Transcript Peri-Operative Governing Council Report to Quality of Care

PERI-OP GOVERNING COUNCIL
ST. LUKE’S HOSPITAL
CEDAR RAPIDS
IHS Leadership Symposium
April 17, 2012
Background
• Operating room is a significant driver of net
revenue and cost in the hospital
• > 10,000 inpatient and outpatient cases annually
• Limitations to hospital resources
• Skilled specialty specific staff
• Rooms
• Specialty equipment
• Inefficient scheduling system contributes to
unintended competition for resources
• Surgeons have limited understanding of the
management of those resources beyond their
schedule
Peri-Operative Governing Council
(POGC) Established 2008
• Aim: To create a shared governance model comprised of
hospital administration, peri-operative service mgmt,
surgeons, and anesthesiologists
• Purpose: Engage physicians in operational decisions that
affect them
 To keep physicians abreast of peri-operative initiatives
 To identify opportunities to increase physician satisfaction and ease
of practice
 To support initiatives to improve the efficiency and effectiveness of
the OR
POGC Structure
Original Charter
• Advisory capacity
• Physician membership assigned and approved by St.
Luke’s administration
• All physician members had voting privileges in
determining recommendations referred to responsible
hospital personnel & medical staff committees as
appropriate
• Other medical staff attendees invited as topics dictate
2008-2009 POGC Business
Identified and discussed operational issues affecting OR flow
• On time starts, first case of the day
• Definition of "start time“
• Scheduled time vs. actual time
• Anesthesia schedule management
• Epidural block placement prior to surgery
• Ease of adding on cases
• Turn-over times
• The Flood - our response and what we learned
• ED to OR patient throughput
2010 - Surgical Services Assessment
• Built political capital through engagement and
communication
• Took time for due diligence
• Educated physicians
• POGC selected external consultant for surgical services
assessment (Sullivan Group)
• Physician participation in assessment interviews
• Communication, Communication, Communication
2010 – Assessment Conclusion and
Action plan
• The Peri-Operative Governing Council has worked to
establish an organizational foundation that will allow the
peri-operative program to function in a high quality,
patient-centric, customer-focused, and cost-effective
manner
• A primary goal is to get the appropriate resources to the
surgeon, including skilled help, the right equipment, and
anesthesia services, so that he/she can give the best care
to the patient in a timely fashion
• Many surgeons unintentionally compete with other
surgeons for the same resources at the same time in the
same hospital by way of past scheduling practices
• It is beneficial for everyone to improve scheduling
processes and define elective block schedules that are
site specific so as to reduce the unintended but frustrating
competition for resources
A Platform for Change
Recognize:
• This is a political process
• There are multiple stakeholders
• Foundational changes required to affect real change
• The importance of communication and deliberation
Presentation to St. Luke’s BOD
Oct 2010
• History of POGC – Aim and Purpose
• Peri-operative stakeholders
• Proposed improvements in peri-operative services
• Request to advance from an advisory council to a
governing council
• Governing Council supported by BOD
2011 –Surgery Executive Committee
Director of Surgery, Anesthesia Director, COO, Director Surgical Services
Effective governance structure is essential to a well-run
surgery program
• Structure: subset of the POGC
• Purpose:
 Educate, develop, support physician leaders
 Charged with operational responsibility and authority for all aspects
of the surgical program, including:
• development, implementation, and enforcement of all policies related to
surgical services’ operational issues including block scheduling and
patient throughput
• responsible for creating the monthly agenda for the POGC
• examine educational opportunities for physician leaders
2011 – POGC Business
• Update charter to evolve from:
 Advisory capacity to Governing capacity
 Physician membership assigned and approved by St. Luke’s
administration to membership selected and approved by POGC
 All physician members had voting privileges in determining
recommendations referred to responsible hospital personnel & medical
staff committees as appropriate to voting privileges extended to creating
policy
 Other medical staff attendees invited as topics dictate
• Universal Block Scheduling Policy
• Add-on classification system
• Communicate Council activity to physician colleagues
2011 – POGC and Block Scheduling
• POGC oversight of transition from city-wide block
scheduling system to a hospital-based or site- specific
system to be completed January 2012
• Collaborative effort between the hospital, anesthesia
services and multiple surgeons and offices
• Issue surgeon and specialty-specific blocks
• Define scheduling terms
• Develop and implement Universal Block Scheduling
Policy
• Develop and review block utilization reports
Elective vs. Add-On
Principle:
• A well managed elective schedule along with clinically
driven prioritization of add-ons can reduce wait times
for urgent/emergent volumes.
Elective vs. Add-On
Must be Managed Separately
• Wait times and other delays are key drivers in both
patient satisfaction and clinical quality. The most
effective organizations will address patient flow issues
through “changing the production process” via
operational management techniques from private
industry.
• Variability in the elective schedule is the main driver in
OR delays. The elective schedule is totally
schedulable and within our control. Proper
management of an elective schedule improves
physician/patient access to patient-driven peaks in
demand (add-ons). Elective and non-elective volumes
are different and must be treated separately.
Results
• Operations / Flow:
• Variability – Hours of elective vs. hours or add-ons per day
• On-time starts first case of the day
• Block utilization
• Matching OR staffing to volumes
• OR staff overtime and Extra Hours Incentive
• OR rooms open after 1530, 1730 and 1930
90.0
Block Start:
Neuro
St. Luke's Hours of Surgery
Block Start:
GYN, Gen. Surg,
Block Start:
Ortho, ENT
80.0
70.0
60.0
50.0
40.0
30.0
20.0
10.0
3-Jan
11-Jan
19-Jan
27-Jan
4-Feb
14-Feb
22-Feb
2-Mar
10-Mar
18-Mar
28-Mar
5-Apr
13-Apr
21-Apr
29-Apr
9-May
17-May
25-May
3-Jun
13-Jun
21-Jun
29-Jun
8-Jul
18-Jul
26-Jul
3-Aug
11-Aug
19-Aug
29-Aug
7-Sep
15-Sep
23-Sep
3-Oct
11-Oct
19-Oct
27-Oct
4-Nov
14-Nov
22-Nov
2-Dec
12-Dec
20-Dec
29-Dec
9-Jan
17-Jan
25-Jan
2-Feb
10-Feb
20-Feb
28-Feb
0.0
Elective Hours of Surgery
Add-on Hours of Surgery
Prior to St. Luke 's Blocks
Q4 2010
Ele ctive Add-On
Average
47.77
4.79
Median
46.25
4.15
Standard Dev.
11.50
3.00
Q4
Average
Median
Standard Dev.
Sta rt of N e uro Blocks
Q1 2011 - Q2 2011 Ele ctive Add-On
Average
48.60
5.10
Median
47.5
4.5
Standard Dev.
11.16
2.78
Sta rt of GYN , Ge n Surg, & U ro
Ja nua ry
Ele ctive Add-On
Average
57.80
10.34
Median
60.6
9.6
Standard Dev.
8.34
4.14
Sta rt of Ortho/ EN T Blocks
Q3
Ele ctive Add-On
Average
46.34
4.04
Median
46.4
4.0
Standard Dev.
10.92
2.63
Sta rt of GYN , Ge n Surg, & U ro
Fe brua ry
Ele ctive Add-On
Average
48.38
9.18
Median
47.5
8.7
Standard Dev.
9.12
3.83
Ele ctive Add-On
53.22
7.18
54.6
6.4
12.70
4.56
Block Utilization Report Summary
Total OR Blocked Hours Utilization
Quarter
Block
Hours
Scheduled
Time
Scheduled
Time
Actual Time Out of Block
Utilization Actual Time Utilization
Time
Q1
310.50
208.00
67.0%
207.87
66.9%
34.00
Q2
337.50
237.00
70.2%
227.09
67.3%
115.50
Q3
1,002.00
661.00
66.0%
556.01
55.5%
150.63
Q4
1,744.00
1,160.20
66.5%
988.97
56.7%
308.24
Key:
Total
2011
3,394.00
2,266.20
66.8%
1,979.94
58.3%
608.37
> 80% Utilization
Jan.
1,107.50
728.70
65.8%
550.41
49.7%
103.55
60 - 80% Utilization
Feb.
1,158.00
765.06
66.1%
656.19
56.7%
190.00
< 60% Utilization
Mar
1,166.00
793.50
68.1%
661.25
56.7%
184.05
On Time Starts – 1st Case of the Day
Overtime and Extra Hours Incentive
Rooms Open after 1530, 1730, 1930
1st Qtr 2012 OR Rooms in Use 15:30 - 23:00
10
15:30 - 17:00
19:01 - 23:00
9
17:01 - 19:00
Linear (15:30 - 17:00)
8
7
6
5
4
3
2
1
0
1/2
1/11
1/20
1/31
2/9
2/20
2/29
3/9
3/20
3/29