OR Manager - April 2020 - 21

OR business
Surgeon engagement
Another benefit of the Olympics program
at Lehigh Valley Health Network, Allentown,
Pennsylvania, was that surgeons
learned more about wasted surgical
spending. The OR leadership team had
identified five surgical divisions to target
in addressing procedure standardization,
but additional service lines got on
board as a result of the program. " They
came to see that reducing supply costs
would improve margins, allowing them
to help more patients in need, " says Alex
Warman, MBA, director of perioperative
business services.
Strategies included:
➤ Leveraging the power of the chair
of the department of surgery. For
Procedure
Transurethral resection of the prostate
example, the chair helped division
chiefs understand the importance of
reducing procedural variance in the
OR. " He provides a clinical viewpoint
surgeons can relate to, " Warman says.
➤ Encouraging competition and peer
pressure. Each surgeon's total
cost per procedure compared to
their colleagues is posted, so that
everyone can see the names of the
lowest performers. The chief of the
division works with low performers
to resolve issues.
To maintain gains, Warman and Hope
Johnson, DNP, RN, administrator for perioperative
services, meet for 90 minutes
with new surgeons to discuss everyone's
expectations. Warman holds brief meetings
with individual surgeons on a quarterly
basis to review block utilization and
key performance indicators such as first
case on-time starts, turnover, and scheduling
accuracy. He also discusses any
significant procedure variation within the
division, for example, large differences
in supply costs for the same procedure.
Finally, Warman tracks metrics such as
length of procedure, length of stay, and
readmissions. " Costs are more than just
the supplies, " Johnson says.
Warman emphasizes the need to educate
surgeons about what is being spent.
" Transparency makes surgeons more
likely to agree to change, " he says.
Examples of successful surgeon-led initiatives
Original average case cost Average case cost after changes
$577
Transurethral resection of bladder tumor $277
Percutaneous nephrolithotomy
Laparoscopic cholesytectomy
$450
$186
$1,443
$641
$1,016
$429 (primarily by eliminating use of the harmonic
scalpel for elective procedures)
Making the play
Staff received a memo about the Olympics
and the need for cost savings.
" The goal was to empower the staff to
innovate and figure out how to tackle
cost savings and expense control, "
Johnson says.
Frontline staff from all surgical
areas, including the preoperative area,
OR, and the postanesthesia care unit
(PACU), of the four main hospitals in the
system were eligible for the Olympics.
" They are the ones who observe on a
daily basis the potential opportunity for
change and elimination of waste, " Johnson
says, adding that managers and
physicians could also participate.
Each hospital in the system was
considered a " country. " Staff members
completed a submission form and
pitched a cost-savings idea during a
3-hour meeting at each campus (sidewww.ormanager.com
bar,
p 20). In 1 week, 78 submissions
came from frontline staff, managers,
educators, business service staff, and
physicians. Warman and the senior
value analysis coordinator judged the
presentations at each hospital.
" We were pleased with the level of
participation, " Johnson says. Everyone
who participated received a certificate
of recognition.
And the medals go to...
The winners and runners-up in three categories
received " medals " and jackets
with the hospital's logo; they were also
recognized in front of their peers, and
an email announcing the results was
sent.
Frontline staff: most savings. First
place went to a surgical technologist
(ST) who pitched standardization of
drapes. He compared two packs for
the same procedure from two different
hospitals: One had four drapes,
the other 19. " It wasn't surgeon preference,
so we standardized the pack to
four drapes, " Warman says.
Second place went to another ST for
standardization of procedure packs.
Most creative. First place was
awarded to an OR nurse who proposed
automatic scrub sink sensors to help
avoid wasted water. The sensors,
scheduled to be implemented in 2020,
are anticipated to net an annual savings
of $934,000. " Water conservation is
something you don't think about, so we
were surprised by the amount of savings, "
Johnson says.
Second place went to a PACU nurse
who suggested repurposing arterial line
pressure bags. He used them to inflate
basketballs, so they didn't end up in
Continued on page 25
OR Manager | April 2020
21
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OR Manager - April 2020

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