OR Manager - June 2018 - 11

Performance improvement
Surgical Council
Continued from page 1
The council
This article describes the evolution
of the ESC. Although much of the information
applies to large hospital systems,
facilities of any size can adopt
the lessons learned in establishing multidisciplinary
collaboration and decision
making to improve efficiency.
The Cleveland Clinic model
Carol
Pehotsky,
DNP, RN,
NEA-BC,
ACNS-BC,
CPAN
The Cleveland Clinic system
employs 50,000
caregivers, including
3,500 physicians and
12,000 nurses. A total
of 60,000 inpatient and
148,000 outpatient surgeries
are performed
each year.
" Our model, which
feeds into some of the
challenges we had to
surmount initially with
the ESC, is that we are a physician-led
group, " says Pehotsky.
The main campus was founded in
1921 by four physicians who wanted
to do something different with the way
healthcare was run.
Today, especially at the main campus,
physicians are employees. They
have 1-year contracts that may or may
not be renewed based on a variety of
factors including quality, behavior, and
performance.
" The physicians have 'skin in the
game' in terms of continuing their employment
with us, " she says. " We do
not give bonuses. We provide other incentives,
but their main incentive is to
continue working with us. "
Some of the regional hospitals are a
mix of private and employed physicians,
and some of the smaller hospitals are
up to 50/50 private and employed.
Taking this model where some physicians
are employed and some aren't, and
getting them all on the same page about
www.ormanager.com
provides a formal
structure for
decision making
and accountability.
how to do surgery at the Cleveland Clinic,
was a big challenge, notes Pehotsky.
Institute model
Adding to the challenge was that the
Cleveland Clinic is aligned in an institute
model, which means that instead
of having a department of surgery and
a department of nursing, the institute
is aligned by clinical specialties. Within
that alignment is an institute leadership
and a department leadership.
For example, there is a digestive
disease and surgery institute, which
has an institute chairman, department
chairmen, and institute and department
administrators. They all have their own
ideas, plans, and strategies about how
to optimize digestive disease and surgery
across the organization.
Some institutes are cross specialty,
such as the nursing institute, anesthesia
institute, quality and patient safety
institute, and the cancer institute, which
looks at cancer across the continuum.
All nurses report to the nursing institute,
all anesthesia providers report to
the anesthesia institute, and quality
care is delivered across the continuum,
no matter the specialty.
Instead of a department of surgery
or institute of surgery, there is surgical
operations, which is a service provider
to the surgeons and the patients.
Surgical operations includes:
* surgical support-eg, cleaning the
ORs, transporting patients, taking
specimens to the lab
* surgical supplies-ensuring supplies
are available for specific patients
and cases
* surgical scheduling-working with
the schedulers to adjust and optimize
the OR schedule
* administration
* capital-funding of the OR
* finance-paying the bills and staff
* OR infrastructure-ensuring the infrastructure
is up to date.
The institutes have a vision about
improving care for all patients, and the
operationalization of that is what the
ESC is all about, says Pehotsky.
ESC is born
As an organization, the Cleveland Clinic
has 230 ORs, says Pehotsky. " We had
to ask ourselves: Is that enough, is
that too much, and are they being properly
utilized? "
The community hospitals, which
came into the fold of the Cleveland
Clinic one at a time, had to decide if
they were going to continue to be everything
to everybody in their local communities
or if they were going to be a part
of something bigger.
The Cleveland Clinic actually started
this process 8 years before the ESC
was born. Because fewer babies were
being delivered each year at the main
campus, the decision was made to stop
providing labor and delivery services
there, says Pehotsky.
Instead, resources were put into two
nearby hospitals where most women were
going for labor and delivery, and into redirecting
other women to those facilities.
Similarly, Pehotsky says, surgical patients
were increasingly following their
surgeons to other hospitals for surgery
instead of going to their local hospitals,
and the Cleveland Clinic decided to provide
a structure for it. Thus, the ESC
was born, with these members:
* surgical department chairman
* institute chairman
* medical operations chairman
* regional leadership (chief of surgery
or surgical director)
* hospital presidents
Continued on page 12
OR Manager | June 2018
11
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