Building the Skeleton: Creating a Dedicated Orthopedic Service Line
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This document discusses creating a dedicated orthopedic service line at Butler Health System. It emphasizes the importance of having a surgeon champion, administration champion, and orthopedic service line director to lead a multidisciplinary team in addressing issues like variable costs, inconsistent patient expectations, and long lengths of stay. The team should work on small, early successes like streamlining order sets before tackling bigger challenges. Regular meetings, recognizing accomplishments, and social activities can help build team cohesion over time as the service line works to continuously improve processes and patient outcomes.
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Building the Skeleton: Creating a Dedicated Orthopedic Service Line
- 1. Creating a Dedicated Service Line Sandy Nettrour, PA-C December 3, 2013
- 2. Hospital Vision Statement Butler Health System: “We exist to make a positive difference in the lives of our patients by providing compassionate, high quality care and comfort and inspiring health and well being.” Serves as a way to build consensus for all parties December 3, 2013
- 3. Administration and Surgeon Support December 3, 2013
- 4. Surgeon Champion • Traits – Energetic – Motivated to increase volume and improve efficiency – Team player (with administration and staff) – Interested in controlling hospital costs – Supported by other orthopedic surgeons on staff to represent their interests December 3, 2013
- 5. Administration Champion • Able to understand the surgeon’s perspective • Willing to work creatively to overcome obstacles • Willing to invest time, money, and personnel to develop the service line • Expects to see Return On Investment through increased volume and decreased costs December 3, 2013
- 6. Core Conflicts • Surgeons can not – Divide their focus between patient care and hospital management – Personally fix all the problems • Administrators have difficulty – Seeing past costs to initiate the service line – Are working with an ever shrinking budget – Must trust the surgeon to increase volume • That is why goal alignment is key! December 3, 2013
- 8. Orthopedic Service Line Director Non-surgeon (background can vary) • Favorable traits: – Good organizational skills – Good communication skills – Ability to facilitate alignment of goals – Analytical skills-attention to details – Ability to see the larger picture December 3, 2013
- 9. Take Down the Silos: The right people have to be at the table together. What solves for one can increase issues for another Prevent the “hospital salute” December 3, 2013
- 10. Team Composition • • • • • • • • Physician(s) Administration Service Line Director Nursing (floor manager) Operating Room (ortho team leader) Physical Therapy Pre-Admissions Representative Case Management/Social Services December 3, 2013
- 11. Ad Hoc Team Members • • • • • • • Anesthesia Sterile Processing Pharmacy Billing and coding Outpatient Rehabilitation Home Health Physician office staff December 3, 2013
- 12. Getting Started • Listen to all of your team members • Start with individual interviews • What are the common issues? • How can the service line team improve these issues?
- 13. Investigate • What is reality? Go and See: observe the problems • What are the strengths and weaknesses of each department? • What will show quick success over the most areas? “Pick low hanging fruit.” December 3, 2013
- 14. Issues Identified • • • • • • • Variability in surgeons’ care pathways Inconsistent and late OR start times Slower than ideal OR turn over times No unified total joint patient education Poor discharge planning pre-op Inconsistent patient expectations High variable costs December 3, 2013
- 15. Early Implementation • Work to fix the common problems – Start with small projects- streamline order sets, progress notes, patient education, pre-op testing – Early success will spark team interest • Assign action items with clear deadlines and accountability • Engage and empower frontline people • Meet every 2-4 weeks to keep the team engaged December 3, 2013
- 16. BHS Total Joint Camp Our first team project • Covered all departmentsincluding physician office • Streamlining patient education revealed redundant work • Improved patient expectations • Reduced length of stay (1.5 days first year) • Unified the operations team
- 17. Later Process Improvement Projects • Operating Room Efficiency – Streamlined OR trays; Improved on time start • Length of Stay management-D/C planning • Patient satisfaction- improve expectations with consistent message • Variable Cost Control • Constantly look for further improvements • You will have to revisit prior issues to keep them on track. December 3, 2013
- 18. How can YOU create a dedicated team? Be the solution, not the problem Your team should want to work with you December 3, 2013
- 19. Pearls and Pitfalls • Be open to feedback • Turn criticism into positive action • Small initial successes will help to gain momentum • Changing culture takes time-Resistance is natural December 3, 2013
- 20. The Importance of Team Building • Consider both rewards and recognition • Give credit where credit is due • Small things have a big impact (pizza, milkshakes) • Social activities as a team – Ortho Nurses Day, – Ortho Christmas party
- 21. In Conclusion Action Items: • Provide supportive team leadership • Engage and empower front line people • Show profitability • Listen • Praise and Thank December 3, 2013
Notes de l'éditeur
- Improve hospital profitability, Decrease staff overtime costs, Create a Win-Win
- So, three major elements early on are having a vision, a surgeon champion and an administrative champion.Questions to surgeonsTell the group about your vision for the joint replacement programTell the group about how you see your role as surgeon championTell the group about how administration is showing commitment to the programAsk the audience for questions related to vision, surgeon champion, administration champion
- Questions to Sandy, Vanessa, AllenTell the group about your day to day responsibilitiesTell the group about your biggest challenges in your roleQuestion to surgeonsWhat does the role of the joint coordinators mean to youAsk for audience questions as to the role of the joint coordinator
- Question to faculty What was the first thing you worked on?
- Question to faculty What are some of your current initiatives
- Be on time (early) Be helpful Streamline your instruments Provide a sensible case orderHave monthly team meetings to resolve issues and create solutions Provide rewards and incentives (milkshakes, mopping THANK YOU’S)
- Question to surgeonsTell the group about how you incentivize your teams