Executives from four award-winning hospitals took different approaches to achieving distinction. And their advice reflects that. Hire good consultants. Listen to your doctors and patients. Study and improve your processes. Integrate the latest, evidence-based practices and protocols. Design the facilities to focus on the patient. Make it easier for physicians to practice there. Sweat the details.
“It’s not one thing,” points out Kevin Lundon, vice president of operations for 525-bed St. Joseph Hospital in Orange, Calif. “It’s a whole series of commitments.”
Mr. Lundon says his hospital achieved the ranks of U.S. News & World Report’s “Top 50 Hospitals for Orthopedics” in 2007 and 2008 by committing to improvement. Mr. Lundon, who oversees orthopedics for St. Joseph, says the organization decided with its physicians how to distinguish themselves as the best in its region. “The goal was linking with our physicians and not just treating orthopedics as another procedure, but to develop it as a topnotch program.”
Mr. Lundon says St. Joseph hired an experienced program coordinator to oversee the entire orthopedics continuity of care, from pre-op to post-op and follow-up, and built dedicated orthopedics, spine and joint specialty teams working exclusively within those areas.
“As they become more expert in orthopedic procedures, it allows for very smooth procedures and helps to make the patient experience the best possible,” he says.
The program hired joint and spine surgical coordinators to work with the dedicated teams and coordinate supplies, equipment and implants, getting the programs off the ground in 2004.
“It takes years for those teams to coalesce and work well together,” he says.
Mr. Lundon says surgeons need three things to be happy and successful: tools, time and teams. The hospital spent more than $500,000 on the most advanced surgical tables, microscopes and a computerized joint system. “We made a commitment to be leading edge. We committed to our surgeons to allow them to be the most efficient practitioners they could be.”
St. Joseph provided the high volume surgeons with PAs to assist them. The most efficient surgeons are allowed to “flip” two of the hospital’s 31 operating rooms and patients are transported post-op to a 30-bed orthopedics unit staffed exclusively by a post-op nursing team. The hospital, which is one of only a few hundred designated a Nursing Magnet Hospital for nursing excellence, also invested in the “Smart OR” program.
The hospital’s efforts weren’t recognized only by awards. Orthopedic volume has increased by 25-40 percent and the program’s contributions to the hospital margin have risen commensurately, particularly in the spine program. Mr. Lundon says St. Joseph logged the third highest volume of orthopedic procedures in California in 2008, performing 28,000 inpatient and outpatient surgeries, among them about 1,200 joint replacements.
“You need phenomenal surgical expertise and we’re blessed to have high quality surgeons and great nurses,” he says.
Integrate health improvements throughout the hospital
Colleen Becker, director of peri-operative services for the Barnes Jewish Hospital Center for Bariatric Surgery, says the St. Louis center for treating obesity dates to the late 1970s. But it expanded its focus to include the entire continuity of care at Barnes Jewish, involving pre-counseling, dietary, social work, mental health and rehabilitation, as well as patient families and even former patients.
“We believe in working together to best manage the patient’s needs,” Ms. Becker says. “We saw this as an opportunity to improve outcomes and wanted to pursue the centers of excellence designation.”
Barnes Jewish was designated a Center of Excellence by the American Society for Bariatric Surgery, which sets standards for care. “They left no stone unturned,” she recalls.
To achieve designation, the organization pulled together a bariatric care committee that involved multiple services from throughout the hospital and involved other departments from surgery to oncology. “We examined everything, from the kind of slippers we offered to the size of the bed and toilets and chairs in the cafeteria and the IV catheters, from shower curtains to ambulances and helicopters and the stretchers and tables we use,” says Ms. Becker. “We looked at equipment and whether it met our needs. We realized that the bariatric population is throughout the hospital, not just in our center. We don’t separate them out.”
She says the results of those efforts manifested itself in new designs and influenced construction projects throughout the hospital, not just within Barnes Jewish.
“Our entire environment was evaluated for all patients, not just bariatric patients. It expanded our entire focus from the time patients enter as outpatients or in patients. We looked at every facet of how we provide care,” she says. “The changes spanned the organization.”
She says the organization’s gastric bypasses have increased since 2005 and overall hospital patient satisfaction scores have risen as well. Surveyed bariatric surgery patients reported higher quality of life outcome scores.
“The program has helped boost the hospital overall and supports our hospital mission. Bariatric surgery isn’t always profitable, but it’s the right thing to do,” she says.
Treat well patients like healthy patients
Teresa Woodard, administrative director of rehabilitation and sports medicine for 262-bed Bon Secours St. Francis Health System in Greenville, S.C., says that program won distinction in U.S. News & World Report as one of the nation’s best hospitals for orthopedics and joint replacement.
Ms. Woodard says St. Francis began by contracting with a consulting group, TVC, which advocates a very standardized approach to healthcare delivery. She says the hospital organized a multidisciplinary group that still meets monthly to develop care pathways and documentation templates for physicians.
“We’d always had a good program. But we were trying to get over that last hurdle to the next level and that’s when we thought we needed outside help, a model to work from,” she says.
Ms. Woodard explains that all the orthopedic patients except hip patients are well people choosing to have surgery. “And we treat them that way. There’s a lot of emphasis on education, bringing patients in early so they know what to expect. We involved family members. We call the joint replacement program, Joint Camp.”
She says the Joint Camp concept resonated with staff, physicians and patients, who were getting mobile sooner. “We branded everything. There were Joint Camp tent cards and T-shirts and coaches’ pins and group exercises. We tried to make it fun. There’s a graduation ceremony.”
The results have validated the investments. Joint replacement volume more than doubled from 704 in fiscal 2003 to 1,664 in 2008, the most in South Carolina for the fifth consecutive year. Total inpatient orthopedic volume grew as well, from 1,775 procedures in 2003 to 2,762 last year. The program also achieved the top decile in patient satisfaction at both campuses for orthopedics and earned a 2005 award from Premier for hip and knee replacement. Ms. Woodard says the contribution margin for inpatient orthopedics has increased 50 percent in the past three years and by 25 percent for outpatient orthopedics. HealthGrades has conferred its five-star ranking on St. Francis in hip, knee and total joint replacement through 2009 and ranked the hospital among the nation’s top 5 percent for joint replacements through 2009 and the state’s top orthopedics program. Regionally HealthGrades ranked St. Francis seventh in the Southeast in joint replacement and 18th in overall orthopedics through 2009.
Community outreach programs connect prospective joint replacement patients with St. Francis doctors and promote the program. “We help them build their practices,” she says. “The patients love it. Our scores average between 97-99 percent. Our market share has risen from 24 percent to 32 percent and the doctors appreciate what we’ve done for their patients.”
Starts with ground up and top down
Jeff Senall, MD, who chairs the department of orthopedics at the Central DuPage Hospital in Winfield, Ill., says its successful orthopedics programs starts from the ground up and goes the top down.
“We strive to be the best and everything we do is based on being in the top decile in country,” Dr. Senall says. “That approach is taken in every hospital department, but certainly in orthopedics.”
But saying it alone didn’t make it happen. Dr. Senall says the orthopedics program worked hard to improve an already solid department.
“Our recent administrations have had a vision of being the best, of being a destination hospital. We were one of the first in the country to do joint replacements and we’ve always had strong clinicians,” he says.
He says Central DuPage reexamined its processes, improving the turnaround time between cases so doctors who wanted to could perform more procedures. The hospital changed the way surgical instruments are processed to track them better and improve efficiency.
Dr. Senall says Central DuPage performed 1,459 joint replacements in 2008 and expects to do 2,000 this year, and the orthopedics department performed 4,400 procedures, accounting for about one-quarter of the hospital’s 17,225 cases. Orthopedics accounted for 10.4 percent of revenue in fiscal 2007, and that figure is expected to rise to 11.3 percent in 2009.
“We are second in the state in the number of joint replacements and for years we’ve had a fellowship program training fellows from Rush University (in nearby Chicago). That was a big move for a community hospital and helped increase our volume in joint replacements. We’re very lucky to be financially sound as a hospital to be able to provide the resources that our patients and doctors want and to make it easy for surgeons to practice here,” he says of the program, which staffs 31 orthopedic surgeons from nine group practices.
Contact Mark Taylor at mark@beckersasc.com.