OR Manager - December 2019 - 16

Special Series: ERAS
SPECIAL SERIES
Continued from page 15
Next steps
Creation of quality standards is just
the beginning of implementing ERAS
as a standard of care. An ERAS standard
of care program must consider
cost, optimal workflow, executive support,
and appropriate staff training.
The program must be supported by a
suite of data analytics that not only
measure compliance with the process,
but also look at surgical outcomes
and the correlation between the two.
Additionally, a formalized change management
process is imperative to successful,
sustainable transformation. ✥
Paula Spencer, MSHA,
PMP, CPHIMS, is director,
office of clinical effectiveness,
at Virginia
Commonwealth University
Health System in Richmond. She
is also adjunct professor, department
of health administration, at Virginia
Commonwealth University.
Mary Fain, PMP, is program
manager, office of
clinical effectiveness, at
Virginia Commonwealth
University Health System
in Richmond.
Michael J. Scott, MB,
ChB, FRCP, FRCA,
FFICM, is professor and
vice chair of research,
department of anesthesiology
and medical director,
office of clinical effectiveness,
at Virginia Commonwealth University
Health System in Richmond.
He is also adjunct professor, department
of anesthesia and critical care
medicine, at the Perelman School of
Medicine, University of Pennsylvania,
in Philadelphia.
References
1. Ljungqvist O, Scott M, Fearon
K C. Enhanced Recovery
After Surgery. JAMA Surg.
2017;152(3):292-298.
2. Gustafsson U O, Oppelstrup H,
Thorell A, et al. Adherence to
the ERAS protocol is associated
with 5-year survival after colorectal
cancer surgery: A retrospective
cohort study. World J Surg.
2016;40(7):1741-1747.
3. Woolf S H, Grol R, Hutchinson A,
et al. Clinical guidelines: Potential
benefits, limitations, and harms
of clinical guidelines. Br Med J.
1999;318(7182):527-530.
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OR Manager | December 2019
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Success stories
Transitioning from a paper-based data and operations
management system to one that uses relational database
software has helped improve workflow and achieve cost
savings at Lahey Hospital and Medical Center in Burlington,
Massachusetts. This article describes the role of the surgical
services value analysis committee in guiding this transition
and offers lessons learned that may help other healthcare
professionals embarking on a similar journey.
OR Manager periodically publishes contributed articles from
nurse leaders or other healthcare providers who want to
share their experiences with our readers.
Do you have something to share? Please contact Elizabeth Wood, Editor, OR Manager, at ewood@accessintel.com; 301-354-1786.
All contributed articles are reviewed by our editorial advisors and, upon acceptance, are edited for style and clarity.
Surgical VAC mines new software for deeper look at products
A
fter transitioning from a paperbased
data and operations
management system to one
that uses relational database software,
Lahey Hospital and Medical Center
(LHMC) in Burlington, Massachusetts,
saved more than $1 million in product
purchases in 2017. The surgical value
analysis committee (VAC) evaluated
150 product requests and managed
the conversion of three large suites of
products to alternate vendors. Rebates
for meeting product use agreements
made possible through vendor loyalty
contracts amounted to $589,000.
LHMC, a 335-bed acute care hospital,
is part of Lahey Health, a system of
hospitals northeast of Boston with more
than 1,400 local providers in adult and
pediatric primary care spread among
community group practices and five hospitals.
LHMC employs more than 500
physicians, including 125 surgeons,
and more than 1,300 nurses.
The surgical VAC is one of several
value analysis committees at LHMC
that collaborate to optimize cost, quality,
and clinical outcomes. Use of customized
software to support all of the
surgical VAC's functions-notably,
evaluating non-commodity products
and physician preference products and
equipment for the OR-has been highly
successful.
The committee is also responsible
S
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for:
* evaluating and managing surgicalrelated
group purchasing organization
(GPO) savings opportunities and
bundled product transitions
* setting up and administering product
trials
* ensuring effective communication
between stakeholders and administrative
decision-makers
* tracking product savings opportunities
and rebates.
Committee members include the
Success stories
There's growing recognition of how contaminants from
garments can contribute to infection rates among surgical
patients. An increase in surgical site infections at one
community hospital prompted more thorough cleaning of
OR surfaces and protective garments, leading to a dramatic
vice chair of the department of surgery
(committee chair), three senior staff
surgeons, the chief nursing officer of
surgical services, the nursing administrative
lead, service lead nurses,
the OR supply chain specialist, the
financial director of surgical services,
a surgical technician, a GPO representative,
and the administrative director
of value analysis.
Do you have something to share? Please contact Elizabeth Wood, Editor, OR Manager, at ewood@accessintel.com; 301-354-1786.
All contributed articles are reviewed by our editorial advisors and, upon acceptance, are edited for style and clarity.
Room for improvement
Four years ago, the VAC was reorganized
with a newly appointed chief of
surgery. The VAC's goal was to increase
data-driven decision-making and create
workflows that produced consistent and
measurable results.
At the time of the transition, the
Protective garments get makeover in new cleaning protocol
urgical site infections are multifactorial,
and perioperative leaders
often struggle with how to reduce
or eliminate them. In 2013, after
an unexplained increase in surgical site
infections (SSIs) among patients undergoing
total hip arthroplasty at our facility,
we began to investigate the cause.
A fairly robust ERAS (enhanced rebasic
activities of the VAC-including
minutes, attendance, meeting
proceedings, decisions, and trial outcomes-were
entirely paper based.
Committee members were often unfamiliar
with the products being presented,
and most of the reimbursement
and quality information came
from the provider who was requesting
the product.
There was no consistent way to
covery after surgery) protocol was already
in place, along with rigorous programs
aimed at addressing National Patient
Safety Goals at Franciscan Health
in Indianapolis, a 267-bed community
hospital where nearly 9,000 procedures
are performed annually.
What seemed to be missing was direct
attention to the OR environment
and the level of cleanliness therein.
And once we delved into a thorough
examination of our practices, we found
that we needed not only a more rigorous
cleaning protocol for the OR, but
also a means of disinfecting our lead
wearables.
This article describes our efforts to
compare the requested product's financial
impact with the financial perSuccess
Stories
served and recorded existing workflows,
which were not consistently followed.
Previous improvement efforts weren't
sustained under a paper-based system,
and we clearly needed software support
to provide a structured environment for
consistent process performance. We
used the plan-do-study-act healthcare
improvement model to facilitate the
transition.
cence meters measure the concentration
of ATP as relative light units (RLU)
in organic material and living cells.
Anecdotal information was collected
from OR staff nurses, surgical technologists,
and cleaning personnel regarding
their perceptions of OR cleanliness.
Staff saw colleagues wearing gloves for
a patient care activity and then touching
keyboards, door handles, countertops,
etc, with those same gloved hands.
They identified 10 high-touch surfaces
as areas of concern, and these became
the basis of weekly ATP testing during
the next 5 years (sidebar below).
Successful leaders make themselves accessible to staff, listen
to their concerns, and create an atmosphere where everyone is
accountable but also recognized for accomplishments. These
common-sense practices can be hard to implement in the OR,
where stress and time constraints often take a toll on people. By
making these practices a priority, perioperative services leaders at
Lights above
surgical table
Light switches
Keyboard
Turning a vision into a process
We initially used Filemaker's relational
database software (Filemaker Pro 15
version 15.0.2.220 8-20-2016), although
we could have used any commercially
available relational database.
A relational database stores data in tables
that relate to one another through
Continued on page 28
Surgical attendants, the team memOR
Manager | February 2019 27
bers responsible for between-case and
terminal room cleaning, performed the
weekly ATP tests. This practice provided
the team with immediate feedback
regarding the effectiveness of
their cleaning so that re-cleaning could
be done when necessary. Initial ATP
testing results validated the suspicions
that more arduous OR cleaning protocols
were a must.
In ascending order, the top five surfaces
of concern were:
* the various buttons and dials on the
anesthesia machine
Surfaces requiring adenosine triphosphate bioluminescence testing
Item to be tested
Specific instructions
Alternate between light handles and surface of light
Alternate between front, side, and back of OR suite
Alternate between keyboard used by circulator and
anesthesiologist
Beneath the surface
Microbes that cause SSIs are not visible
to the naked eye, so a method
of determining cleanliness at a microscopic
level is essential for the accurate
detection of bioburden. The hospital
was using adenosine triphosphate
(ATP) bioluminescence technology to
test the cleanliness of inpatient hospital
rooms, but this practice had not yet
been applied in the OR. ATP bioluminesT
20
OR Manager | April 2019
Need for change
The Employee Workforce Engagement
Survey, administered by Press Ganey
Associates, a leading third-party research
firm, features more than 50 multiple
choice items and two open-ended
questions. The survey, taken by Plainview
Hospital perioperative department
staff in 2014, provided an opportunity
for them to verbalize their work experiences,
including what was working well
and what needed improvement.
Plainview, a 219-bed acute care community
hospital located in Plainview,
New York, is part of Northwell Health,
a large health system with 23 hospitals
and more than 700 outpatient centers.
In 2014, the engagement indicator
at Plainview's perioperative department
was 3.40, which meant the department
was at approximately the 17th percentile
for employee engagement nationwide.
By 2018, the Plainview engagement
indicator rose to 4.57-the 99th
percentile nationwide. How did that
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Gain and sustain staff satisfaction through trust and respect
Anesthesia machine
Door handles
sional accountability for continual practice
enhancement. Research finds that
efforts to improve the culture of the
perioperative work environment consistently
lead to better teamwork and
communication among staff. These enhancements
will positively impact the
safety of surgical patients. Guided by
effective nursing leadership, a team's
culture can be transformed.
OR table
Armboard
Countertops
Telephone
Alternate between sub-sterile door, core door,
and patient entry door
he trust bestowed upon the nursing
profession by the public is
a privilege and requires profesSponge
count meter
happen? The perioperative leadership
team at Plainview effectively changed
its culture from one that was complacent,
noncollegial, and counterproductive
to one that is mission-driven, engaged,
enthusiastic, transparent, and
empowered. With unwavering commitment,
staff empowerment, resilience,
communication, collaboration, and zero
tolerance for incivility and disrespect,
the department continues to thrive.
Alternate between various dials
Alternate between surface areas on surface of mattress
Alternate between surface areas
Alternate between nurses' workstation and
anesthesiologists' workstation
Alternate sites between various buttons
mirrored expected behaviors: " Be the
change you want to see. "
Alternate between primary room phone and
anesthesiologists' phone
Ingredients for success
In April 2018, Northwell's Perioperative
Corporate Services sent a team to
speak to the perioperative services staff
at Plainview about the unprecedented
improvement in employee satisfaction
and engagement. The majority of feedback
from staff members was that the
incredibly supportive culture was directly
related to the actions of the leadership
team led by perioperative services director
Winnie Mele, BSN, RN, NE-BC.
The main themes identified by staff
were overall accountability, a zero
tolerance for negativity, a profound
respect for work-life balance, the expectation
of interdisciplinary mutual
respect, and leadership visibility. Although
accessibility is a vital competency
for a leader, it is often difficult
to manage in the overcharged, fastpaced,
stressful perioperative environment.
Mele and her team leaders
managed to maintain a sense of
accessibility while setting realistic
boundaries and encouraging staff empowerment
and accountability. They
Trust
An environment of trust is essential
for relationships to form and flourish.
By gaining the trust of their staff members,
the perioperative leadership team
played an essential role in improving
the dynamics of the department.
The leadership team united employees
and motivated them to embrace
a shared vision-to provide exceptional
care to every patient, every time.
Cultivating a high-trust culture is not
a " soft skill " -it's a hard necessity.
Trust comprises two-thirds of the criteria
when deciding Fortune's " 100 Best
Companies to Work For. "
Although employees typically come
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to work and perform the work expected
of them, staff members who trust their
leadership team increase their performance
dramatically. Taking care of your
people, recognizing employees for a job
well done, and truly listening creates
trust. Such an environment increases
communication and transparency,
which are crucial for creating a safe
patient environment.
Mutual respect
The leadership team values everyone's
contributions and regularly seeks out
staff members' opinions. By listening
well and treating team members with
kindness and respect, leaders develop
Continued on page 26
a community hospital with low employee satisfaction scores saw
dramatically improved employee engagement within a short time.
OR Manager periodically publishes contributed articles from
nurse leaders or other healthcare providers who want to
share their experiences with our readers.
Do you have something to share? Please visit https://www.ormanager.com/contribute-to-or-manager/ to learn more, or contact Elizabeth
Wood, Editor, OR Manager, at ewood@accessintel.com; 301-354-1786. All contributed articles are reviewed by our editorial advisors and,
upon acceptance, are edited for style and clarity.
reduce bioburden and thereby improve
patient safety.
formance of the existing product. Several
deficiencies were noted:
* multiple unresolved agenda items
* inconsistent recording of attendance
* no premeeting preparation
* lack of product familiarity
* incomplete product information
* lack of stakeholder involvement
* inability to assess multiple related
products for financial impact
* no real-time financial data for decision-making
*
inconsistent product trial preparation
and follow-up
* lost trial results
* no ability to send reminders for trial
completion
decrease in contamination levels detected by adenosine
triphosphate bioluminescence technology.
* open trials without any data or follow-up.
To
improve this process, we first obOR
Manager periodically publishes contributed articles from
nurse leaders or other healthcare providers who want to share
their experiences with our readers.
OR Manager | July 2019
25

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OR Manager - December 2019

Table of Contents for the Digital Edition of OR Manager - December 2019