The Institute of Medicine estimates the scope of waste in the U.S. health care system at $765 billion per year. The bad news is obvious. The good news is hospitals are a target-rich environment for improvement.

When hospital executives really listen to the frustrations of their clinical staff, they can hear the performance challenges that are creating or contributing to waste in time and resources. Turning those challenges into process improvement opportunities will make physicians and clinicians more productive — which in turn makes the hospital more productive. Further, focusing on the challenges they are most passionate about helps answer the question that is crucial to making any substantive change: “What’s in it for me?”

“When executives approach physicians for their help with a major initiative such as PPI cost management, it’s not unusual to get the response, ‘Fix the OR (or cath lab or ICU) and then I’ll help you.’ What physicians are really saying is, “’I’m frustrated. Help me be more efficient. Protect my time, and I’ll give some time to your initiative,’” said Debbie Schuhardt, principal, clinical consulting and advisory services for Vizient.

A prime example of staff frustrations that created time and resource waste existed at a Vizient member hospital in the Southwest. Surgeons felt their time was being squandered by late starts and cancellations in the OR. Other clinical staff supporting the OR also felt stressed when the schedule didn’t run well. While there was agreement there was a problem, no one really knew where to start to fix the situation.

Diagnosing waste and creating a fast-track solution

In the early stage of the assessment work using a Lean approach, one glaring inefficiency was large variation in surgeons’ pre-op ordering practices. Some preferred to order their pre-op tests the morning of surgery. Others ordered patients to get tests in advance but didn’t communicate to the OR staff which tests they had ordered. Some surgeons sent their patients for pre-anesthesia review, while others insisted on doing the work-up themselves. It was up to the OR staff to scramble and assemble the relevant information from various sources in order to prepare for the case. Case delays and even cancellations were common.

“Other processes such as scheduling forms and consents were inefficient, too. No one — staff, physicians, patients, their families — was faring well under this system,” said Schuhardt. “Surgeons felt the hospital didn’t know how to run an efficient OR. Staff felt that allowing such variety in surgeon practices meant that the hospital really didn’t care about staff efficiency or patient satisfaction. As a result, no one was engaged in finding ways to improve because everyone felt like someone else was to blame.”

A data-driven diagnosis of all pre-op functions provided an objective starting point for solving the problems. A team of surgeons and anesthesia, pre-op, OR, sterile processing and information technology staff was established and empowered to redesign the process without pointing fingers. The team members re-engineered the steps for scheduling and consent and standardized pre-op lab orders. Additionally, a physician leadership team addressed on-time arrivals by surgeons and anesthesiologists and implemented new rules for on-time starts and block scheduling.

“The staff now has all the necessary information in advance to prepare the patient and the case for the surgeon. Expectations for everyone are clear and transparent, and real-time measurements keep everyone accountable. On-time starts are now at 80 percent — which was unprecedented for this OR. The hospital has improved its credibility with physicians, staff and patients. And, there’s a track record for clinician-led performance improvement that’s straightforward, effective and rapid,” said Schuhardt.

Tackling waste in health care starts with listening to front-line staff and physicians. Addressing their pain points gives them a clear answer to the “what’s in it for me?” which paves the way for engagement and adoption of new processes.

Start waste-reduction initiatives by engaging physicians and clinicians with these fundamentals in mind:

  • Implement evidence-based care processes that improve quality and reduce clinically unnecessary variation in care and outcomes
  • Eliminate overutilization, redundancy and inefficient workflows
  • Leverage flex staffing to accommodate new models of care
  • Enable analytics to create benchmarks, analyze performance against goals
  • Align physicians and clinicians with organizational priorities

Health care executives must rely on physicians to lead many of the efforts required to be successful. Starting the conversation may be as simple as framing challenges and solutions using meaningful analytics that resonate with everyone.

Learn more information about how Advisory Solutions at Vizient can help drive performance and savings across your organization.


Published: March 14, 2017