OR Manager - June 2020 - 20

Special Series: ERAS
Continued from page 19
gic priorities fall within the organization's
quality improvement
structure. For VCU Health,
it
a strategic priority to improve
performance in our ranking compared
to other academic medical
centers. To effect this, organizational
improvement
in
areas
related to mortality, hospital-acquired
complications,
and length of stay-all
outcomes that are
positively impacted
through ERAS-are
required. As a result,
our quality and
safety officer is seen
as a natural ERAS
program sponsor.
Characteristics of a successful governing
structure include:
* combined executive, provider, and
clinical sponsorship
* ability to remove barriers
* ability to secure funding
* visible sustained support for implementation
of the program.
ERAS governance at VCU Health
started with forming a focused ERAS
steering committee consisting of key
leaders in surgery, anesthesia, nursing,
allied health, quality and safety,
and operations. The steering committee,
co-chaired by the quality and
safety officer and the VP of perioperative
services, is supported by a combination
of ERAS program champion
teams and reinforced by the operational
structure for clinical governance
(sidebar above).
The ERAS Nursing Committee and
ERAS Provider Champions Team consist
of committed champions representing
anesthesia, surgery, nursing, pharmacy,
and allied health professionals who are
influential leaders among their peers
and well respected in their field.
These individuals, who exhibit strong
listening and collaboration skills, may be
in the early stages of their careers and,
20
OR Manager | June 2020
therefore, years of experience should
not be the primary deciding factor when
selecting champions.
These influencers are a key ingredient
to ERAS implementation success
and must be actively supported by the
program sponsor, the steering committee,
and management.
To ensure that recommendations
and decisions made within the program
governance model would have
broader support across the entire
perioperative arena, changes were
brought first to the Quality, Safety and
Regulatory (QSR) Committee for acceptance
and implementation guidance
and then formally ratified via the Perioperative
Executive Committee (PEC).
(Details of the function of these operational
governance bodies were shared
in " Establishing quality standards for
ERAS care elements, " OR Manager,
December 2019, 13-16.)
Together, these oversight teams
signify the unified, committed sponsorship
of ERAS that is necessary for
sustained success.
Increasingly, there is pressure for
hospital systems to reduce their focus
on costs and expand efforts to improve
quality. Previous articles in this series
have addressed this concept, but it
is worth repeating that Medicare payments
are shifting away from volume toward
value (quality outcomes). Although
other payers may lag behind Medicare
in adopting value-based care, there is
little reason to expect the fee-for-service
model will last for much longer.4
Strategies that can achieve the aims of
excellent clinical care-fewer complications
and reduced costs-are key to
the value system of healthcare provider
organizations.
Comprehensive implementation of
an ERAS program can help achieve
these aims in the surgical population.
ERAS was founded on the principle
of producing a predictable quality outcome
by reducing morbidity and shortening
hospital stay. This is accomplished
by incorporating optimized multimodal
perioperative care in a variety
of different surgical specialties, which
leads to reduced cost of care.
Incremental vs radical change
There are 24 core elements of ERAS
underlying these components. No single
element by itself will improve outwww.ormanager.com
SPECIAL
SERIES
VCU Health ERAS Governance Model
is
Source: Paula Spencer, MSHA, PMP, CPHIMS. Used with permission.
http://www.ormanager.com
OR Manager - June 2020

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