There has never been a more difficult time to be a hospital executive in the United States.  Regulations, billing systems, technology, politics, and customer demands are all evolving at dizzying and unpredictable paces.  Hospital revenues are under increasing stress from labor unions, capital requirements, 3^rd party payers, and competition from ambulatory service centers (ASC).  Moreover, most of these forces are completely out of a hospital’s control.

Many hospitals have had a hard time adjusting to new demands and competition, and are now seeing their bottom lines erode and their service levels decrease:

• Average Total Hospital Margins in 2008 were 2.6% vs. 5.8% in 1998.
• 32.4% of hospitals reported negative margins in 2008 vs. 26.6% of hospitals in 1998.
• 43% of hospitals expect to report negative margins for YE2009.
• Chance of receiving care that meets generally accepted standards is only 55% in US.

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What:…..Surgical Directions’ Executive Forum, “How to Develop and Operate a Great Perioperative Service Line”
When:….March 4th & 5th (Registration Due by February 15, 2009)
Where:…Tuscon, AZ

Surgical Direction’s is pleased to announce our upcoming Executive Forum entitled, “How to Develop and Operate a Great Perioperative Service Line”. This event will take place alongside the American Association of Clinical Directors’ 2010 Annual Meeting on March 4th & 5th and is being held at Loews Ventana Canyon Resort in Tucson, AZ.

Surgical Directions has designed this event specifically for hospital and health leaders that have completed a perioperative transformation and are looking for additional insights and guidance into what other top hospitals and managers are doing to build and maintain market leading perioperative services.

The forum will include educational sessions and workshops on perioperative topics of interest, such as:

• Impact of Health Reform on Perioperative Services
  • How Health Reform will impact volume and reimbursement
  • What you should do to prepare

• How to Develop A Great Perioperative Service Line
  • Characteristics of “Better Performing” Perioperative Services
  • What are the benchmarks for “Better Performing” Operating Rooms
  • What will be the future benchmarks

• Utilizing Sales to Grow OR Volumes – Lessons from the battle field
  • How do you structure and implement sales into perioperative services
  • How do you appropriately incentivize and monitor sales representatives
  • How do you grow OR volume

• Utilizing Processes to Improve Perioperative Processes
  • How can Lean Six Sigma be utilized to improve scheduling PAT processes

• Utilizing PAT to establish a competitive advantage for your hospital, grow surgical volume and improve clinical outcomes
  • Presentation of a case study that demonstrations how PAT contributed to Advocate Lutheran General Hospital being designated as “Best Performing” by the American College of Surgeons

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One of the key factors for making successful changes to a block schedule or to the block schedule guidelines is working through a collaborative group with significant physician (surgeon and anesthesiologist) representation. The collaborative group approach allows the surgeons to have a say in what is “fair” ie: utilization thresholds, block durations, and mechanisms for enforcing the guidelines.

What challenges have you faced in trying to make changes and/or enforce the “rules”?

As you are well aware, block scheduling has a direct impact on an OR’s efficiency and on surgeon’s satisfaction. Over the past several years, Surgical Directions has developed and effectively deployed block schedules that have improved OR utilization and actually increased surgeon satisfaction and productivity. Some of our “best practice” guidelines include:

• Establish and monitor block guidelines via a Surgical Executive Committee (with surgeon, anesthesia, nursing and administration involvement)
• Allow only 8+ hour blocks
• Variable release times by specialty
• 20%+ “open time” to allow for ease of access to schedule by non-blocked surgeons
• Monitor block utilization on a monthly basis and provide individual surgeon notices on a quarterly basis
• If necessary, reduce block time by frequency of block not duration of block

These are just some of our guidelines – what has worked well at your organization?

Are your hospitals leveraging one of your most valuable assets: OR time?

In spite of economically challenging times it is possible – and even essential – to transform troubled operating rooms into optimally performing departments.

Where do you start the transformation?

Start by changing the way the OR has historically been run.  In most hospitals, the OR has historically been run by nursing which has put the nursing leadership in the awkward position of trying to control physician behavior only to be “undermined” by administration who is put in the awkward position of going up against a surgeon who is threatening to take valuable cases elsewhere. By changing the “governance” from the old model to a more collaborative model, hospital administration, surgeons, anesthesiologists and OR leadership are able to work together to assess the OR utilization and performance and begin to tackle some tough issues such as access to the OR and disruptive physician behavior. Sometimes takes an outside “force” to get all these factions to meet and begin to move in the same direction, but once you do… it will completely transform the OR and have a direct and positive impact on the hospital’s bottom line. Some key points for implementing a successful transformation are:

• Engage the physicians – both surgeons and anesthesiologists
• Create a collaborative OR governance model
• Establish physician leaders (Medical Directions) in the ORs to co-lead the ORs with the Nursing Directors on a daily basis
• Mentor OR Nursing Leadership on new model of shared-governance
• Communicate with staff, physicians, physician’s offices and other hospital departments

What can you accomplish?

• Revised block schedules that allow for greater operating room utilization and access
• Metrics for monitoring the operating room performance, individual surgeon performance and anesthesia performance
• Rapid process/efficiency improvement projects with accountably to the new governance board
• Transformed OR culture

The results?

• Increased OR volume
• Increased hospital revenue and profit (more profit = more money for the mission)
• Increased surgeon, anesthesia and nursing satisfaction

We want you to share your experience with us…

Do you have a collaborative governance model for the OR?

For more information, or to discuss your concerns with us directly please visit our website www.surgicaldirections.com.