Mr. Macy discusses seven critical aspects of NOH’s operations that help the organization to maintain its success and ensure that it delivers high quality care.
1. Patient satisfaction a priority. “The most significant component of patient satisfaction is hiring the right people and retaining them” Mr. Macy says, “For NOH, this is critical for all new hires, but we very focused on direct patient care staff. Typically, nurses are the people who are hands-on, and have the most direct contact with patients. We hire people for attitude and skill set. We also give people the tools they need and we’ve staffed appropriately so that nurses can spend quality time with patients, develop a relationship and be focused on patient-care as opposed to other things.”
Along with paying particular attention to hiring the right people, NOH continually monitors the work of the staff through patient surveys to make sure patients are receiving the highest quality of care.
“We decided, early on, to make an investment in the survey process, even before HCHAPS got started,” Mr. Macy says. “We hired a third party to do patient satisfaction data collection, instead of doing it ourselves, so that we could benchmark against other hospitals. We thought it was worth the investment to do it externally and, because of that, we are able to get very solid data. Leaders throughout the organization use the information to continually improve processes to maintain and improve our high levels of satisfaction.”
“We also distribute the general information to the staff once a quarter,” he says. “As we get comments back, we share them where relevant. Positive and negative. We know upfront that we are not going to please 100 percent of our patients, but we look for trends.”
2. Rely upon benchmarking data. NOH gathers and closely reviews benchmarking data, particularly in relation to patient satisfaction. Using the data found on The Commonwealth Fund’s Web site, which takes HCHAPS data and allows hospitals to perform comparisons for multiple hospitals, NOH looked at data for all the hospitals in a 400-mile radius for a comparison on overall satisfaction, Mr. Macy says.
“In terms of overall patient satisfaction, the next closest hospital was 7 percentage points behind us,” he says. “We tend to benchmark against hospitals in our region and like-facilities nationally. The challenge is that there is a lot of variation out there in terms of what people are collecting and looking at.
“We also look closely at the quality measures that Medicare is reporting, such as surgical infection data,” Mr. Macy says. “And we tend to benchmark against ourselves, as a way to set goals.”
3. Ensure staff satisfaction. “We recognize staff that patients have complimented,” Mr. Macy says. “We have a program where staff can recognize each other. We also use compensation perks such as incentives — bonuses for meeting organizational goals.”
Mr. Macy says that running an effective hospital would not be possible without a happy, hardworking staff. It is for this reason that NOH offers regular opportunities for continuing education.
“Currently, we’re in the process formalizing our education program to create something even better,” he says.
4. Surgical care improvement is always a focus. Along with making sure NOH is competitive and pursuing patient and staff satisfaction, it endeavors to be technically precise and deliver the best medical care.
“Medicare has a set of surgical care indicators,” Mr. Macy says. “We tend to be in the higher section, but not at the top where we’d like to be. But we’ve been very focused on decreasing our already low infection rate and making sure that our processes for identifying and monitoring treatment and prevention of deep vein thrombosis (DVT). “
In order to improve the services and surgeries NOH offers, Mr. Macy says the organization put uses committees and teams with physicians and staff to rethink preoperative, operative and postoperative processes.
“In 2008, we developed our own process for screening every patient to identify individuals are at risk for DVTs,” he says. “And now we are working through the process of how we best manage the care of those patients at risk.”
5. Keep a close eye on costs. “From a cost perspective, we’ve focused over the last 18 months on looking at all expenses and revenue on a case-by-case basis as well as by surgeon-by-case,” Mr. Macy says. “We are benchmarking surgeon versus surgeon. The entire process has created a number of great conversations, and cost savings amongst surgeon practices.”
Two of the areas pertaining to cost that have received the most focus at the hospital are labor and supply chain.
“From the supply chain perspective, our biggest expenditure is implants, specifically total joint implants,” Mr. Macy says. “We brought all the surgeons together and we decided what we were willing to pay for a knee or a hip. That has been very successful. We were a little concerned at first that vendors might not support our methodology, but now three have agreed to that pricing structure. We are also- looking at other implants, including spine, sports medicine and trauma. We look at cost by implant and comparable items; constantly looking for opportunities.
“We have also put some processes in place to manage new products,” he says. “As we have entered into new contracts we told our vendors that if a new product comes in here and we haven’t signed off on it in advance, we are not paying for it.”
Setting your charges based on your actual costs is critical for successful cost accounting, says Mr. Macy.
6. Keep an eye on future needs and opportunities. “We’ve had five really great years, and right now our challenge is that we are close to maxed out from a space standpoint,” Mr. Macy says. “We have a strategic planning committee which is examining where we want to be in two to three years as well as the longer term. They are focusing on expansion, quality, patient satisfaction, returns for our owners, and basically, continuing to build on our model.
“We see a huge opportunity for growth out there because of the baby-boomer generation, and because that generation is more active,” he says. “There will continue to be an increasing need for orthopedic surgery. Our challenge is finding more surgeons to do the work,” particularly for total joint replacement. “Over the next 10 to 15 years it seems there will be a shortage of them.”
7. Physician teamwork, hospital partnership. There are two other elements that have proven vital to NOH’s success, Mr. Macy says. “We’ve had great physician support and great physician alignment,” he says. “We are also a little bit unique as the hospital is half owned by The Nebraska Medical Center, which is the academic teaching hospital for the University of Nebraska Medical Center That partnership has been a huge support, and we’ve been able to tap into their resources, data and benchmarking.”
About Nebraska Orthopedic Hospital
Location: Omaha, Neb.
Primary services offered: Orthopedic medicine
Facility size: 82,000 sq. ft.
Number of private beds: 24
Web site: www.neorthohospital.com
Prior to working for NOH, Tom Macy (tom.macy@neorthohospital.com) worked as a group practice executive for multispecialty physician groups in Nebraska and Texas. He also worked in a similar capacity with Tenet Healthcare. He has served as the CEO of Nebraska Orthopedic Hospital since Oct. 2005.
