Running a successful neuroscience institute brings with it a set of unique problems and organizational issues due to the specialized nature of the field. Debbie Spielman, assistant vice president of the Florida Hospital Neuroscience Institute in Orlando, shares her thoughts on the best practices for running a specialized institute.
1. Institutional commitment. A successful neuroscience institute must have significant support from hospital leadership, says Ms. Spielman. Organizational support is necessary for obtaining the long-term investment required to support the newest technology and specialized teams to care for the neuro population. Florida Hospital has supported its neuroscience institute by increasing the number of beds at the institute and investing in the build out of seven new neuro ORs, as well as the latest intra-operative imaging capabilities. Before the expansion, the institute often reached capacity and had to decline patient transfers from outside facilities because patients with neurological problems can't be put in any critical care bed and must be monitored by trained neuro nurses. As a result of the expansion, the institute has been able to take meet the demands in its community and surrounding counties by always accepting transfers. "The infrastructure is intensive," she says. However, this infrastructure needs to be organized and run in a well-defined manner with the right teams available at the right time.
2. Governance structure. Ms. Spielman says having a strong governance structure in place is also vital to success. At the Florida Hospital Neuroscience Institute there are three pillars of governance. The first pillar is the medical staff department who concentrate on clinical quality and the competency of the physicians on staff. The second pillar is a neuroscience governance committee made up of the nursing staff, rehabilitation specialists, physicians and physical therapists. They focus on operations and process improvement. The third pillar is the Neuroscience Institute Physician Leadership Council, which is made up of physician leaders, nursing leaders, administrators as well as the marketing team. They focus on strategy, growing market share and improving products. These pillars need to work together and also work with other centers, especially the emergency transfer center, to allow for efficient care coordination.
3. Streamlined access to emergency transfer. An efficient process for transferring patients who need specialized neurological care from emergency rooms across the region needs to be in place. At the Florida Hospital emergency transfer center, qualified teams are on standby 24/7 to accept calls regarding patients experiencing neurologic emergencies from a radius of up to 200 miles. The emergency transfer center alerts physicians depending on what kind of care is needed, says Ms. Spielman. If there seems to be a neurological problem, a physician at the institute is notified. "Without that kind of process and availability in place, you cannot build the reputation and volume needed to sustain your program," she says. Reputation and volume are also built on the reputations of the physicians and physician leaders who specialize in different aspects of the field.
4. Strong physician leadership. The structure for physician leadership at the institute is always evolving, says Ms. Spielman. Currently, the physicians are diversified according to specialty at the neuroscience institute, and different physicians lead different areas of neuroscience. It may evolve into a system with an overall physician leader who works closely with the administration in the future.
5. Physician relations. The institute has a physician relations representative who interacts with neurosurgeons, neurologists and primary care physicians who refer patients to neurosurgeons within the institute. The representative is tasked with actively building and maintaining those relationships. The representative also provides key connectivity between the hospital and the practices that are vital to sustaining and growing the programs. Understanding the physicians' business model from their perspective is paramount.
6. Direct marketing to patients. The institute markets directly to patients through consumer marketing campaigns, typically with a call to action to contact our care coordination program including our spine care program, minimally invasive brain Surgery program and our neuro pressure hydracephalus program. 50 percent of the institute's volume is scheduled, elective treatment. Care coordinators interact with patients who are aware of their neurological condition and are trying to decide where to seek treatment. The coordinators walk them through the process, and then patients decide whether or not they want to come to this institute for care. "It is a little bit clinical and a little bit of marketing," says Ms. Spielman. Fostering a relationship with patients doesn't end once the initial deciding process is over, however. Our focus is also on the patient’s long term success, she says.
7. A solid plan around patient experience. Today, patients seeking clinical solutions also have high service expectations. "We call it the relentless pursuit of excellence," says Ms. Spielman. There was a great gap between what the Florida Hospital Neuroscience Institute thought it was delivering to patients and what the patients said they were actually experiencing. But once it started implementing ways to make the patient's experience better, the gap began to close. One of changes the institute has implemented to improve patient experience is having a nursing leader rounding on every patient, every day, as well as intentional hourly rounding conducted by nurses for each patient. This fosters a connection between patient and nurse and sets service expectations and eventually ends up avoiding concerns or issues before they happen. "It is our goal to perform in the top quartile nationally when it comes to our patient's and their experience. We have an opportunity to be a part of a once in a lifetime event for each patient and we believe that demands the highest performance from our staff and our physicians," she says.
8. Strong clinical outcomes. It is difficult to measure successful outcomes when it comes to neurological problems in most areas other than stroke, but the institute makes great efforts to obtain outcome information. Outcomes in neurological care are often based on functionality post treatment, which is subjective. As a result, the institute has to reach out patients every couple of months to check on their functionality and satisfaction, for example with spine surgical patients. While this is the only way to do so currently, the next phase for Florida Hospital is to be a part of the national conversation on how to measure success and benchmark our program with others across the country, Ms. Spielman says.
According to Ms. Spielman, to ultimately run a neuroscience institute successfully you need to be clear on why you are creating it, what the value proposition is to your organization and community and then get full commitment from your organization. The aforementioned practices will align themselves with the value proposition, once it is clear.
9 Steps for Hospitals, Health Systems to Build a Neuroscience Center
11 Latest Hospital Expansions in Neuroscience, Pediatrics and Other Specialties
1. Institutional commitment. A successful neuroscience institute must have significant support from hospital leadership, says Ms. Spielman. Organizational support is necessary for obtaining the long-term investment required to support the newest technology and specialized teams to care for the neuro population. Florida Hospital has supported its neuroscience institute by increasing the number of beds at the institute and investing in the build out of seven new neuro ORs, as well as the latest intra-operative imaging capabilities. Before the expansion, the institute often reached capacity and had to decline patient transfers from outside facilities because patients with neurological problems can't be put in any critical care bed and must be monitored by trained neuro nurses. As a result of the expansion, the institute has been able to take meet the demands in its community and surrounding counties by always accepting transfers. "The infrastructure is intensive," she says. However, this infrastructure needs to be organized and run in a well-defined manner with the right teams available at the right time.
2. Governance structure. Ms. Spielman says having a strong governance structure in place is also vital to success. At the Florida Hospital Neuroscience Institute there are three pillars of governance. The first pillar is the medical staff department who concentrate on clinical quality and the competency of the physicians on staff. The second pillar is a neuroscience governance committee made up of the nursing staff, rehabilitation specialists, physicians and physical therapists. They focus on operations and process improvement. The third pillar is the Neuroscience Institute Physician Leadership Council, which is made up of physician leaders, nursing leaders, administrators as well as the marketing team. They focus on strategy, growing market share and improving products. These pillars need to work together and also work with other centers, especially the emergency transfer center, to allow for efficient care coordination.
3. Streamlined access to emergency transfer. An efficient process for transferring patients who need specialized neurological care from emergency rooms across the region needs to be in place. At the Florida Hospital emergency transfer center, qualified teams are on standby 24/7 to accept calls regarding patients experiencing neurologic emergencies from a radius of up to 200 miles. The emergency transfer center alerts physicians depending on what kind of care is needed, says Ms. Spielman. If there seems to be a neurological problem, a physician at the institute is notified. "Without that kind of process and availability in place, you cannot build the reputation and volume needed to sustain your program," she says. Reputation and volume are also built on the reputations of the physicians and physician leaders who specialize in different aspects of the field.
4. Strong physician leadership. The structure for physician leadership at the institute is always evolving, says Ms. Spielman. Currently, the physicians are diversified according to specialty at the neuroscience institute, and different physicians lead different areas of neuroscience. It may evolve into a system with an overall physician leader who works closely with the administration in the future.
5. Physician relations. The institute has a physician relations representative who interacts with neurosurgeons, neurologists and primary care physicians who refer patients to neurosurgeons within the institute. The representative is tasked with actively building and maintaining those relationships. The representative also provides key connectivity between the hospital and the practices that are vital to sustaining and growing the programs. Understanding the physicians' business model from their perspective is paramount.
6. Direct marketing to patients. The institute markets directly to patients through consumer marketing campaigns, typically with a call to action to contact our care coordination program including our spine care program, minimally invasive brain Surgery program and our neuro pressure hydracephalus program. 50 percent of the institute's volume is scheduled, elective treatment. Care coordinators interact with patients who are aware of their neurological condition and are trying to decide where to seek treatment. The coordinators walk them through the process, and then patients decide whether or not they want to come to this institute for care. "It is a little bit clinical and a little bit of marketing," says Ms. Spielman. Fostering a relationship with patients doesn't end once the initial deciding process is over, however. Our focus is also on the patient’s long term success, she says.
7. A solid plan around patient experience. Today, patients seeking clinical solutions also have high service expectations. "We call it the relentless pursuit of excellence," says Ms. Spielman. There was a great gap between what the Florida Hospital Neuroscience Institute thought it was delivering to patients and what the patients said they were actually experiencing. But once it started implementing ways to make the patient's experience better, the gap began to close. One of changes the institute has implemented to improve patient experience is having a nursing leader rounding on every patient, every day, as well as intentional hourly rounding conducted by nurses for each patient. This fosters a connection between patient and nurse and sets service expectations and eventually ends up avoiding concerns or issues before they happen. "It is our goal to perform in the top quartile nationally when it comes to our patient's and their experience. We have an opportunity to be a part of a once in a lifetime event for each patient and we believe that demands the highest performance from our staff and our physicians," she says.
8. Strong clinical outcomes. It is difficult to measure successful outcomes when it comes to neurological problems in most areas other than stroke, but the institute makes great efforts to obtain outcome information. Outcomes in neurological care are often based on functionality post treatment, which is subjective. As a result, the institute has to reach out patients every couple of months to check on their functionality and satisfaction, for example with spine surgical patients. While this is the only way to do so currently, the next phase for Florida Hospital is to be a part of the national conversation on how to measure success and benchmark our program with others across the country, Ms. Spielman says.
According to Ms. Spielman, to ultimately run a neuroscience institute successfully you need to be clear on why you are creating it, what the value proposition is to your organization and community and then get full commitment from your organization. The aforementioned practices will align themselves with the value proposition, once it is clear.
More Articles on Neuroscience Centers:
6 Growing Service Lines to Monitor Over the Next 5 Years9 Steps for Hospitals, Health Systems to Build a Neuroscience Center
11 Latest Hospital Expansions in Neuroscience, Pediatrics and Other Specialties