacred Heart Hospital has also had an impact outside of the hospital’s walls. Although more difficult to quantify, it has resulted in job creation and talent infusion within the medical community, and area businesses outside of the health care industry have benefitted from the opportunity to provide the necessary technology infrastructure, construction, renovation and other supporting services.
What the future holds…
Specifically for the Brain and Spine Institute, it has become a learning site as designated by BrainLAB to extend the benefits of this technological integration to other neurosurgery programs and physicians looking to redefine patient care and potentially elevate overall institutional performance. Efforts are also underway to establish the Brain & Spine Institute at Sacred Heart Hospital as a destination center of excellence for the entire Hospital Sisters Health System.
For the hospital-industry as a whole, it has just begun to tap into the vast capabilities that leading edge technologies bring to the table. In the not too distant future, investment in state of the art technology that fundamentally changes how care patient is delivered and financial performance is maximized may become the rule, not the exception.
Acknowledgements: The author wishes to acknowledge the following individuals for their valuable assistance in researching this article: Steve Palecek, CPA, Controller, Sacred Heart Hospital; Susan Peiffer, MS, MT (ASCP), MHA, Performance Improvement Coordinator, Sacred Heart Hospital; Cheri Roesch, MS, Program Coordinator, Brain and Spine Institute, Sacred Heart Hospital; Carrie Ronstrom, student researcher, College of St. Scholastica, Duluth, MN.
