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.

The most common reasons hospitals are having trouble adjusting to change are listed below:

• Physicians are often incentivized or driven to optimize their short-term revenues at the expense of the hospital’s (and their own) long-term health.
• Administration and oversight boards often have limited understanding of clinical processes.
• RNs/Techs are often forced to manage critical OR processes without support or training.
• Hospitals are often thought of as so complex that the “Band-Aid” approach to problem solving is the only viable solution.
• Physicians, nurses, administrators, and 3^rd party payers are territorial and function in silos.

Fortunately, these problems have already occurred in other industries and there are many practical (sometimes revolutionary) tools that hospitals can employ to increase their efficiency, service levels, and bottom lines.

Over the next few weeks, we will be doing a series on the evolution of process improvement in manufacturing and the application of Lean Six Sigma in the management of hospitals.  From W. Edwards Deming and the Toyota Production System, to Six Sigma, Lean manufacturing, and process improvement in service industries, we want to demonstrate the practicality and effectiveness of applying these systems in the U.S. health care system.

Next week we begin with W. Edwards Deming and the history of process management.  See you then…

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

Registration/Reimbursement

To register for this event, please contact Steve Blasco at sblasco@surgicaldirections.com or  312-321-6136.

All registration forms are due by February 15th.

Travel and Hotel Arrangements

Travel and hotel arrangements are the responsibility of each attendee.  Surgical Directions does not have a room block reserved at the Loews Ventana Canyon Resort.  However, if you are attending the AACD Meeting, you may reserve your room at their negotiated rate (visit AACD’s website at www.aacdhq.org for exact details on hotel rates and deadlines.  The AACD negotiated rate is only available if you are attending their Annual Meeting taking place March 5-7, 2010).

For more information, please go to: http://www.shsmd.org/shsmd/conference/index.html

Questions/comments? Please give us a call 312.239.2967.

http://bit.ly/2g6qxx

Do you regularly monitor your anesthesia billing company’s performance? We’d like to hear from you…

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

• 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.