Operational Effectiveness in Surgical Services

Episode Overview

• One of the biggest mistakes that hospitals make is collecting data without taking the next step to understand and interpret it. After gaining analytic insights into the problems you are facing, you can move forward with an exercise like value stream mapping and identify opportunities for improvement right away.

• It's really important to not only measure certain KPIs on a regular basis, but also share the analytic insights with the right people on a regular basis. If you aren’t informing the staff who are affected by the inefficiencies and are instrumental in enacting the changes needed, then it will be very difficult to make improvements in processes.

• Making changes to processes that surgeons and staff have become accustomed to for years can be stressful. Necessary changes may involve more paperwork or more steps and this can create frustration. Bringing the focus back to the purpose and why you’re doing it will help maintain the level of commitment needed to implement meaningful changes for improved operational effectiveness.

Transcript:

Daniel J. Marino: Welcome to another episode of Value-Based Care Insights. I'm your host Daniel Marino. In today's episode, we're going to spend some time talking about operational effectiveness. And for any of you that have listened to our podcasts over the last couple of months know that we talked about operational effectiveness and how it can be used to improve workforce performance. And during that episode, we discussed how a lot of challenges had occurred to our workforce, in terms of recruiting staff, keeping staff happy and retaining staff, and how we could improve the process to make staff more effective. And at that time, I had my colleague Kate Geick, who is an expert in operational effectiveness. I'm happy to have Kate back on today. Very excited to have her. And during our episode, we're going to talk about using operational effectiveness to improve surgical services, and a lot of the surgical O.R. (operating room) activities that occur for many of the hospitals. Kate, welcome to the program.

Kate Geick: Thank you, Dan. Happy to be back.

Daniel J. Marino: So Kate, when we think about surgical services, and the impact of surgeries on a hospital, the impact of our efficiencies on the financial performance of hospitals, it's a pretty big impact there. And when I think about the, let's say, the number of cases that could occur, or even, let's say, total surgical case time, or the turnaround time, all of that is process driven. So the more efficient we are in the O.R. the more that we could, let's say handle a few more cases, the more it keeps our costs down, the more it keeps our surgeons happy. What are you seeing in terms of how operational effectiveness can be used to improve surgical services and O.R. performance.

Kate Geick: I think not just with surgical services, but any part of the hospital or any processes that you can think of that could improve. And if you look at it, we can make improvements in any area. We talk about continuous improvement, nothing is perfect, there's always opportunities to improve. I think the thing that people get surprised about is how there was such an inconsistency in processes. So obviously, there are lots of nurses and surgeons and lots of people involved, and depending on who's working, the process is different every time depending on what they prefer to do. And even though standardized processes are typically documented, they don't usually get followed. So I think that what I see very often is people doing whatever they prefer, and there's no standardization on the processes.

Daniel J. Marino: Well, and like you said in the O.R., it's tough, because you've you know, you have many different surgeons that come in, and they have a little bit of their own practice style, their own nuances. You know, you'll have the staff there, you'll have the supplies, all of those things as much as you try to standardize it, variability comes into play. So I guess if I'm, say, a chief nursing officer or chief operating officer, how do I know if I have a problem?

Kate Geick: I think you kind of need to identify different KPIs, key performance indicators. And compare yourself with other organizations that are similar to you and see if you're really off and then be able to identify why are we so slow, in turnaround time for example, compared to other organizations. Then you could do maybe a value stream mapping exercise or diving in and go and see in person instead of making assumptions. Go and see what's going on and see how you can improve in the KPIs that you're not on target with. 

Daniel J. Marino: Obviously data is key, right? You have to be able to have the data, interpret the data, understand how, what we would call analytic insights, right can drive some performance and some opportunities to, to change the process, if you will, I would think that as we start to look at the data, and you do some say value stream mapping on the process, you're going to be able to identify opportunities right away, where you can reduce some of the variation, everything from maybe block time utilization to on time starts, or even the turnover of the rooms.

Kate Geick: I think when they do the value stream mapping exercise, they'll be able to see what kind of things are really easy to change and be able to pilot or launch straightaway and what other items that might take maybe a little bit more financial support or more redesign of the process that might take a little bit more effort. They should consider all those things and see how they can prioritize, and what's going to move the needle when we talk about operational effectiveness.

Daniel J. Marino: And we talked a little bit about this at the last podcast, but I think it's I think it's worth discussing further, how do we begin to approach whether we have an opportunity to improve the process, maybe you can talk a little bit in terms of the tools you would use to be able to launch some type of an operational effectiveness process, maybe using Lean Six Sigma, or something of that nature. Where do you start?

Kate Geick: I think it's two parts. One we already kind of discussed, it's around data and measuring performance on a regular basis. And typically, they would have people who just focus on doing that. But it's tricky, because if you have the people from IT or operations doing these KPI measurements, they need to make sure that they're looping back in with the surgical staff. Because sometimes it could be separate. Sometimes they're measuring KPIs on a regular basis, and maybe sharing it with people, but if it doesn't get back to the surgical staff, sometimes they don't even know what the data shows. They can probably feel it and they can probably see it day to day, but you'd be surprised how many times the nursing staff or surgical staff don't even know what the KPIs are, and what the performance is. So I think it's really important to not only measure certain KPIs on a regular basis, but also share that with the right people on a regular basis.

Daniel J. Marino: Oh, yeah, I absolutely agree. You know, as you're describing, that reminds me of a project that I was on a couple of years ago, this particular hospital did not have very good data, not very good reports, frankly, I think they had a lot of data, they just didn’t have very good reports. So we had helped them create some things, some pretty good reports to help them identify some of their performance. And one of the things that we did was we shared the reports with the surgeons, with the anesthesiologist, just frankly, with the staff. And as they started to see where some of the challenges were, you know, the Hawthorne effect came into play, just the sheer fact that they were able to, to understand what was occurring, it clicked for them right off the bat, and they were able to identify areas of opportunity without having good reports like that without being able to share that information, It's very difficult to be able to improve it.

Kate Geick: I think another thing is, often, if they are aware of areas that need to be improved, they might not have the capacity to work on those. It's not that they don't have ideas, or they're not smart enough. They totally are. They are the experts. But sometimes they're so busy and work so many hours, as we talked about in previous conversations around workforce, the staff shortages and things like that. They don't have the capacity to think about improvement, they just want to get through their day. I think it's the hospital and their leadership considering making a case to provide assistance to people, to make their lives easier, and to improve patient care.

Daniel J. Marino: I absolutely agree. And sometimes it's tough. You're managing the crisis, not necessarily proactively managing a lot of the issues. It's tough when you have short staff or not the right processes in place when you're managing a crisis. I would think going through an operational effectiveness improvement process, whether it's with the O.R. or it's with another area within the hospital operations. It may be a little easier with staff to go through that because the staff are there. But what about physicians? Physicians have such a big impact, particularly in the O.R. How do we engage the physicians to help them understand that not only are they an important part of the process, but there's a big implication for them both financially, operationally, and certainly from a patient care perspective. Thoughts on how physicians should be engaged?

Kate Geick: I think engagement can be quite hard, especially with the level of stress or burnout that they're dealing with. But I think what really brings people together is to think about making sure that they're trying to aim for the same goals, and bringing it back to patient care. So you might say in order to address the KPI or to improve the KPI we must change our process, which is actually going to create more work for them. And it might be really stressful for them to change that process, something they've been doing the same way for the past 10 years. And all of a sudden you have to do more paperwork or more steps to improve the KPI might be quite frustrating. And it's bringing it back to the purpose and why we're doing it. So they can say this is kind of annoying right now, it's a lot of work, but in the long run it's going to improve the patient care, and after a couple of times I'm gonna get used to it, and it's going to get faster, it's going to get better.

Daniel J. Marino: With surgical services, there's a dual benefit here. If you improve surgical services, if you make your own wire more efficient, there's a direct revenue opportunity. Because frankly, if you do it well, you improve the on-time start, or if you improve the total surgical case time, for instance, if you're able to squeeze one more case in a day, that's going to improve your revenue. But then the second to that is there's a cost opportunity, cost reduction opportunity. So if you create efficiencies, you're going to be able to reduce, I would think, your variable costs. So that opportunity that I think is presented through improving surgical services, helps the hospital, helps the physicians, and then it also helps the patient because the satisfaction, I would think coming out of the surgical care from the patient's perspective has to be enhanced.

Kate Geick: I think it's interesting though. We've had a number of podcasts and conversations with Dr. Mayzell and Steven Berger. I think clinical folks don't have enough conversations around financial KPIs. Obviously, it's important to cover clinical KPIs and see how they can improve, but I don't know how often clinical people and finance people have conversations about the cost and the revenue side of things. Maybe with the leaders they do, but not with all the surgeons, not with all the surgical nurses. So I think that's an opportunity for us to change moving forward with organizations on having those conversations and learning to speak each other's language. There's a lot of education involved with that, and I think it's really beneficial to get that with regular processes.

Daniel J. Marino: You have to engage the physicians in a process improvement like surgical services. I guess the question really comes in as to what level and how involved the physician should be. I think a lot of the driving of the process efficiencies couldn't come from the nursing staff, but at the end of the day, I sort of see the physicians as kind of the coaches, if you will, of the O.R., with maybe the nursing staff being the quarterbacks. They may be running the show, but at the end of the day, it's the physicians who are really going to make the decision. In my mind we have to have a level of physician leadership, physician governance, physician input, but it has to be done at the right level. So I think to your point that it translates well for the physicians and the surgeons to understand where the improvements can come in. Plus, they need to be able to relate to the benefit. We talk about it all the time. Dr. Mayzell talks about it all the time. It's what's in it for me from a physician standpoint. So those elements of operational effectiveness, I think, are critical in order to drive performance.

Kate Geick: There's a lot of education that is involved that people might not think about.

Daniel J. Marino: You mentioned there's a webinar coming up that you're going to be participating in talking about surgical services and operational effectiveness. Can you talk a little bit about what that webinar entails?

Kate Geick: We have a webinar coming up on Tuesday, May 24, at 11:00 AM Central Time. It's called Surgical Services Effectiveness: Five Measures to Drive Results. And in that webinar we're going to dive into five particular KPIs and go through part one from the surgical directions team that we have collaborated with many times, they're going to focus on the KPI and from our Lumina Health Partners side, we're going to talk about the Lean Six Sigma and people side of things, and how to address a KPI from the people side of things.

Daniel J. Marino: That sounds good. And I'll tell you, I've spoken to many CFOs around the country, many of them are still struggling with their financial performance. As we've talked about time and time again, expenses are up, revenues are pretty much flat, some of them still haven't totally recovered from COVID, although they're moving in a good direction. I think to dive into the opportunities around surgical services and opportunities around improving processes, as we've talked about, has a direct opportunity to improve the financial performance from a revenue standpoint, from a cost standpoint, and certainly from a provider and patient satisfaction perspective. 

Kate Geick: We're going to identify causes of inefficient processes, and we'll talk about how improving efficiencies and productivity can help with the overall financial success.

Daniel J. Marino: That's great. So for some of our guests that are listening, let's say they're working at a hospital and they believe they might have some issues with their O.R., they believe that their O.R. could run a little bit more efficiently. Where would somebody look to start? How do they know if they have a problem? Or what can they do internally in the organization to assess if they do have a problem and the potential opportunities going forward?

Kate Geick: I think they should definitely utilize the tools that they already have. So if they have dashboards and KPIs, like we talked about, if they have data, use that to make a case to the leadership and say, Hey, we're looking at this data on a regular basis, we're comparing ourselves with other organizations, we have a target. This is the gap that we have. We don't really know where to start, or we don't have the right resources to address this. And make a case to have a conversation and have the data to back it up.

Daniel J. Marino: And then looking at that data, I guess you have to engage with physicians at some point, right? 

Kate Geick: I think it would be really important to identify each KPI who was involved. So like you mentioned anesthesia, maybe there, there's so many people involved in pre-op, post-op, and anesthesiology. So identifying who is involved and how they're going to be impacted or how they can make a big impact, they can influence the KPI in a positive way.

Daniel J. Marino: Right. And then hopefully, they have some resources internally in the organization around Lean Six Sigma or operational effectiveness where they can start to put in place a plan or value stream mapping or something of that nature. As you mentioned, I think that's sometimes a challenge for folks. Where would they go? Or how can they identify some opportunities around process improvement? Any thoughts there?

Kate Geick: What's been really interesting is a lot of organizations have started having their own in-house, Lean Six Sigma team, or if they don't, they have been expanding their quality department capability to support different initiatives throughout the hospital. So maybe people could reach out and partner with those people and use those expertise and the resources to address some of the stuff.

Daniel J. Marino: You know, one of the things for our audience, it would be interesting to hear back as to whether organizations really have that depth of knowledge and that depth of experience. I know, Kate, given your depth of experience and operational effectiveness and Lean Six Sigma, one of the things that I've thought about is maybe doing kind of a deep dive of all of the tools or the capabilities that are required around operational effectiveness, if this is something the audience would be interested in hearing. Well, I think that would be just just a great discussion.

Kate Geick: I think with our podcast, they are about 30 minutes and there's only so much you can cover and we touch on things at a high level and we are planning through Lumina Health Partners to do some articles and webinars and more of these podcasts where we discuss specific tools on how to get started. I think sometimes with these podcasts, we don't have enough time to cover everything that we want to. Going through the specific tools it takes a little bit more education and a little bit of more time. And they are never cookie cutter solutions, right? So it's really customizing, you know, what really needs to get done from organization to organization. If a certain organization has massive cultural issues, forget about all these KPIs, they're not in the right place to even have these conversations. So starting with the cultural problems and leadership and things like that might be a little bit different.

Daniel J. Marino: Well, I know you've got a series of articles coming out too. The article you released a couple of weeks ago on using operational effectiveness to improve workforce performance was extremely well received. And I think we got another one coming out on using operational effectiveness to improve surgical services as well, too. Is that correct?

Kate Geick: Yes, we will release that in either May or June. And from that article, we will talk about specific tools and how to use them. So be on the lookout for that.

Daniel J. Marino: I've always been fascinated with process improvement and using operational effectiveness techniques to improve the way we do business, the way we take care of patients within hospital operations. Particularly because as we've talked about, it has a direct opportunity to reduce cost, it has a direct opportunity to increase revenues, depending upon the department, and all organizations are trying to figure out ways to do things better, to make things more efficient. And I think for many organizations, if they could start to adopt some of these principles of operational effectiveness, I think the opportunities could be endless.

Kate Geick: For sure. And I think always remember to focus on people, people are going to be the ones who can activate these initiatives. Without the people it's not possible.

Daniel J. Marino: That's great advice. Well, Kate, thanks for coming on. In another couple of weeks, as you mentioned, we're going to have our webinar on operational effectiveness. What is that date, again?

Kate Geick: May 24 2022, at 11:00 AM Central Time. For those of you who are not able to attend the webinar live, we'll record the session and share the presentation with you on our website. So be on the lookout for that.

Daniel J. Marino: And folks can sign up at luminahp.com/insights. Well, thanks, Kate, I appreciate your time. Just to summarize, I think there were a couple of key takeaways for me that Kate mentioned that I think are really important, that drives the success of operational effectiveness. I think one is the data, and many hospitals have a lot of data, but they don't have a lot of good information or insights coming out of the data, you have to really be able to use that data to understand, one, if you have a problem, and two, where to start in fixing that problem. I think the second thing that Kate mentioned was engaging physicians and engaging the staff. Can't forget about the people's side. Especially if you start to engage physicians, at the right level, deliver reports in a way that they can understand, that aligns with the way that they're taking care of patients. That level of information in and of itself is going to drive improvements. And then I think third, when you think about operational effectiveness, it's one of those things that does require a commitment, but it has a lot of opportunities around it. It has opportunities to reduce costs, improve patient satisfaction and physician satisfaction, and also improve revenues. So hopefully, the information we shared today was valuable. I encourage a lot of organizations to think about these tools and think about these aspects of operational improvement or effectiveness to drive a lot of improvements in their organizations. Until next time, I'm Daniel Marino, appreciate everyone's time in listening. Thank you and take care.

About Value-Based Care Insights Podcast

Value-Based Care Insights is a podcast that explores how to optimize the performance of programs to meet the demands of an increasingly value-based care payment environment. Hosted by Daniel J. Marino, the VBCI podcast highlights recognized experts in the field and within Lumina Health Partners.