Culture Change: Engaging Surgeons to Decrease Costs in the Operating Room

Transcription

1 Culture Change: Engaging Surgeons to Decrease Costs in the Operating Room Ash Mansour, M.D., RPVI, FACS Chairman & Professor of Surgery Spectrum Health Medical Group

2 Who We Are and How We Operate

3 Spectrum Health

4 Spectrum Health Delivery System Spectrum Health Hospital Group Spectrum Health Medical Group Priority Health Spectrum Health Physician Alliance

5 Spectrum Health

6 Spectrum Health Delivery System Spectrum Health Hospital Group Spectrum Health Medical Group 12 Hospitals 170+ Service Sites Licensed Beds Priority Health Spectrum Health Physician Alliance

7 Spectrum Health

8 Spectrum Health

9 Spectrum Health Delivery System Spectrum Health Hospital Group Spectrum Health Medical Group Priority Health Spectrum Health Physician Alliance

10 Spectrum Health Delivery System Spectrum Health Hospital Group Spectrum Health Medical Group Priority Health Spectrum Health Physician Alliance Multi-Specialty Medical Group that aligns Spectrum Health s medical care, hospital resources and insurance system in a way that creates unique value Members

11 Spectrum Health Delivery System Spectrum Health Hospital Group Spectrum Health Medical Group Priority Health Spectrum Health Physician Alliance

12 Spectrum Health Delivery System Spectrum Health Hospital Group Spectrum Health Medical Group Priority Health Spectrum Health Physician Alliance Non-profit health plan Service area coverage: Michigan Employer groups Individuals 652,000 members 12,000 employers

13 Spectrum Health Delivery System Spectrum Health Hospital Group Spectrum Health Medical Group Priority Health Spectrum Health Physician Alliance

14 Spectrum Health Delivery System Spectrum Health Hospital Group Spectrum Health Medical Group Priority Health Spectrum Health Physician Alliance Collaboration between Spectrum Health and private practices. PHO, PO or IPA 75 Practices 500 Physicians

15 Spectrum Health & Process Improvement

16

17 Spectrum Health - Priorities

18 Spectrum Health - Priorities

19 Spectrum Health - Priorities

20 Spectrum Health Priorities Case Costing

21 Spectrum Health Priorities & Process Improvement Lean Thinking (Toyota Production System)

22 Spectrum Health Priorities & Process Improvement Lean Thinking (Toyota Production System) Philosophy complete elimination of waste

23 Spectrum Health Priorities & Process Improvement Lean Thinking (Toyota Production System) Philosophy complete elimination of waste Waste anything that does not contribute to the value of the quality of service to the patient

24 Spectrum Health Priorities & Process Improvement Lean Thinking (Toyota Production System) Philosophy complete elimination of waste Waste anything that does not contribute to the value of the quality of service to the patient Kaizen Culture everyone, every day

25 Spectrum Health Priorities & Process Improvement

26 Case Costing & Process Improvement

27 Case Costing & Process Improvement

28 Case Costing & Process Improvement

29 Case Costing & Process Improvement Challenge people to perform to their peak ability

30 Case Costing & Process Improvement Challenge people to perform to their peak ability Mutually trust one another

31 Case Costing & Process Improvement Challenge people to perform to their peak ability Mutually trust one another Regardless of titles, our teammates are our moral peers

32 Case Costing & Process Improvement Challenge people to perform to their peak ability Mutually trust one another Regardless of titles, our teammates are our moral peers Awareness and reduction of authority gradient Process improvement is everyone not just leadership making decisions

33 Process Improvement 8 Wastes Transportation

34 Process Improvement 8 Wastes Transportation

35 Process Improvement 8 Wastes Transportation Motion

36 Process Improvement 8 Wastes Transportation Motion People

37 Process Improvement 8 Wastes Transportation Motion People Waiting Time

38 Process Improvement 8 Wastes Transportation Motion People Waiting Time Over Processing

39 Process Improvement 8 Wastes Transportation Motion People Waiting Time Over Processing Over Production

40 Process Improvement 8 Wastes Transportation Motion People Waiting Time Over Processing Over Production Defects

41 Process Improvement & Case Costing Over Production

42 Process Improvement & Case Costing Over Production

43 Process Improvement & Case Costing Over Production

44 How Spectrum Health Priorities, Process Improvement Themes and Case Costing are Interdependent

45 Case Costing Typical OR team ST s taught to be ready for surgeons needs/wants Nurses focused on pt. Surgeons want efficiency Cost is always an issue but too often sidelined at the point of care

46 Surgical Services Culture Financial planning Based on the previous years data Guessing on what the next year will bring Develop initiatives based on operational goals Generally set by operational managers Developed into smart goals for clinical leaders If goals are not met then tell the story why

47 Culture change Clinical Leadership The clinical teams should develop their own financial goals Operational teams should assist with those goals Need physician support and engagement Spectrum Health Developed a clinical model around case costing

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49 Clinical team owned this objective Easy Achievable No discussion needed Data teams had clear direction

50 Case Costing Approach: - Collaboration - Process - Success

51 Collaboration Planning phase included Open house product display for surgeons Prices on every product Were able to see what their partners use Total cost of cases were made transparent

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53 Collaboration Nursing leadership commitment No product would be removed without physician support Total engagement from the team if physicians remained engaged in the work Physician commitment Would engage the whole physician group in the work Required to help negotiate product prices with contract administrators Willing to trial new items

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55 Process 1. Set a baseline price for each procedure 2. Clinical teams discuss the most important items for these procedures 3. Develop a plan to reduce the cost by $100 for each provider Negotiate contracts (surgeon led) Change practice

56 1. Pull data for baseline cost analysis

57 2. Clinical Team discussion 3. Negotiate price

58 Success Met the goal Clinical outcomes unchanged (or better) Safe and open environment Culture built on open communication and trust Authority gradient is greatly reduced

59 Surgeon Engagement

60 Surgeons to Decrease Variable Costs in the Operating Room Lindsey M. Korepta MD 1, M. Ashraf Mansour MD 2, Stefano Bordoli MD 2, Robert F. Cuff MD 2, Jason D. Slaikeu MD 2, Christopher M. Chambers MD 2, Peter Y. Wong MD 2, Eanas S. Yassa MD 2 GRMEP/MSU Vascular Surgery Residency 1, Spectrum Health Hospital 2 Grand Rapids, MI

61 Introduction The cost of a surgical procedure can vary from case to case and surgeon to surgeon. While there are certain fixed costs associated with the operating room, surgeons can greatly influence the variable cost for each procedure.

62 Fixed Costs Power Light Water Salaries

63 Variable Costs Sheaths Catheters Wires Stents Grafts Shunts

64 Variable Costs Surgeons have control over many of the variable costs for each type of procedure that they perform, and often follow the techniques of their mentors and predecessors.

65 Purpose To assess whether the variable cost per case can be significantly decreased by informing surgeons of the price tag for the materials that they use and by comparing surgeons to one another.

66 Method A retrospective database was created to include the number of cases, baseline costs, and variable costs of commonly performed general, vascular, colorectal, and orthopaedic surgical procedures

67 Methods Cost analysis prior to intervention July 1, 2013 through June 30, 2014 Cost analysis after intervention July 1, 2014 through June 30, 2015

68 Method The intervention included holding a forum in which procedural supplies were pulled for each surgeon/procedure (Table 1). Variable costs were itemized and totaled. Surgeon comparisons total supply cost and differences in technique Surgeon feedback & identification of opportunities Surgeons encouraged (but not mandated) to change practice to cost-effective care.

69 Table 1. Total Case Number

70 Laparoscopic Inguinal Hernia Repair

71 Laparoscopic Inguinal Hernia Repair

72 cases reported cases reported Results

73 Results Overall cost average decreased anywhere from $24 to $944 per procedure. Significant decreases observed Open & Lap Inguinal Hernia Lap Appy Lap Chole

74 Results Lap Appy 13 surgeons 6 surgeons with significant differences (pre & post) Lap Hernia 3 surgeons 3 surgeons with significant differences (pre & post) *Only surgeons with 10 or more procedures pre & post were included.

75 Median Supply Cost per Case ($) Supply Cost Data * Pre Post * * * 200 * p < Lap Appendectomy Lap Cholecystectomy Open Inguinal Hernia Repair Lap Inguinal Hernia Repair

76 Median Supply Cost per Case ($) Figure 2. Pre and Post Supply Cost Data for Laparoscopic Appendectomy by Individual Surgeon Pre Post

77 Median Supply Cost per Case ($) Figure 3. Pre and Post Supply Cost Data for Laparoscopic Inguinal Hernia Repair by Individual Surgeon Pre Post Green line indicates significant difference between pre and post (p < 0.05)

78 Median supply cost per case ($) Pre Post All Procedures * p < 0.05

79 Did Patient Outcomes Change?

80 BEFORE - General Surgery

81 AFTER General Surgery

82 AFTER - General Surgery

83 Conclusions By engaging surgeons and involving them in illustrations of variable cost analysis for specific procedures, we were able to decrease the overall cost for many commonly performed procedures. These savings do not have a negative impact on efficiency in the operating room or patient safety.

84 Conclusions Changing the culture and reducing the authority gradient are essential to engagement and overall team success.

85 What s Next? Celebrate Sustain Spread

86 Celebrate!

87 Celebrate!

88 SUMMARY Changing the culture is hard work It is possible to engage surgeons to decrease costs in the OR This work can be spread in other areas

89 Questions?