Surgical Services Transformation Operational Wins

October, 2019 | Scott Nygaard, M.D., MBA, COO

The Surgical Services Transformation (SST) project was created in response to feedback regarding concerns and suggestions for improvement in our ORs. We launched this project with an open mind, recognizing that there were opportunities to improve in regard to flow, costs and experience. As Dr. Antonucci mentioned in his column this month, the right mindset was necessary for this project to be successful; and, it was.

As a result of the team’s commitment, collaboration and hard work, there were many operational wins, including:

The implementation of technology that delivers real-time data that provides more clear information and enables our ORs to make better decisions and to be more agile.

The OR Scheduling Tool, is an example of this technology, which helps managers make more proactive scheduling decisions to better align staffing levels to case volumes.
. New reports enable better alignment, such as:

The Daily Operating Report (DOR), which measures key operational metrics including on-time starts for all cases, volume, labor utilization and quality of service. The DOR is shared broadly through the Huddle Boards so every team member is informed and working toward the same goals.
The Weekly Operating Report (WOR) measures each campus’ financial performance, quality and patient care metrics against the plan each week. The WOR is reviewed weekly at each campus by the dyads and managers. Kandy DeWitt, OR Director, says this is a valuable report, especially when looking at details of supply costs. One week, for example, HealthPark Medical Center was over their budget for the number of cases they performed. Kandy was able to see that the team performed 16 heart valve procedures that week. Heart valves are very expensive, and they drove up her supply costs.
The Variance Report provides insight into OR delays, Pre-Op and PACU extended wait times, turnover, all case on time starts and case turnover.
The standardization of procedure cards, which reduces inventory requirements by reducing variability and waste, and improves efficiency in Sterile Processing Department and the OR. During the project, the team got through 90 of the 600 cards. Because there are so many procedures to go through and because there are always new surgeons and technology, this is an ongoing process.

New stocking standards, whereby infrequently used items are in reach of the OR suite but are not stocked on the cart, are helping reduce waste. Kandy says they also looked at supplies, like suction tubing—which is not a critical device but offers different functions based on the complexity of the procedure ranged in price from $11 to more than $130. By choosing an appropriate, less expensive tubing, we can save a substantial amount of money. Throughout the system, we do 50,000 cases a year that require the use of suction tubing. 

Pre-procedure testing was completely restructured and, as of Sept. 16, reopens as the Pre-Anesthesia Evaluation Center. This change came as a result of patients being scheduled for procedures without having proper documents, therefore leading to work-arounds and cancellations.

The peri-anesthesia department focused on reducing extended holds and delays by rolling out delay codes, which enables the accurate identification and root cause reasons for holds. Kandy says some patients are out of the PACU in 60 minutes, while others were being held for hours to avoid an ICU admission. The new process helps everyone understand the PACU hold times.

The clinical team now uses HAIKU, the mobile-friendly Epic application, which notifies surgeons when patients are ready for surgery, which is helping to reduce surgery delays, ensuring timely communication with surgeons and improving the patient experience. The next phase of this communication tool will be rolled out to anesthesia.

Communication, in general, has improved as a result of this project, which is a huge win. The communication cadence, with and across departments has helped provide a clear understanding of our focus areas, performance, any gaps and the necessity for additional support. By aligning everyone through clear and open communication, we are paving the way for more progress on our ExceptionalLee Performance Excellence journey.

When asked how to describe the SST project and experience, Kandy said she would use two words: “transparency and inspiration.” Process improvement requires us to put on a new pair of glasses and to look at the way we do things in new and different ways. The critical conversations, the challenges, the teamwork all lead the way to transformation. We appreciate our physician partners who helped us through the SST project. As we continue to improve our health system through our ExceptionalLee Performance Excellence journey, you all will be key to our transformation and continued success.