Hospitals are facing a perfect storm. Payors and society are demanding excellent quality supported by data and transparency. At the same time, the general economy and a national movement to reduce the cost of health care are stressing hospitals with lower hospital reimbursements. And, all of this is before Accountable Care Organization programs take hold. The challenges created by this perfect storm are resulting in the closure of many hospitals and the destabilization of many others. However, there is a way to survive by embracing concepts like the following:
- Embrace protocols based on evidence-based best practice. Autonomy is wonderful but some standards should be utilized most of the time.
- Develop a collaborative environment among the administration, medical staff and nursing staff. Improving quality at a lower cost requires a level of collaboration that is hard to find in an environment where administration, nursing and physician incentives are not aligned.
- Make economies of scale work for you. This could mean that hospitals find ways to partner together or it could also mean that multiple smaller but similar programs are combined to create a larger best practice.
- Take a look at the low hanging fruit presented by equipment standardization. Typically, a large amount of savings can be found when hospitals leverage volume purchasing contracts from best of breed vendors. In many hospitals it is not uncommon to find that the same type of equipment is bought from multiple vendors, each at a premium. Standardization does not always mean the least expensive. Very often, standardization allows a hospital to get the best product at a volume-discounted best price.
- Create a culture that makes physicians, staff and patients want to come to your hospital. In the operating room this means creating a user-friendly environment that takes starting on time and avoiding cancellations seriously. Building such a culture will not only improve OR efficiencies but will drive surgical and patient satisfaction.
The above suggestions may seem simple, but they take a tremendous amount of teamwork. Leadership, administration and physicians need to be part of the team in order to be successful.
One of the medical disciplines that is identifying itself as a resource for global hospital issues is anesthesia. This makes perfect sense given that the goals of the anesthesia department are naturally aligned with the goals of the hospital. As a hospital-based program, the well-being of the anesthesia department is tied to the reputation and financial stability of its hospital. Furthermore, when a large amount of a hospital's financial success relies on a healthy perioperative program, it is perfectly reasonable for a hospital to expect that its anesthesia department engages with administration on quality and financial improvement programs. The modern anesthesia department can and should have a major involvement in areas such as pre-surgical testing, pain management and program development out of the OR.
John Di Capua, MD, serves as deputy CEO and chief medical officer of North American Partners in Anesthesia and as vice president of anesthesiology services for North Shore-Long Island Jewish Health System. He also holds the title of Peter Walker Professor of Anesthesiology in the department of anesthesiology at Hofstra University North Shore-LIJ School of Medicine.
More Articles Featuring Dr. John Di Capua:
NAPA's Dr. John Di Capua Addresses Questions on OR Turnover, Adding Anesthesia Coverage and Other Critical Hospital Efficiency Issues
Assessing the Financial Viability of Anesthesia Coverage for a New Service: Q&A With Dr. John Di Capua of North American Partners in Anesthesia and North Shore-LIJ Health System