adopting innovation in the or: leading and managing change...digital and the culture is shifting •...
TRANSCRIPT
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Adopting Innovation In The OR:
Leading And Managing Change
Michael Meyer, MD, Board of Directors - Pulse Heart Institute, Physician Executive and OR Leader
Sanjeev Agrawal, President and Chief Marketing Officer, LeanTaaS
Session 256, February 14, 2019
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Michael Meyer, MD, has no real or apparent conflicts of interest to report.
Sanjeev Agrawal is employed by and holds equity in LeanTaaS, Inc.
Conflicts of Interest
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• Learning Objectives
• About MultiCare Health
• Motivation to Change
• 2017 Goals
• What We Did
• Increased Access and Results
• Enforcing Accountability and Results
• Adding a Single Source of Truth
• Enabling Innovation and Change
• Comparing the Past with Today
• Q&A
Agenda
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1. Discuss why focusing on traditional metrics like block utilization
and first case on-time starts do not improve patient access, OR
utilization or revenue
2. Recognize how predictive analytics and the same mobile
technologies we use as consumers every day can be leveraged
to improve OR utilization
3. Assess how to convince surgeons to embrace change and
innovation in the OR
Learning Objectives
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MultiCare
West Pierce Region
• Tacoma, WA
• Level 2 trauma center, community
hospital, children’s hospital,
and an ambulatory surgery center
• 35 ORs across 4 locations
• 1700+ cases a month
• 100+ active surgeons
• Epic
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• Expensive, “perishable” OR capacity
• Block “reservation” system creates winners and losers
• Process gridlock in enforcing accountability for blocks
• Inconsistent definitions and no single source of truth
Fixed Supply Of Expensive OR Capacity…
Motivation to Change:
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…And Significant Demand VariabilityAmong Block Owners
.. Significant Demand Variability Among Block Owners
• Clinic volume variation
• % surgical cases
• % that can be fit on day of block
• Variability in case length
• Vacation, clinic conflicts,
conferences
• Limited mechanism to create
and broadcast open time
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OR Time Is Precious
and Never Available….
Yet “Reserved Time”
is Left on the Table
Each Day…
• Each operating room minute is worth
$100 - $300
• A 500-minute day is worth $50,000 -
$150,000
• 1% improvement is worth $125,000 -
$375,000 per operating room per year
• On average, for a 20-operating room
hospital, improving utilization by 3% is
worth $15,000,000 per year
Demand/Supply Mismatch = Large Paradox
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Create more ACCESSIBILITY to open time,
right-size blocks to increase ACCOUNTABILITY,
and create credible VISIBILITY into performance metrics
2017 Goals
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Accessibility Accountability Visibility
No such thing as a perfect
block allocation - Block time
will never be used exactly
as planned…
How can we ensure
advance time release,
create visibility into open
time, and make it simple to
request time – “a liquid
marketplace for open time”
The current process for
right-sizing blocks is
broken… “Block utilization”
is not actionable
”Collectable time” is far
more surgeon-centric and
actionable
Is reporting “admiring
the problem” or driving
decisions? Are providers
and administrators
engaged in credible
data?
Becoming more data-
and hypothesis-driven
and bring reporting into
the 21st century?
What We Did
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• Easy to release time with
proactive interventions
• Transparency into open
time for surgeon clinics
• Easier process for OR
scheduling has allowed
schedulers to work
remotely
• Effective use of robot
End-to-end release and request process streamlined
Marketplace for Open Time
Increased Access
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• Easy to release time with
proactive interventions
• Transparency into open
time for surgeon clinics
• Easier process for OR
scheduling has allowed
schedulers to work
remotely
• Effective use of robot
End-to-end release and request process streamlined
Marketplace for Open Time
Increased Access
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110 70
50% 15
Blocks Per Month
Released
Blocks Per Month
Requested
Requests From Surgeons
Without Allocated Time
Average Release
Proactivity (days)
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• Surgeon-centric,
defensible, and actionable
methodology
• Enables conversations
with underperforming
block owners
• High defensibility of data
mitigates back-and-forth
for quick decisions
Collectable Time made it easier to take blocks away
Identify the right capacity,
and then put it to work
Enforcing Accountability
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• Surgeon-centric, defensible, and actionable methodology
• Enables conversations with underperforming block owners
• High defensibility of data mitigates back-and-forth for quick decisions
Collectable Time made it easier to take blocks away
Identify the right capacity,
and then put it to work
Enforcing Accountability
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7+ 20+Block Owners
with DecisionsBlocks Per Quarter
Collected
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Deep Visibility Into Metrics
• Formalized and standardized
set of KPIs
• Accessible across mobile
and web
• Comprehensive, accurate,
and timely information
• Deep drill-downs into the
data to granular level
• Used by individual care line
leaders and hospital
leadership
Adopting a Single Source of Truth
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Deep Visibility Into Metrics
• Formalized and standardized
set of KPIs
• Accessible across mobile
and web
• Comprehensive, accurate,
and timely information
• Deep drill-downs into the
data to granular level
• Used by individual care line
leaders and hospital
leadership
Adopting a Single Source of Truth
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Open
Marketplace as a
Recruitment Tool
Better Capacity
Identification for
Tighter Allocation
Diagnostic
Insight into
Current State
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Enabling Innovation and Change
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The Past
OR and Clinic Scheduling was a Manual, Cumbersome Process• OR schedulers and clinic
schedulers dealt with fax,
emails, calls, sticky notes etc.
• Clinic schedulers had no
visibility into true open time
inventory
• OR schedulers had no visibility
into true patient flexibility
• This imbalance created
inefficient back-and-forth
conversations
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Today
OR and Clinic Scheduling is a Highly Streamlined, Centralized, Digital Process
• Clinic schedulers now have full
visibility into open time, and can
self-balance based on patient
flexibility
• OR schedulers can now focus
on managing OR constraints and
outlier cases
• Back-and-forth conversations
significantly reduced through
digitization
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Today
Scheduling Workflows are Becoming Digital and the Culture is Shifting• Some OR schedulers have
started working remotely!
• Cardiovascular volumes are up
by 40% YoY
• Initially resistant CV schedulers
now feel left out – they still have
to deal with arbitrary release
times and outdated scheduling
methods
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The Past
Surgeons Were Not Active Participants in Data-Driven Conversations• Reports were being sent out,
but definitions were often
decentralized
• The data was not surgeon-
centric, and scattered over
different sources
• Information was disseminated
through email or paper, which
was inconvenient for busy
surgeons
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Today
Surgeons are Actively Engaging with Personal and Institutional Data• Access to performance metrics and
leaderboards
• Weekly text summary of KPIs –
linked to a mobile web experience
for deeper engagement
• Surgeons often interact, challenge,
and directly engage with the data
• Surgeons are active participants in
having data-driven conversations
about their own performance
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Today
Surgeons View Direct Data Engagement and Visibility as a Differentiator
• Facilitated the successful on-
boarding of new surgeons – without
allocating any permanent block
• Easy access to open time is a hiring
differentiator
• Newly hired surgeons have been
picking up time from Exchange as
needed, including a plastic surgeon
from the Franciscan system and a
new Colorectal surgeon
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The Past
Practice Leadership Had Limited Insight Into Their Practice/Service Line
• Difficult to balance demand (from
their surgeons) and supply (from
the OR)
• Poor visibility into the state of
their practice (KPIs, performance
metrics by surgeons)
• Broken accountability
mechanisms meant it was difficult
to balance existing schedules
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Today
Practice Leaders are Empowered Through Digital Visibility Into Metrics• Able to make data-driven
decisions through the
Collectable Time methodology
• Deep visibility into practice-
specific metrics
• Allows practice leaders direct
supervision over intra-service
allocation efficiency
• Allows OR leadership to take a
decentralized role in allocation
management
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Today
Decision-Centric Approach to Block Right-Sizing• OR Committee meetings stopped
reviewing requests – all based on
data now
• If data supports it, time is taken away
• In the past, people looked at
utilization and TOT data – with better
visibility some surgeons have recently
been voluntarily giving up time
• 80-20 rule: One CV surgeon is 2
sigma over time in their length of
cases. Contracts with insurance
companies can be impacted because
he skews their cost per case
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Q&A
Dr. Michael Meyer, MD
Physician Executive and OR Leader
Pulse Heart Institute, MultiCare Health
www.multicare.org
Sanjeev Agrawal
President and Chief Marketing Officer
LeanTaaS
www.leantaas.com