OR Manager - November 2019 - 19

Special Series: ERAS
SPECIAL SERIES
Figure 2. Source: Paula Spencer, MSHA, PMP, CPHIMS.
other programs such as hospital valuebased
purchasing (VBP), the hospitalacquired
condition (HAC) reduction program,
and the hospital readmission
reduction program (HRRP).5 The quality
of care for surgical patients is represented
in each of these programs.
How ERAS implementation
can help
In our introductory article, " Enhanced Recovery
After Surgery: The new standard
for perioperative care, " we shared the
importance of ERAS principles to the delivery
of high-quality care (OR Manager,
October 2019; 1, 14-17). Implementing
a hospital-wide ERAS program helps
achieve key goals for payers, providers,
and-most importantly-patients.
Government and private payers alike
are moving from volume to value in order
to control costs and place increased emphasis
on better outcomes. Making ERAS
principles the standard of care is one way
to move providers in that direction. These
value-based payment models mean hospitals
and surgery centers must find a
way to deliver care via reliable processes
that afford better predictability of desirable
outcomes, thus resulting in better
cost control.
With ERAS, these savings are realized
through less need for intensive
care, reduced utilization of pharmaceuticals
and parenteral nutrition, reduced
complication rates, and shorter hospital
length of stay (LOS) with fewer (or unchanged)
readmission rates. 6, 7
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A well-implemented ERAS program
benefits everyone. Patients can expect
to be actively engaged in the care process
and enjoy better short- and longterm
outcomes. Improved engagement
and outcomes lead to improved satisfaction.
Surgeons benefit from increased
OR capacity and timely availability,
predictable case booking, and
avoidance of cancellations and delays
caused by unprepared patients.
An ERAS program engages the entire
care team across the continuum of
care. Decreased nursing and attending
work per patient leads to improved
efficiency and, subsequently, a more
positive work environment. Provider organizations
benefit at the highest levels
by improving throughput, increasing capacity,
reducing costs to create financial
stability for value-based payment
models, and improving publicly reported
measures, which make them more market
competitive.
With all of these benefits, it is no
wonder the American College of Surgeons
launched an AHRQ (Agency for
Healthcare Research and Quality) safety
program for ERAS in 2017 to support
hospitals in implementing the evidencebased
protocols of ERAS.8
Role of the OR manager
The first and foundational step the OR
management must take is to articulate
the " why " to the frontline staff. Kotter's
seminal manuscript (Leading Change,
Why Transformation Efforts Fail) identifies
his " eight steps. " 9 In Kotter's
first step, leadership must establish a
sense of urgency by articulating " Why
[ERAS]? " and " Why ERAS Now? "
line-level
leaders will set
In
steps two through four, a powerful guiding
coalition consisting of multi-professional,
the
vision
for what the OR will look like and
how patients will benefit, and will communicate
this vision through multiple avenues
such as grand rounds presentations,
in-services, early success stories,
posters, and data.
Daniel Pink, author of Drive, notes
that the key drivers for intrinsic motivation
are a sense of purpose, sense
of mastery, and desire for autonomy.
The insightful leader will immediately
perceive that ERAS very easily connects
to these drivers. The target audience-
frontline staff-consists of individuals
who have devoted a large portion of
their lives to the care of other human
beings. Hence, the purpose is to improve
the care for patients in a measurably
better way (patient-centered,
clinically relevant outcomes), and to get
better at taking care of patients. The
desire for autonomy can be tied into
Kotter's " Step 5: Empowers Others to
Act on the Vision. "
The leadership team bears responsibility
for enabling the care team to
develop standards of care; providing
training, education, and access to measures
that can be evaluated for alignment
with clinically relevant outcomes;
Continued on page 20
OR Manager | November 2019
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OR Manager - November 2019

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