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18 November 2014

Achieving the Triple Aim, Part 2:  Strategies for Anesthesiology Departments

In our last blog, we discussed the perioperative surgical home (PSH) and why anesthesiologists are well positioned to take on a larger role in the coordination of surgical care, with achieving the “triple aim” as the ultimate goal. Anesthesiologists have always been involved in pre-, intra- and post-surgical activities, so their methodology is already aligned with the PSH approach to surgical care. Additionally, anesthesiologists have the comprehensive medical training and OR experience necessary to participate fully in the planning, execution and recovery phases of the surgery.

The challenge that hospital executives face is finding ways to empower anesthesiologists and physicians to be the agents of change. Fortunately, management frameworks exist that can help achieve this goal. Two powerful and complimentary approaches for improving the perioperative process are Kaizen lean process improvement and a standardized pre-admission testing process.


Japanese for "continuous improvement," Kaizen focuses on continually improving and standardizing processes based on the input of everyone involved in the work itself. Kaizen was first developed in Japanese businesses after WWII by American business experts helping to restore industry in Japan. It was made famous by Toyota and has since been applied to a wide variety of different industries.

Kaizen excels in the clinical setting because it is cross disciplinary, enables rapid implementation of new processes and encourages a culture of continuous improvement.

The methodology makes processes more reliable and less wasteful while encouraging legitimate and meaningful employee involvement. All hospital staff work to identify the biggest time wasters and processes that lead to inefficiencies. These processes are examined and new procedures are tested.

Knowing what you need to do and knowing how to do it are completely different things. One Kaizen tool that can help bridge this gap is value stream mapping (VSM). VSM shows how materials, people, equipment, methodology and measures interact over time to create value in a system. A VSM map is a very powerful way to identify problems and see how time and resources are lost along the path of the work flow. The map turns techs, RNs, physicians and anesthesiologists into process engineers, giving them the tools to drastically reduce time, complexity and errors in each step of a clinical process.

Kaizen promotes using the input of people at all levels of the organization, from the CEO to junior staff. However, special attention should be given to physician involvement, as it is a key factor that influences a protocol’s clinical acceptance and long-term sustainability. A clinical Kaizen team consists of a variety of hospital staff, but without physician buy-in, many Kaizen teams find that their process improvement goals get blocked by physicians who are unwilling to change. Encouraging anesthesiologists to lead a Kaizen initiative in a surgical setting helps improve physician buy-in.

To learn more about how one hospital in South Florida used a multi-specialty team to reduce cancellation rates by 75 percent, read our Kaizen anesthesiology white paper here.

Standardized Pre-Admission Testing Process

Due to Sheridan’s involvement in several Kaizen events around the country, each addressing waste in the pre-admission testing process, Sheridan was able to develop a standardized pre-admission testing process: ClearPATh. ClearPATh is a guided workflow that streamlines the pre-admission testing process and ensures the surgical readiness of patients. The system has been vetted by the perioperative directors at Brigham & Women’s Hospital, a teaching affiliate of Harvard Medical School.

Traditionally, surgical teams order unnecessary pre-op tests and consultations in an effort to prevent cancellations. ClearPATh’s workflow helps anesthesiologists determine a personalized and more refined list of the tests and exams that are necessary to ensure a given patient’s surgical readiness. This tailored approach cuts costs, reduces the patient’s time spent in the doctor’s office, and also avoids false positives, which can lead to costly same-day cancellations. Using a patient questionnaire, ClearPATh collects the patient’s comprehensive medical history and uses that information to offer personalized pre-op recommendations and facilitate scheduling. It also ensures the pre-op plan is communicated to all involved in the surgery. By addressing the needs of all stakeholders—the administration, pre-op department, OR, surgical team, PCPs and patients—ClearPATh facilitates the PSH model of better coordination of surgical care.

While ClearPATh only began in 2013, it is already demonstrating dramatic results. One partner hospital was able to decrease its same-day cancellation rate from 8.7% of surgeries to 3.3% in just one year. This blog post explains how anesthesiologist-driven ClearPATh strategies drove such remarkable results.

Achieving the “triple aim” isn’t easy: it’s extremely difficult to simultaneously improve patient experience, increase patient health and reduce healthcare costs. However, the answer often lies in empowering all staff members—and particularly anesthesiologists—to analyze and improve the day-to-day processes they follow. Kaizen and ClearPATh are two of many solutions to help achieve this, but we believe that they’re among the best options available for making the triple aim possible.

14 November 2014

Achieving the Triple Aim, Part 1:  Anesthesiologists & the Perioperative Surgical Home

In 2007, the Institute for Healthcare Improvement introduced “Triple Aim for Populations,” an approach to optimize health system performance by improving 1) patient experience, 2) patient health and 3) healthcare costs simultaneously.  Over the past few years, the anesthesiology community has honed in on this “triple aim” framework, applying it to surgical processes with an approach called the Perioperative Surgical Home (PSH).

The Triple Aim: Healthcare Quality, Cost and SatisfactionThe Perioperative Surgical Home

The ultimate goal of the PSH model is to better coordinate care through the entire surgical continuum. Operating rooms struggle with a multitude of inefficiencies and expense multipliers stemming from lack of coordination, from duplication of services, clinical variation and medical errors. The PSH approach aims to eliminate these inefficiencies—and achieve the triple aim—through a “patient-centered, physician-led, multidisciplinary and team-based system of coordinated care” (American Society of Anesthesiologists). In the PSH, surgical teams lead patients through a personalized and evidence-based surgical program that mitigates the risk of unnecessary pre-op testing, unforeseen errors or complications, and readmission. As the name implies, PSH-modeled surgery plans are perioperative—they begin at the decision of whether to have surgery, follow the patient through the entire procedure, and continue through the 30 days following the surgery.

This past summer, the American Society of Anesthesiologists (ASA) formed a PSH learning collaborative, in which 41 health care organizations from across the country analyzed the PSH model in an effort to develop a “road map” for other providers to follow. The anesthesiology society’s interest in the PSH model stems from the fact that the system focuses on the interconnectedness of each phase of surgery—a process that anesthesiologists are acutely aware of.

Anesthesiologists at the Helm

Too often, surgical plans are fragmented, with insufficient communication between parties responsible for pre-operative activities, intra-operative care, immediate post-operative care and discharge. Because anesthesiologists already play a role in all of these phases, the PSH provides the opportunity for a natural evolution from the traditional OR anesthesiologist to a perioperative physician.

Though surgeons are often the “face” of the surgical team to a patient, anesthesiologists are uniquely positioned to bridge the gap between providers and play a larger role in the coordination of surgical care. In the planning phases, anesthesiologists have the training and knowledge-base of general health management and comorbidities that surgeons are less focused on. They are also present during the surgery itself, unlike the patient’s primary care physician. Their involvement continues in post-surgery, where anesthesiologists are responsible for much of the pain management and care. Having a consistent point person throughout the surgical continuum improves the patient experience and ensures the care is as efficient and streamlined as possible. The ASA sums it up as follows:

Physician anesthesiologists will be key contributors to the success of the PSH model as experts in preoperative evaluation, optimization of coexisting disease prior to surgery, pain management, and post-anesthesia care. However, current payment structures create barriers to applying this hard-earned knowledge and systems expertise across the continuum of perioperative care. Breaking down these barriers will allow anesthesiologists to work with other physicians and healthcare practitioners during all phases of surgical care, improving safety, quality, and efficiency.

Sheridan Best Practices

Pending the payment model overhaul the ASA advocates for, Sheridan Healthcare has established two anesthesiologist-led processes that work to achieve the triple aim goal and the PSH model. In our next blog post, we will outline the two initiatives—Kaizen lean management and Sheridan’s guided pre-admission testing process ClearPATh—as examples for anesthesiology departments to draw from.

Continue to Achieving the Triple Aim, Part 2: Stratetgies for Anestheiology Departments

30 October 2014

Implementing a blood management program for better quality, cost reduction

The healthcare industry is in flux today, and market pressure continues to drive the demand for a more standardized approach to anesthesia care delivery. Anesthesia leaders who actively manage their ORs and who participate in their hospital’s quality initiatives can succeed in this challenging landscape.

Implementing a standardized blood management program is one hospital initiative that addresses many of today’s challenges, including reduced funds, rising blood costs, and the desire for better clinical outcomes. Blood transfusions are one of the most common procedures occurring in hospitals today, but when it comes to this lifesaving treatment, more is not always better. Transfusions come with a high risk of mortality and other dangerous complications, yet they are managed differently from hospital to hospital across the United States.

“Blood transfusions in heart surgery, or anywhere, are only good for you if you really need it. It’s like a liquid organ transplant. If you don’t absolutely need to have it to save your life, you shouldn’t get it.” — Robert Brooker, M.D., Sheridan Anesthesiologist. 

Due to this, several Sheridan anesthesiologists have taken the lead at their facilities to implement blood management programs. These hospitals and their physician partners are spearheading the efforts, studying the impact, and developing the protocols. Find out what Dr. Brooker had to say about new blood conservation techniques in this interview, and bookmark our Resource Center and sign up to read our upcoming blood management white paper.

21 October 2014

What Hospital CEOs Really Want

Sheridan Healthcare recently participated in a Q&A discussion where hospital CEOs shared with each other their strategies for addressing a myriad of healthcare topics. A key takeaway from the session – CEOs want long-term partnerships that help them reach their growth objectives. These meaningful partnerships must include transparency, collaboration and growth.

Hospital CEOs expressed the importance of transparency on the part of their outsourced service providers, so they are comfortable with hiring practices, compliance procedures, and the performance metrics used as an extension of their hospitals’ departments.

Great partnerships make life easier for hospital CEOs and the right partners truly collaborate with hospitals to develop solutions to challenges. In working with health systems, hospitals and ASCs for decades, Sheridan continually collaborates with its clients to standardize metrics, improve facility performance, develop and apply best practices, and create unique programs like ClearPATh pre-admission testing procedures to promote efficiency.

Many growth goals for hospitals often involve cost savings, OR utilization, patient satisfaction and quality of care, and department physician and staff retention. Sheridan’s physician leaders have spearheaded significant process improvement and cost-saving initiatives at the hospitals in which they work, which have a positive ripple effect of increased quality of care, and satisfaction rates of both physicians and patients.

15 October 2014

How Hospital EDs Prepare for Weather-Related Disasters

Natural disaster and mass casualty emergencies often occur unexpectedly; when they do, hospital Emergency Departments often experience a surge in volume that overwhelms their day-to-day capacity. EDs prepare year-round for these events by conducting frequent drills and ongoing training that is inclusive of all hospital personnel and local community first responders. Vigilance in staying up-to-date on ACEP guidelines also is highly recommended. 

Lean process tools can add an extra layer of preparedness to disaster procedures that are already in place. These tools and systems can help ensure that hospitals handle surge volume more efficiently and also that they return back to “normal” operations as soon as possible.

  • ClearPathED is Sheridan’s lean workflow suite that streamlines the patient experience and ensures the timely, appropriate evaluation of ED patients. Through this Emergency Medicine best practice that focuses on reducing waste, right sizing staff and efficient throughput, Emergency Departments can reduce Arrival to Evaluation times, LBBS, AMA, LOS unnecessary testing, and risk exposure. Hardwiring lean philosophy/culture and deploying lean principles during disaster events can improve an Emergency Department’s ability to successfully manage surge capacity. 
  • Kaizen tools, a key component of the ClearPathED suite, can help hospitals EDs set up streamlined procedures for triaging patients, enhancing direct-to-bed concepts, and can ensure that patients efficiently flow through the ED. A hospital based Kaizen event can help frontline staff identify flow “pain points” and develop breakthrough processes, so they are better prepared when disaster strikes.

Read about one hospital that used ClearPathED processes to improve patient satisfaction and reduce “Left Before Being Seen” scores.

6 October 2014

Treat the Child, Treat the Family

In an emergency room setting, pediatric patients are unique. They aren’t “small adults” and cannot be treated as such. Many factors play a role in treating these patients, including differences in a child’s age, developmental stages, and special needs. These factors make pediatric ER cases different from adult ER cases. Also, when pediatric patients enter the ER, they often have a whole care team behind them – from family members to pediatricians to additional specialists.

Sheridan ER pediatricians provide coordinated care to this entire team – this can include calling to update the regular pediatrician or making sure the family is kept informed and comfortable. In this video, Sheridan ER pediatrician Dr. Flaster shares his insights when it comes to treating children in the ER.

Learn more about Sheridan's pediatric care programs.

15 September 2014

Hospital CFOs Agree, Innovation is Key to Success – 4 Tips to Get You Started

What does it take to be innovative? Entrepreneurs and business leaders strive to craft novel solutions to combat daily challenges in their industries, and we know that hospital leaders are no different. When we talked to a group of Chief Financial Officers (CFOs) from top hospitals about the challenges they face, innovation was a hot topic. Many CFOs wished that hospital departments would come to them proactively with cost-effective ideas and ways to increase the volume in the anesthesia department.

True innovators look at processes and tools that already exist and ask, How can I make this better? In a hospital, innovations can help reduce waste, cut costs, or increase efficiency. They also can help hospitals meet new regulations in the changing healthcare landscape. At Sheridan, we encourage our physicians at client hospitals to constantly examine their current processes to realize positive change. Here are some of the innovation tips we live by:

  1. Identify your pain points. The old saying goes, “the squeaky wheel gets the grease” – so isolate that one issue or procedure that causes the most problems, and drill down until you have a solution.
  2. Ask better questions. Broad questions can be intimidating and hard to answer, so get specific. Instead of asking how to reduce hospital costs, look at a specific process and ask how you can make it better.
  3. Examine current standards. Look at your existing processes to see if you can take advantage of any economies of scale?
  4. Ask for help from a trusted partner. Take advantage of your partnerships with physician groups. When you work with an anesthesia group that is aligned with your hospital’s needs, you have an immediate resource to champion positive change. Get tips for how to evaluate a hospital partner in this video.

What do you think – do you have any additional tips for encouraging innovation in a hospital? Share them with us on Facebook!

9 September 2014

How to Implement the Changes From a Kaizen Event

After your team completes a successful Kaizen event to improve hospital processes from the bottom up, it’s time to celebrate – right? Not quite yet. This is when the real challenge begins. Now, it’s time to implement those changes and keep them going to make a real impact on hospital cost savings and efficient processes.

In part 3 of our video series, Dr. Tony Andrulonis discusses the sustaining process after a Kaizen event, and compares the Kaizen team members to coaches. Learn about the tools they can share with the rest of the hospital staff – their players – to produce truly astounding results. He also shares results from hospitals and CEOs who have used Kaizen to transform their departments:

Catch up on part 1 and part 2 of this series. Or, get in touch to learn more about how Kaizen can help you.

2 September 2014

How to Run a Successful Kaizen Event

Your Kaizen event is all planned, and you’ve put some serious thought into your goals and the team. What comes next? How can you ensure the actual event will run smoothly and produce hospital performance improvements?

In this video, Regional Medical Director Dr. Kaplan shares his insights on what makes a Kaizen event successful. Find out who the “natural leaders” in a clinical team are, how to encourage team members to to have an equal voice during the Kaizen, and what tools and processes are most valuable. Learn more in part 2 of our 3-part series, below:

If you missed part 1 of this series, watch it here. And read this blog post to learn about key Kaizen tools.

Update to this post: part 3 of Sheridan's Successful Kaizen Event Video Series is now available.

25 August 2014

How to Plan for a Successful Kaizen Event

At the Becker’s Hospital Review Annual Meeting this year, three Sheridan leaders teamed up to discuss how hospital executives can implement Kaizen methodology for improved cost savings, efficiency, and communications across hospital departments.

According to Dr. Andrew Greenfield, EVP of Anesthesia Services at Sheridan, every successful Kaizen event starts with phase 1 – the consultation and assessment phase. Watch the video and see what he had to say about topics such as: 

  • Encouraging top executives to coordinate
  • Putting together your Kaizen team
  • Outlining the pain points
  • Setting objectives and thinking about the big picture

For more on Kaizen, read our blog post “Hospital Improvements Made Possible.” 

Update to this post:  you can also now watch part 2 and part 3 of Sheridan's Sucessful Kaizen Event Video Series.