A Managers Guide to Quality Improvement and Cost Control
The current environment of value based health care has many administrators scratching their heads about perioperative services. The environment is becoming more chaotic as different medical associations and private/governmental healthcare organizations weigh in with best practice guidelines. Trying to weigh the confusing amounts of information can be daunting. You still have one set of providers who have the skills to evaluate the entire range of perioperative services: Anesthesiologists.
Anesthesia is one of the only fields in medicine to approach six-sigma status for safety. Through innovation and superb research, Anesthesia has improved care for its patients beyond any field in medicine. At its heart, Anesthesia care is truly about risk-adjusted medical care. Providers ask the following each day: Is the patient healthy enough for the surgical risk? What can we do to optimize the patient? What interventions can optimize medical and surgical results?
As anesthesia practice has become safer, an Anesthesiologist’s role has expanded to improve the care of patients, not just for 24 hours after surgery, but for the weeks and months after surgery. They are in a unique position, more than surgeons or hospitalists, to reduce resource utilization, improve quality of care, improve patient satisfaction and decrease length of stay. I am always surprised at how infrequently hospital administrators utilize Anesthesiologists in this capacity. Honestly, this may be the professions own fault. Individual practitioners may have grown complacent and less willing to extend their practice. I believe that market forces will combine to create an environment where physician anesthesia providers will accept a greater role. Lower cost providers have the skills to be good anesthesia technicians in the operating room, but lack the medical knowledge to be true perioperative physicians. I urge everyone to start to transition their anesthesia departments to provide true perioperative services.
Here are some of the concepts your department should be working on right now:
1. Practice Outcome And Value Creating Management: PQRS, Blood Conservation, Perioperative Management Protocols, Protocols for Regional Anesthesia, Sleep Apnea identification and management
2. Survey based quality assurance
3. Data analysis
4. Experienced Negotiating Skills
5. New strategies for creating value such as Accountable Care and Bundled Payments you may never have considered before!
6. Evaluate and implement compliant, meaningful use electronic records
7. Perform Continuous Quality Improvement
8. Benchmark and compare to national standards
9. Perform routine surveys and analysis to prove your great service
10. Teamwork Analysis and Operating Room Optimization
The last point is critically important. Now, its time for the entire operating room to work together to improve care. As we venture into the new arena of outcomes based quality assessment and compensation, everyone’s success is dependent on the patients success. Therefore, the entire OR culture should reflect that premise. One method of assessing the culture of your operating room is to use a teamwork climate scale such as the “safety attitudes questionaire” (Anesthesiology 2006; 105:877– 84 Copyright © 2006, the Amer ican Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. Teamwork in the Operating Room “).
Many of the recent national innovations to enhance teamwork focus on communication. The extended time out is evolving as a standard with checklists to foster communication. While the spirit of the timeout is good, varied implementation and adherence can render it a burden or chore. Ultimately, the key is to foster communication and collaboration- true teamwork
One solution is to improve systems of communication between all providers. DocBook communication software can be used to provide HIPAA compliant communications for all care providers. Surgery Logistics has a process improvement and software solution that may help your department be more efficient. This is just one of many examples that can help. Contact an expert like AnesthesiaStat Consulting to help guide you though the process.
Amar Setty, MD
AnesthesiaStat Consulting and Perioperative Management