The following article is written by Joyce Thomas, senior vice president, operations, for Regent Surgical Health.
Perhaps the title of this column is an oxymoron. The terms 'efficiency' and 'hospital operating room' in the same sentence can seem like opposing forces. Nevertheless, last year Regent, my company, was commissioned by a community-based hospital to convert the culture of an inpatient operating room to that of a freestanding, physician-owned surgery center. I must admit, I thought I had drawn the short straw when given the assignment.
The background of this facility is somewhat unique. The project hospital was a sister facility of a larger more productive hospital. Located five miles apart, the little hospital was performing about 100 cases per month, primarily outpatient. The hospital was in the red and the threat of closure was being discussed. The community valued the location of this hospital and the public relations of closing would be difficult to manage. Two very small operating rooms were being utilized, while two very large operating rooms shelled out in a previous expansion project were now being used for storage. The facility was very old and unappealing and customer service of the facility had a reputation of being uncooperative, yet quality of care remained excellent.
In the local community, a group of successful and respected orthopedic surgeons became available for recruitment. Regent was asked to facilitate the completion of the two operating rooms, convert the culture of the people, recruit the orthopedic group and facilitate the design to remodel the facility to emulate a surgery center. We were also to oversee the construction and ensure the project came in on time and at budget.
In true ASC style, the project was launched in a 'can do', 'let's get 'er done' manner. Later, I realized I had forgotten hospital processes of meetings, time and more meetings. The following challenges were addressed during the first three months:
- Day 1: Removed sign "Refreshments are for Patients Only." This sign prominently posted sent a huge message to physicians, guests and employees. It was unfriendly. (As a note: Costs for providing refreshments have not gone up with the sign removal.)
- Organized the hospital designated architect and construction contractor to initiate completion of the operating rooms and begin design of the future ASC support areas. Operating rooms were completed within eight weeks.
- Interviewed all employees to ascertain ability to retain for the future ASC. It was found that most of the employees were itching to be busier and more productive.
- Interviewed anesthesia department and discovered there was minimal enthusiasm for providing service in a timely and consistent manner. With the cooperation of senior management, this 'approach' to providing service was challenged and changed, if you know what I mean.
- Ordered and procured equipment for new operating rooms in a cost effective manner.
- Reviewed all policies/procedures for unnecessary processes that would impede efficiency. As the clinical policies were interlinked with the main hospital and tied to The Joint Commission, state and Medicare, these policies were not changed.
- Documentation was streamlined. It was found that the clinical history was documented in three places for ease of the anesthesia department. This was changed to one time documentation, freeing up the nursing staff to provide care.
- Scheduling was brought back to the little hospital from centralized scheduling at the main hospital. This allowed forging of relationships between office schedulers and the hospital. It also improved efficiency and reduced mistakes in the scheduling process for physician offices and the hospital.
- Met individually with each orthopedic surgeon to ascertain their needs, issues they may have in scheduling and obtain their buy in for the new ASC.
- Developed a sustainable marketing plan to include the department director and newly assigned scheduler.
- Implemented monitoring of staffing productivity to decrease costs. Froze nursing wages to current levels. Staff agreed this was acceptable as they would no longer have to take call or float to main hospital.
- Implemented CTQ patient satisfaction process for measuring of individual department satisfaction. Prior measurements were incorporated into the hospital system measurements and results were not reliable for quality improvement.
- Organized a board to oversee the new ASC. Members included hospital executives, anesthesia director, surgery director and three surgeon medical staff members. The newly formed board approved:
- ASC name
- Design of ASC remodel
- Approval of anesthesia providers
- Approval of director of ASC
- Approval of specialty specific equipment and supplies
The board continues to meet on a quarterly basis.
The project has been very successful. The facility is now financially viable and the previous imminent danger of closing is a very distant memory. Volume of surgical procedures is currently 200-plus procedures per month and continues to grow incrementally. Staffing hours per case meet ASC benchmarks. All other ASC benchmarks related to quality of care are also being met to include infection rate, complication rate, and patient satisfaction. Renovation of the support areas is underway with an open house and community celebration scheduled in the near future.
As with any project there are lessons to be learned. Hospitals are complex animals by regulations and standards. In an ASC we can easily make a change within hours if necessary. Due to the complexity and interdepartmental relationships in a hospital, it is important to respect and obtain the buy-in of all parties who will be impacted. What I noted was quite often hospital meetings get caught up in why a change cannot occur vs. the excitement of making a change. We generated enthusiasm for moving forward and not accepting defeat; this same principle can be used in all areas of healthcare. Do we accept defeat or do we garner all our enthusiasm into high energy and challenge change in the face?
Learn more about Regent Surgical Health.
More Articles Featuring Regent Surgical Health:
What Surgery Centers Can Learn From a Cash Flow Statement
Electronic Health Records: Ready, Set, Go-Live
How to Determine Average Hours Per Case: Q&A With Joyce (Deno) Thomas of Regent Surgical Health