Inside a High-Performing Perioperative System (2)

Several months ago, I described what it’s like inside one hospital’s high-performing perioperative system.  Since then, I’ve been privileged to learn more.

The hospital is successfully applying analytic capabilities rarely found in healthcare settings, and continues on its quest to reduce post-surgical complications, sharing its results more openly than any institution that I know of.

The hospital is now supported by an Operations Research Group that originated in a strategic planning exercise launched by the hospital several years ago.  The group has used a variety of mathematical methods to assist in the design of a new building that houses an ambulatory surgery center, a family clinic and imaging facilities, and has built models that optimize the weekly schedules of individual surgeons who divide their responsibilities among multiple facilities.

Mathematical models, such as those built by the group, are used to compare options for staffing allocations, say for the pre-op area and the PACU; for central sterile; or for a diagnostic imaging department.  In each case, the models assist management to make a decision.

Take, for example, the imaging department.  A model can help decide how many pieces of equipment are necessary and how the staff should be scheduled, subject to an acceptable wait time for patients.   If you’re prepared to accept a longer wait time, you may settle for fewer pieces of equipment or less staff and vice versa.

The beauty of such models is that they explicitly take into account variability present in every healthcare setting but ignored in simpler models based on averages.

In my previous blog posting on this hospital, I mentioned that I didn’t know how well they perform on the operational side in staff utilization, overall OR utilization, turnover time and so on.  Although I still don’t have the answer, I know that they have the analytic capabilities to make the place hum and to do so in ways that may be novel and highly effective.

Communications among those caring for surgical patients have been enhanced.  Thanks to the efforts of the nurse who acts as the day-today formal contact with ACS-NSQIP, there is now a newsletter devoted to the program to reduce complications.

The newsletter reveals that it is a major, multi-year program: Five teams are now working to reduce major causes of complications along with several support teams.  The first issue includes multi-year SPC charts for several complications.  (Where else do you see such transparency?)

The surgeon who launched the effort several years ago weighs in, “To reach our goal of ‘zero preventable complications’ all of us must join in the journey of transformation into ‘High Performing Teams’. We’ve taken the first steps – our patients expect more!”

The dedication is paying off.  The latest results from NSQIP reveal that, since 2007, the hospital has progressed from about the 95th percentile (bad) to about the 30th percentile (good).

So, let me ask, as I did on my first posting on this hospital: How’s your perioperative system performing?