April 9, 2023
Creating a Dedicated Service Line
Sandy Nettrour, PA-C
April 9, 2023
Butler Health System:“We exist to make a positive difference in the lives of our patients by providing compassionate, high quality care and comfort and inspiring health and well being.”
Serves as a way to build consensus for all parties
Hospital Vision Statement
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Administration and Surgeon Support
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Surgeon Champion
• Traits– Energetic– Motivated to increase volume and improve
efficiency– Team player (with administration and staff)– Interested in controlling hospital costs– Supported by other orthopedic surgeons on staff
to represent their interests
April 9, 2023
Administration Champion
• Able to understand the surgeon’s perspective • Willing to work creatively to overcome
obstacles• Willing to invest time, money, and personnel
to develop the service line• Expects to see Return On Investment through
increased volume and decreased costs
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• Surgeons can not– Divide their focus between patient care and
hospital management – Personally fix all the problems
• Administrators have difficulty– Seeing past costs to initiate the service line– Are working with an ever shrinking budget– Must trust the surgeon to increase volume
• That is why goal alignment is key!
Core Conflicts
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Elements
Program Vision
Surgeon Champion
Administration Champion
Program Director
Operations Team
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Non-surgeon (background can vary)• Favorable traits:
– Good organizational skills– Good communication skills– Ability to facilitate alignment of goals– Analytical skills-attention to details– Ability to see the larger picture
Orthopedic Service Line Director
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The right people have to be at the table together.
What solves for one can increase issues for another
Prevent the “hospital salute”
Take Down the Silos:
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• Physician(s) • Administration • Service Line Director• Nursing (floor manager)• Operating Room (ortho team leader)• Physical Therapy• Pre-Admissions Representative• Case Management/Social Services
Team Composition
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• Anesthesia• Sterile Processing• Pharmacy• Billing and coding• Outpatient Rehabilitation• Home Health • Physician office staff
Ad Hoc Team Members
Getting Started
• Listen to all of your team members
• Start with individual interviews
• What are the common issues?
• How can the service line team improve these issues?
April 9, 2023
• What is reality? Go and See: observe the problems
• What are the strengths and weaknesses of each department?
• What will show quick success over the most areas? “Pick low hanging fruit.”
Investigate
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• Variability in surgeons’ care pathways• Inconsistent and late OR start times• Slower than ideal OR turn over times• No unified total joint patient education• Poor discharge planning pre-op• Inconsistent patient expectations• High variable costs
Issues Identified
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• Work to fix the common problems– Start with small projects- streamline order sets,
progress notes, patient education, pre-op testing
– Early success will spark team interest• Assign action items with clear deadlines and
accountability• Engage and empower frontline people• Meet every 2-4 weeks to keep the team engaged
Early Implementation
BHS Total Joint CampOur first team project
• Covered all departments-including physician office
• Streamlining patient education revealed redundant work
• Improved patient expectations• Reduced length of stay (1.5
days first year)• Unified the operations team
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• Operating Room Efficiency– Streamlined OR trays; Improved on time start
• Length of Stay management-D/C planning• Patient satisfaction- improve expectations with
consistent message• Variable Cost Control• Constantly look for further improvements• You will have to revisit prior issues to keep them on
track.
Later Process Improvement Projects
April 9, 2023
Be the solution, not the problemYour team should want to work with you
How can YOU create a dedicated team?
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Pearls and Pitfalls
• Be open to feedback• Turn criticism into
positive action• Small initial successes
will help to gain momentum
• Changing culture takes time-Resistance is natural
The Importance of Team Building
• Consider both rewards and recognition
• Give credit where credit is due
• Small things have a big impact (pizza, milkshakes)
• Social activities as a team– Ortho Nurses Day, – Ortho Christmas party
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In Conclusion
Action Items:• Provide supportive
team leadership• Engage and empower
front line people• Show profitability• Listen • Praise and Thank