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GE Healthcare Camden Group Insights Blog

Physician Preference Cards: An OR Director’s Key To Efficiency

Posted by Matthew Smith on Sep 1, 2017 3:27:57 PM

By Don Martin, Senior Manager, GE Healthcare Camden Group

Efficiency and cost management – the metrics by which OR Directors live and breathe. Data on First Case On Time Starts, cut to close times, room turnover, supply usage help administrators keep a close eye on how efficiently their perioperative suites are running. And among the tools every OR Director should use to ensure they’re running efficiently and profitably: physician preference cards.

Preference cards contain clear and concise procedural instructions that, when combined with an accurate record of needed supplies and equipment, prevent unnecessary delays and procedure interruptions. More importantly, they positively impact patient safety and quality by enabling the surgeon, nurses and technicians to focus exclusively on the patient. Preference cards improve surgeon satisfaction, instrumentation and supply inventory management, as well as staff orientation and training.

Discovering Value In Preference Card Data Mining

Physician preference cards provide another significant benefit. Taken together with supply usage data, preference card information becomes a vital source of data for uncovering valuable supply savings opportunities in the operating room. With surgical costs increasing and reimbursements decreasing, hospitals and physicians need to partner to find ways to contain and reduce costs – and a close-up inspection of supplies may deliver big rewards. The key to this effort begins with information – information that can transform simple data into an effective, actionable tool for driving practice change and cost reductions in the OR.

Costs Of Neglecting Preference Card Management

The majority of hospital surgery departments utilize electronic preference cards generated from their clinical information systems and all feature a catalog of surgical supplies and implants needed during a procedure. Hospital leaders at times make the assumption that those preference cards accurately reflect the supplies the surgeon will use during a case. Our experience tells us otherwise. Often we find supplies – sometimes a few, sometimes several – on each preference card that surgeons rarely if ever use. In fact, when we physically display items on a surgeon’s preference card for their review, many are surprised to find certain supplies were being pulled for their case.

Inaccurate and out-of-date preference cards result in real costs: Hundreds of thousands of dollars in wasted supplies and labor jeopardize already thin contribution margins. Fortunately, corrective measures exist to solve this issue, but they require the combined efforts and commitment of OR Directors and surgeons.

Data Is Key To Improving Preference Cards

Relevant, actionable data enables staff and surgeons to quickly identify and evaluate efficiency and cost-savings opportunities. Unfortunately, we frequently hear surgeons say that throughout their years of practice, they have not received empirical data they can use to drive more efficient and cost-effective supply utilization practices.

Information drawn from physician preference cards and historical supply usage data supports surgeon-specific and comparative supply usage analysis. Let’s look at an example. Table 1 shows a partial list of supplies used by Dr. A in laparoscopic appendectomy cases. The highlighted items include supplies provided for the case but never used, or picked in insufficient quantities and requiring the staff to leave the OR to retrieve them during the case. Both represent opportunities for workflow efficiency and supply cost reduction. OR Directors can show surgeons this data and point out how poor preference card management results in case delays, supply waste, and lost time and effort moving unused supplies between the OR and storeroom. In doing so, they will likely gain allies in refining a more selective and efficient case cart build process.

Metrics

Here’s another example. Table 2 shows comparative supply usage data across multiple surgeons for a common procedure. A supply analytic tool like this identifies opportunities to convert a surgeon to a clinically equivalent, lower-cost supply that his colleagues use to achieve similar outcomes. It also identifies opportunities to convert an entire group of surgeons to the same supply, enabling the organization to leverage volume purchasing as well as standardize products and reduce inventory variability. OR Directors can partner with their Supply Chain VP to include not only surgeon supply usage statistics, but also the average cost of supply expense per case for each of the surgeons in the analysis. This approach grabs attention and often motivates surgeons to dig deeper into the data to better understand the reasons behind the cost differences.

Metrics

Our clients have discovered that presenting supply utilization data in this straight-forward and concise fashion invites surgeons to open a dialogue with the OR staff and with each other – leading to a renewed desire to pursue more efficient supply selection and consumption.

Our work with clients has shown us that achieving improved operational and financial results in the OR through effective physician preference cards requires significant effort and focus.

Non-Labor Expense Reduction


MartinD.jpgMr. Martin is a senior manager with GE Healthcare Camden Group with more than 20 years of financial and clinical experience with operational responsibilities for patient care delivery, fiscal management, staff development and government, and regulatory compliance. His collaborative approach guides clients through the complex process of optimizing existing technology to meet healthcare’s Triple Aim: increase operational efficiency, improve the quality of patient care, and decrease the costs of care.

 

Topics: Perioperative Services, Non-Labor Expense Reduction, Operating Room, Supply Chain, Physician Preference Cars, Don Martin

Leveraging Data Analytics To Optimize Supply Availability In The Operating Room

Posted by Matthew Smith on Aug 29, 2017 6:12:44 PM

By Don Martin, Senior Manager, GE Healthcare Camden Group

Imagine you are the OR nurse or surgical technician setting up the sterile field for a procedure when you discover that a critical supply or instrument is missing from the case cart. You scan the physician procedure card and see the item is listed but for some reason has not been picked. The patient is lying on the table and the surgeon will be walking into the room at any time – and she will not be happy to learn that the case will be delayed or possibly postponed while you and others scramble to locate the missing piece. Most of you don’t have to imagine this scenario because unfortunately we’ve all had this experience more times than we’d care to admit.

We all know that the apparently simple task of having the right supply or instrument available when and where it is needed for a surgical procedure is in fact not simple at all. It often involves many tasks performed by multiple staff across several departments, including vendors, materials management, central sterile services and the OR staff itself. We also know that without the ability to forecast the demand for these resources and match that demand against availability, we are leaving it largely to chance that the resource will be available when needed in the operating room. Leveraging data analytics enables hospitals to optimize scheduling and resources in the operating room.

Case Study: Addressing Gaps In Perioperative Automated Supply Inventory Management

Recently, we partnered with a multi-hospital, integrated delivery system to implement a point-of-use automated supply inventory management in the surgery suites of three of its facilities. This project was one element of an overall management initiative to improve supply service delivery to Perioperative Services, with these key objectives:

  • Ensure supply items are available to the operating room staff when and where they were needed
  • Streamline supply throughput processes in the operating room
  • Reassign day-to-day supply chain management responsibilities in the OR from clinicians to supply chain staff, enabling the OR staff to focus exclusively on their clinical responsibilities

While the implementation project was successful from a technical standpoint, end-users soon learned that simply having procedure scheduling and supply inventory data readily available from their respective systems was not particularly useful unless that information was somehow integrated to provide forecasting data, enabling the OR and Materials Management staff to anticipate and act upon identified inventory shortfalls and changes in scheduling volumes. Consequently, the OR staff continued to rely on tribal knowledge to forecast supply demand, often with poor results.

Seeing this, management organized a workgroup composed of managers and key staff from the OR, Central Sterile Services and Materials Management departments to further understand this information need and design a platform to provide the desired forecasting data. The group learned that neither the surgery or point-of-use inventory management systems were capable of communicating directly with each other to produce the required forecasting reporting. They decided to focus their efforts to develop a tool that would assimilate and organize scheduling and inventory data from their respective systems to produce and distribute daily supply forecasting information to the operating room staff.

The team selected the Microsoft Access database application as the platform for generating the inventory data analytics. Extracts were created to source scheduling and inventory updates from the surgery information and point-of-use supply inventory management systems and import them into the Access database. Queries and reports were designed and built and, following a period of application testing and validation with an end-user pilot group, the application was installed on departmental workstations and distributed for use by the operating room and materials management staff. An image of the application’s menu directory is shown in the graphic below.

Metrics

Data Analytics Improves Inventory Accuracy And Availability

Data analytics generated from this tool fulfilled two highly desired and critical reporting requirements:

  • Daily reporting of anticipated inventory shortfalls impacting cases the following day enabled the Materials Management staff to notify and work with the OR staff to secure supplies from alternate sources or identify appropriate product substitutes
  • Analytics of supply demand trending data compiled over time enabled the materials management staff to adjust Periodic Automatic Replenishment (PAR) and inventory refill points to achieve more stable and reliable inventory levels, reducing the spikes in inventory levels prevalent before the availability of this information.

As the OR staff began to gain confidence in the data analytics, they relied less on tribal knowledge and increasingly on the information provided by the analytic tool. With that, we also saw a reduction in behaviors such as supply hoarding, which have a negative impact on supply availability and inventory level accuracy. The graph below represents the OR supply fill rate following implementation of the analytic tool. The results from Day 1 through Day 10 reflect the general volatility of supply availability levels prior to the use of the tool. As the OR and Materials Management staffs gained proficiency with the tool and use of the forecasting data, fill rates were improved and stabilized in Days 13 through 28, with one exception. Please note that the fill rate measures shown below were taken over a three-month period.

Metrics

Lessons Learned

As with any system implementation project, our team came away with several lessons learned:

  • Before embarking on this type of project, it’s important to assess the availability and status of clinical and operational requirements within the organization; we’ve consolidated these requirements into a Data Modeling Checklist to help other hospitals and systems
  • A multi-disciplinary project steering committee was essential to the success of the project in establishing analytic data priorities and maintaining the development team’s focus
  • Begin with small, focused initiatives to shorten the development and product delivery cycles and build rapid team competency
  • Early operational successes resulting from the use of the analytic data fosters staff confidence and reduces reliance on group tribal knowledge
  • As with the inventory forecasting data, future data analytic development initiatives must demonstrate clear quality, operational and/or financial value to gain approval for development

Non-Labor Expense Reduction


MartinD.jpgMr. Martin is a senior manager with GE Healthcare Camden Group with more than 20 years of financial and clinical experience with operational responsibilities for patient care delivery, fiscal management, staff development and government, and regulatory compliance. His collaborative approach guides clients through the complex process of optimizing existing technology to meet healthcare’s Triple Aim: increase operational efficiency, improve the quality of patient care, and decrease the costs of care.

 


Topics: Data Analytics, Perioperative Services, Supply Chain Management, Operating Room

3 Key Priorities in the Perioperative World

Posted by Matthew Smith on May 18, 2017 10:48:47 AM

By Nehal Koradia, RN, MBA, and Ryan Treml, GE Healthcare Camden Group

As has been the case for many years, hospital organizations continue to look to perioperative services to be one of the most important financial engines for the institution – consistently looking for ways to maximize the utilization and efficiency of the department.

As reimbursement declines, new payment models are being explored, and hospitals continue to consolidate, organizations are expanding on and moving beyond past methods to drive improvement. Here are key priorities in the perioperative world that healthcare leaders should keep in mind:

1. Be more deliberate and detailed in linking the strategic plan to perioperative services.

Evaluate volume against capacity. Volume has historically solved most problems. However, with reimbursement changing towards value-based payment, volume has to be analyzed much more thoroughly. The days of adding volume without first understanding the total capacity available and the corresponding costs – labor, equipment, supplies, etc. – are gone. Organizations are tackling this challenge by becoming more specialized in their elective volumes – creating centers of excellence to combine specialty services and procedures in a common location to drive extremely efficient day-to-day processes. In addition, they are increasing their focus in shifting outpatient volume to ambulatory surgery centers, embracing the ability to utilize technology and new techniques to transition traditionally inpatient cases to an outpatient environment. Advanced institutions are also making the tough decision to truly rationalize their capabilities – thoroughly evaluating their market and understanding what the community truly needs and can support long-term. All of these options attempt to maximize the organizations utilization of their highly specialized resources.

Match recruitment to the strategic plan. As noted above, forward thinking organizations are pursuing surgical volume that matches their strategy. Similarly, as these organizations evaluate or recruit potential new surgeons, they are taking much more time than they have historically to consider capacity variables. Equipment and staffing capabilities are usually considered when making offers to surgeons, however rarely does an institution evaluate the inpatient capacity needs for the new surgeon joining and determine the optimal day to allocate block time to both maximize OR and IP Capacity. In order for the entire organization to run efficiently, there has to be a good match between the new providers' needs and the access the organization can provide.

2. A refined focus on operational processes and cost.

Embrace systems-thinking and advanced analytics to inform process improvements. It is well known that the elective surgical schedule typically accounts for more variation in inpatient census than ED admissions. Managing that variation is extremely difficult – very few institutions have been able to create a surgical schedule that maximizes OR utilization while also efficiently smoothing the downstream IP volumes. However, it's becoming more common to utilize simulation and forecasting tools to appropriately match inpatient resources to the demand created by surgical inpatient volume. Nursing, support personnel, ancillary services, etc. are being staffed with much more flexibility to allow for the daily, weekly, and monthly variation in inpatient surgical volume. In addition to these dynamic staffing concepts, organizations are focusing on inpatient operational processes to ensure that downstream capacity is not a limiting factor in growing surgical volume. Units are being re-purposed, the benefits and risks of specialization vs. generalization are being analyzed in detail to ensure that beds are available and utilized in the most efficient manner.

Make difficult decisions regarding supply cost. Organizations have always reviewed surgical supply cost and understood that there were opportunities to streamline/standardize, but the most advanced have taken the difficult step in convincing their surgeons to work with them to manage cost. This requires a very detailed dissection of case cost information while balancing it with quality and utilization measures. Often, the supply opportunity is only viewed from the cost perspective, and decisions are made that can impede utilization, extend case lengths, and impact outcomes. High performing organizations understand these situations and include the information into a surgeon's balanced scorecard – often driving change through awareness rather than forced decisions.

3. Establish governance, don't just talk about it.

Use the governance structure to execute strategy. Governance of perioperative services has typically been a term associated with policy development and enforcement. The problem is that it quickly becomes detached from the consistently changing healthcare environment. Surgeons that sit on committees such as Surgery Executive or Block Management are asked to manage with a set of policies that are infrequently reviewed or refreshed. They are asked to align with strategic imperatives and plans, but are not included in the development discussions. Organizations have realized this is not an effective structure to drive true governance and are incorporating these key strategic decisions into their surgical committees. This drives better alignment with the surgeon community, shortens the adoption of key changes, and actually makes policy enforcement much easier.

Hire a Chief Surgical Officer (CSO). To build on the concept of incorporating strategy into governance, hospitals are hiring a surgeon to drive the surgical portion of the strategic plan. This role is different than the chief of surgery – the CSO is part of the executive team and is involved in the development of the strategic plan, drives the recruitment of new surgeons, and balances the wants of the surgeon community with the needs of the hospital system. This role helps buffer the often contentious relationship between surgeons and the administrative suite – complementing the Chief Medical Officer.

Even though many organizations recognize that these changes need to occur to ensure future success, many have difficulty implementing these strategies due to the complex environment in perioperative services. But overcoming the difficulties and implementing even one to two of these strategies can increase revenue and/or decrease cost significantly for an organization, making it well worth the effort.


KoradiaN.jpgMs. Koradia has been leading healthcare organizations through transformation initiatives for over nine years. Ms. Koradia has worked with many large academic centers and community hospitals to transform their operating rooms, decrease readmission rates, and increasing early morning discharges and reducing ER wait times by utilizing simulation modeling, Lean, Work-Out®, and CAP® methodologies. These initiatives have allowed organizations to improve access for patients, streamline operations and improve financial performance, while creating a culture of continuous improvement. She may be reached at [email protected]

 

treml.jpgMr. Treml is a manager with GE Healthcare Camden Group, with 12 years of management consulting experience. He has led a broad range of engagements including: improving perioperative service departments through scheduling optimization and specific process improvements, developing comprehensive capacity strategy plans for high occupancy institutions, implementing electronic event reporting tools, streamlining discharge planning processes, and increasing throughput in diagnostic imaging departments. He may be reached at [email protected]

 

Topics: OR Optimization, Hospital Operations, Nehal Koradia, Ryan Treml, Perioperative Services

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