On the first day of a two-day virtual summit labeled the “Transform Hospital Operations Virtual Summit,” and sponsored by Becker’s Healthcare, a senior executive at the six-hospital (four acute-care hospitals and a pediatric hospital and rehab hospital), Fort Myers, Florida-based Lee Health, shared insights from that health system’s reengineering of its OR (operating room) management, and what’s been learned.
Cheri Cartwright, Lee Health’s vice president, surgical services, spoke to a virtual audience on Tuesday, Dec. 5, and shared her health system’s narrative around optimizing OR management across the entirety of the health system. Lee Health is Florida’s largest not-for-profit system, and encompasses more than 14,000 employees, while engaging in more than 2 million patient contacts per year, and performing more than 54,000 surgeries annually.
Cartwright and her colleagues began partnering with consultants at the Santa Clara, Calif.-based LeanTaaS in March of this year, reaching out to them for help with ongoing problems around optimizing the use of the health system’s operating rooms. As Carwright explained it, “One of our major obstacles to optimizing surgical workflows was around using our block effectively. We found that as we researched and looked at different possibilities, we partnered with LeanTaaS, and we’ve been using the iQueue platform across the system, from doctors’ offices, through the surgical process. We’ve been able to make data-based decisions, using evidence-based processes.”
At the core of Lee Health’s practical challenges was the issue of “release time” for surgical blocks, an issue that had dogged the health system’s leaders forever. As Cartwright explained to her audience on Tuesday, “We did not have a proactive release time. It was a two-day release time. And there’s no way to even get preauthorization for a patient within that two-day timeframe, for elective surgery. So that wasn’t working for us. And also, there were multiple platforms being used. So there was a lack of visibility into our open OR time.”
Indeed, that set of problems “created a constant stream of emails, calls, faxes, with the physicians’ offices, OR, etc.,” Cartwright said. “The process was difficult for the offices, for our schedulers, and was ultimately a sat dissatisfier for our patients; because there was no one truth in our scheduling system.”
Per that, Cartwright said, “We wanted visibility. We knew our data wasn’t 100-percent clean. And there’s nothing worse than presenting data to a group of surgeons, and they immediately see the data is flawed, and they want nothing further. So we worked with Lean Taas to make sure the data was clean. No single source of truth, multiple systems and data points, and no way to see, is this timeframe open? The surgeons didn’t believe the data, and were not engaged in the scheduling process.”
What’s more, she reported, “We also lacked any block management process. We had no contingency plans for surgeons who weren’t using their blocks consistently. So our ORs were greater than 90-percent block-scheduled, but the blocks were not being used correctly, so they weren’t able to access blocks or get cases on in a clear, consistent manner.”
As a result, Cartwright explained, “We worked with LeanTaaS and worked to create a new platform. We’ve really seen a lot of wins, and also, the ease of use was important for everyone, and something that everyone was thankful for: that this was so easy and quick. It’s really just a part of our workflow now. The AI-powered modules involve exchanges. We do not have office schedulers placing their cases. But they’re able to see the schedule and can see the open rooms and make requests into those rooms. So that creates that case scheduling, to optimize unused spaces. We’re able to use data to see which physicians are consistently using their blocks, as well as which ones run over their blocks,” she noted. “And the analytics module allows us to dig into that data and slice and dice it. It really has created more engagement among our surgeons and teams across our campuses, because it’s transparent across our campuses. Everyone can pull up their own campus platform and we can have conversations across campuses.”
What were the critical success factors? There were several, Cartwright stated. “First,” she said, “you have to gain stakeholder buy-in at each level in the organization. I presented the data to our c-suite executives, to our board, and to our surgeons. Lean Taas has been great about being present and participating,” in that regard, she said. Also, “We also wanted to make sure the AI [artificial intelligence] technology would really support this work. It’s been great. Anytime I’ve reached out to the Lean Taas team, they’ve been more than happy to help, and even to be present and give presentations. And that’s created a system-ness that we had really lacked.”
An extremely important element, Cartwright said, was the desire for “system-ness”—for all processes to become systematized and optimized, across the system. “We want to make sure we’re leveraging our team, our processes, and the technology,” she noted. “We have a very wired organization, but if you’re not using the technology at its greatest potential… It’s helped us standardize processes by using the same metrics across the organization. We’re definitely on the same page. It provides accurate, visible, transparent data. Physicians can even access the data on their phones. They have the opportunity to literally pull out their phone and as they’re speaking with a patient about their surgery, to look at specific times.”
The results, after leveraging the iQueue system for seven months, has been excellent: an additional 737 block releases, for a total of an additional 3,550 hours made available through iQueue. Translation: “We’ve been able to secure an additional 2,890 hours of surgery time through 2,081 requests in Open Time,” Cartwright noted. In addition, she noted, prime-time utilization of OR suites has gone up 2 percent, and, even better staffed-room utilization has gone up 9 percent; as a result, clinical teams are getting out of the ORs in time, and surgeons aren’t standing around waiting for their teams to be available.
The importance of governance
Governance is also very important in optimizing processes around OR management, Cartwright told her audience. “We’re building out an operational governance committee, a multidisciplinary committee including management, frontline workers, driven by our physician and anesthesia partners.” Over time, she reported, “Each facility will have a governance committee reporting up to our executive governance committee, reporting out to our senior-level executives.”
Happily, the constant faxing and emailing that used to take place, as everyone in the health system was constantly having to touch base with everyone else about OR time blocks, has ceased. Indeed, faxing has stopped entirely, while emailing as nearly ceased.
The bottom line? Leveraging technology appropriately, while reengineering complex processes, is the key to process optimization and improved operations; and Lee Health’s experience with OR management optimization provides a perfect example.
