OR Manager - June 2018 - 12

Performance improvement
Continued from page 11
* regional hospital's chiefs of
surgery
* surgical quality and surgical
operations (chairman runs
the ESC meeting)
* surgical nursing personnel
* anesthesia personnel.
ESC responsibilities
The roles and responsibilities
of the ESC include the following.
OR recapitalization. With
230 ORs at different facilities
that are aging at different
inSource:
Cleveland Clinic. Used with permission.
tervals, some are in desperate
need of recapitalization, and some are
fine, notes Pehotsky. Finding an equitable
way to divide the money and
also think strategically about which ORs
need to be recapitalized and how to execute
it is the responsibility of the ESC.
Electronic medical record governance.
The Cleveland Clinic uses both
Epic and OpTime. Epic was started in
2004, and Epic's electronic intraoperative
record, OpTime, started in 2009.
Each hospital went live on Epic at different
times, so there are 10 different
versions of Epic in use.
" It took a year and a half of a long,
grueling process to have OpTime look
the same at all of the facilities, " says
Pehotsky. The ESC helps to mediate
requests for changes and upgrades because
a change in Epic now means a
change for all facilities and locations.
Surgical policies. " We had a lot of
policies, but the question for the ESC
was how to get to a core amount, " says
Pehotsky. The ESC first looked at nursing
policies, but they didn't want a nursing
policy for counts and a physician
policy for counts.
They also needed documents that
spoke to the expectations of everyone
in the room when doing the safety
checklist, not just the nurse. " It has
been good to have the ESC as a vetting
body for these documents and to
12
OR Manager | June 2018
say, 'if you agree to this policy, you also
agree to hold people accountable to it.' "
Scheduling guidelines. There are
scheduling guidelines for when block
times are released, how to do it, and how
to make sure block times for surgeons at
multiple hospitals don't overlap.
Allocation. Each facility has its own
local allocation committee in addition
to the Enterprise Allocation Committee.
The local committee oversees changes
within the same facility and removal of
block time.
The Enterprise Allocation Committee
ensures allocation decisions are in
alignment with organizational strategy
and maximizes OR utilization and workforce
efficiency across all facilities.
It
looks at the new and existing surgeons
and their services and manages duplicate
block times.
" Before the Enterprise Allocation Committee,
we were setting our surgeons up
for failure, " says Pehotsky. " They had
blocks in two different facilities that were
45 minutes away from each other, and
because we were managing everything locally
at that point, no one noticed why the
surgeons were always late. "
The Enterprise Allocation Committee
is made up of:
* 12 surgeons (voting members)
* two anesthesiologists (voting members)
*
three nurses
* administration.
Decision making process
" The original goal of the ESC was service
line optimization, but we are also
a decision-making body, and we have
been challenged with due diligence, "
says Pehotsky.
If the ESC says yes to moving a surgical
specialty to another location, they
send it to the executives for their approval.
Sometimes the executives say
yes and sometimes they don't because
they have to consider larger strategic
initiatives.
formed that
If they say yes, a project team is
includes clinical
leaders
and surgical operations (sidebar above).
The project team interviews stakeholders,
completes an analysis, shares
recommendations with the executive
sponsors, and then takes the idea back
to the ESC for their endorsement.
" The formation of the project team
to dig into the ideas before 'pulling the
trigger' was what really took the process
to the next level, " says Pehotsky.
If the ESC endorses the proposed
idea, the clinical leaders and project
team present recommendations for executive
endorsement. If the executives
approve, the ESC creates an operational
team to drive implementation.
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OR Manager - June 2018

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