How can hospitals replicate the ASC experience in their inpatient surgical department?
"Physicians are a shared decision-making body in the ASC world, and when surgeons own part of the center they are involved," said Matthew Kossman, Vice President-Perioperative Services at Surgical Care Affiliates at the Becker's Hospital Review 6th Annual Meeting during a presentation titled "Creating an ASC Experience in Your Hospital Surgical Departments." "They get deep into staffing and finances, and it impacts their financial situation. They have a vested interest in making sure patients have a top experience."
The key points to shifting the OR culture include:
1. Make quality and safety a top priority
2. Develop clear strategic objectives with the operating plan
3. Promote high accountability among everyone
4. Engage physicians in shared management
5. Teamwork should focus on meeting the mission
6. Place patient needs first
7. Support openness and transparency
"From a results standpoint, top-performing hospitals are comparable to the ASC setting when it comes to on-time starts and turnover times," said Mr. Kossman. "They can go head-to-head with ASCs and have the same results. We partner with top performing hospitals that have the natural success we would expect and the type of volume you want in hospitals."
For example, one orthopedic-focused hospital had nine operating rooms and 55 percent of the case volume was orthopedic-related. The hospital didn't have good numbers when Surgical Care Affiliates began working with them; but SCA identified and assessed the issues, many of which came from how the physician team worked with the anesthesia and nursing teams.
"People weren't working together and there was a lack of recognition around peoples' skill sets," said Mr. Kossman. "There were nurses who didn't have experience working with a surgeon or a certain procedure. That leads to a high level of dissatisfaction. They had one large orthopedic group that was becoming dissatisfied with the hospital; patient satisfaction was at the 25th percentile."
The orthopedic group considered leaving the hospital, but as SCA began to work with them, they organized a specialty team model based on preference and need. Staff were assigned cases based on the different procedures done within the hospital, and provided education to make sure they were competent.
"It increased the skill level and competencies of everyone," said Mr. Kossman. "Surgeons spent more time with nurses who had a special interest in that case and figured out how to work with them as a team. Ultimately that drove a new process for improved efficiencies and patient safety."
In a second example, an ASC wasn't starting on time and had high add-on rates and turnover times. That led to surgeon complaints, inefficiencies and longer staff hours per case. The lead surgeons were complaining and there was significant overtime.
SCA helped the ASC revise their strategy for utilization and optimization for overall strategic growth. They aligned with staff members to focus on workflow and optimizing productivity. Data helped the center "predict the unpredictable" and manage capacity better. Utilization increased and the providers were able to make real-time decisions.
The center looked at historical case volume and how long cases took. They also considered case hours and staffing hours to schedule cases effectively. The center used a staffing model and found how overstaffed they were. The center then began sending staff members home early when possible. They also began projecting when they'd be short-staffed to add extra hours. They tracked outcomes to make sure the changes were having a positive impact.
Finally, in a third example, there was an issue with patient scheduling at a large hospital with 28 operating rooms. Their scheduling process was outdated and their physician officers weren't friendly. Many physicians covered more than one hospital and the patients felt the outpatient services were lacking. Surgeon offices weren't able to connect with a receptionist to schedule OR time and they were taking cases elsewhere.
"In many cases, the patient would get confirmation for surgery, but they weren't ready on the day the surgeon was ready for surgery," said Mr. Kossman. "There was dissatisfaction when the surgery didn't take place. There was also wrong-site surgery."
SCA helped put a concierge practice in place. A supervisor is able to shift things around to make sure surgeons and patients have OR time.
"We made the schedulers realize how important they were in the process," said Mr. Kossman.