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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.

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.” Also, stay tuned for our video post on phase 2 – the Kaizen event tools.

18 August 2014

JAMA Report Recommends OR Briefings to Reduce Errors

The operating room has been called the “revenue engine” of the hospital – at some facilities, OR services can contribute 60 to 70% of hospital revenues. However, according to the Journal of Patient Safety, 400,000+ people each year die from preventable medical errors - many of them in the OR. Last month, the Journal of the American Medical Association (JAMA) released a recommendation on ways to improve the safety and quality of care in an operating room: institute a standard briefing and debriefing process. An effective briefing can be performed in less than 2 minutes and can ultimately reduce delays by more than 80%, leading to hospital cost savings.

In a previous blog post, we discussed some of the obstacles hospital administrators may face when trying to institute hospital process improvements: 

  • Resistance to changefrom physicians and OR staff
  • Concerns about the added time
  • Hierarchy of a typical operating room.

Strategies to address these obstacles can be found here, but JAMA’s report is clear on the benefits of perioperative briefings:

  • Increased team communication
  • Fewer disruptions to surgical workflow
  • Improved overall perceptions about the safety climate in the OR

To conduct an effective briefing, follow these steps:

  1. Have team members introduce themselves by name and role
  2. Take a “time out” to focus on the case at hand without distractions
  3. Ask the anesthesiologist, surgeon, and nursing staff to provide a formal review.

A briefing process is also one of the key aspects of crew resource management (CRM), a strategy used by many hospitals to prevent OR errors. For more information on CRM, check out this blog post or download our paper on crew resource management, titled “Reducing Human Error in the Operating Room.”

13 August 2014

To Embrace Value-Based Care, Look For Economies of Scale

Value-based care was a hot topic at the recent American Hospital Association Forum, and continues to be a subject on hospital executives’ minds. While all hospitals are expected to eventually transition away from the fee-for-service (FFS) model, many are still straddling the line. According to a study conducted by the Office of Civil Rights, the majority of payors and hospitals are still using a dual system of value-based and FFS reimbursements, but 60% are on track with the transition to value-based models. These groups predict that FFS reimbursements will decline more than 20% over the next five years.

Since costs and quality of care factor heavily into value-based purchasing, one strategy for hospital system leaders to help smooth the transition is to increase economies of scale where possible. Executives can spread technology or hospital management costs across multiple hospitals in a system to help bring down individual costs. In a report aimed at helping hospitals master value-based payment, Lisa Goldstein, managing director for Moody’s Investors Service, said “The contemporary thinking is that under reform, the bigger you are, the more you can spread the costs of your infrastructure over the enterprise's footprint…Long term, you can leverage a less-expensive healthcare system to payors, exchanges, employers and all purchasers of healthcare.”

Standardized procedures and common success metrics can go a long way towards maximum efficiency and decreased costs – and these savings are magnified when applied across multiple hospitals in a system. Learn more about our approach to managing hospital operations, and talk to us about using our health care management services across different hospitals in your system.

5 August 2014

What Will the Two-Midnight Rule Cost Hospitals?

One year ago, the Centers for Medicare and Medicaid Services (CMS) adopted the “two midnight” rule, which called for doctors to admit a hospital patient as an inpatient case only if he or she required at least two nights of observation. The law was designed to reduce unnecessary hospital stays, but groups like the American Hospital Association (AHA) immediately pushed back – they argued that this “wholly arbitrary requirement” was a “black-line rule” that takes clinical decisions out of the doctor’s hands.

How does this policy affect a hospital’s bottom line? A report from Moody Investor Services estimates that the two-midnight rule could end up reducing average reimbursement per case by $3,000 to $4,000, since CMS typically reimburses hospitals at lower rates for outpatient cases. This will also impact the volume of patients, which may mean decreased hospital efficiency and overall earnings. Tenet Healthcare, a major hospital system, anticipates losing up to $25 million on both volume and earnings as a result of this rule.

Often times, hospital administrators look to emergency department (ED) doctors to guide whether a patient should be admitted or not. In an interview with Fierce Healthcare, Catherine Polera, Chief Clinical Officer of Emergency Medicine, discussed what this law could mean to these teams. She predicts that some ED patients may sign themselves out against medical advice when they learn they could be responsible for a portion of their hospital bills. This contributes to higher Left Before Being Seen scores for hospitals and increased costs, as these patients will often require additional care when they return to the ED even sicker than before.

In April, the AHA banded together with other associations and hospital groups to file two lawsuits against the U.S. Department of Health and Human Services to challenge the rule. As the U.S. population ages and more individuals are eligible for Medicare, this remains an issue of concern for hospital administrators. The actual implementation of the law has been delayed to 2015 – for now.

29 July 2014

Use Crew Resource Management to Prevent Errors in the Operating Room

In a previous post, we discussed the cost of human error in the OR and the benefits of using Crew Resource Management (CRM) to improve communications. Despite these benefits, physicians can still be reluctant to embrace change and participate in process improvements. In these situations, buy-in from hospital executives and physician department chairs play a key role in embracing and introducing CRM to the operating room.

Address Concerns with Facts
An initial concern of surgeons and anesthesiologists is that the briefing phase will add time in the operating room at the end of each surgery. In a study of more than 37,000 cases in a large medical center, it was found that debriefing took an average of 2.5 minutes to complete, yet this time was recouped in the areas of surgery preparation and performance. Some hospitals found that debriefing actually makes surgeries more efficient and takes less time overall because less time is spent leaving the sterile field to acquire additional instruments or to assemble equipment.

Break Down Traditional Roles
Achieving egalitarianism in the operating suite is another challenge for hospitals. Typical operating room settings have an uneven power structure in which the surgeon is in charge and the medical staff is there to support the surgeon’s role. However, this approach is one-sided and goes against CRM principles. Hospital management’s commitment to the quick resolution of problems and sticking to the processes standardized by CRM will break down these traditional roles and mindsets that are detrimental to patient health and safety.

Results
When an OR department embraces CRM, the results include improvements to quality of patient care and safety. Hospitals across the nation using CRM have reported: 

  • Reduction in untoward outcomes and sentinel events 
  • Discovery of errors that previously would have gone unrecognized 
  • Prevention of wrong-side surgeries 
  • Prevention of potential medication errors Reduction of serious safety events 
  • Reduction in the three-year Mortality Index 

Our leadership brief on reducing human error in the operating room outlines the benefits of CRM and includes the steps for successfully implementing it. Download the article here.

23 July 2014

The Cost of Human Error in the Operating Room

Every year, an estimated 15 million Americans suffer medical harm in hospitals. These errors can be dangerous to patients and also expensive; they cost the health care system $17.1 billion annually.

The most common cause is miscommunication between healthcare workers. Communication errors can be especially dangerous in the operating room; because of this, hospitals have a vested interest in improving communications among OR staff. However, they often turn to admonitions and behavioral sanctions, which are seldom effective.

Recently, some hospitals have looked to other high-risk industries for answers and best practices. Fields as different as aviation, nuclear power, and the military use Crew Resource Management (CRM) to improve communication and ultimately reduce errors and decrease costs.

CRM empowers each OR team member to identify and communicate potential patient harm and contribute equally to the solution. For example, an OR staff member at any level can voice his or her concern by calling a “time out” to immediately pause the surgery in order to discuss the concern or safety issue.

The elements of CRM include: 

  • Pre-procedure briefings 
  • Recognition and verbalization of safety-related red flags
  • Mandatory “time outs”
  • Collaborative creation of standards, procedures, and protocols
  • Empowerment of all team members
  • Immediate post-operative debriefs
  • Culture of continuous improvement

Our next post will examine the roadblocks to CRM and the benefits hospitals have experienced when implementing it. To learn more about reducing human error in the operating room, read our leadership brief.

16 July 2014

When Evaluating Your Hospital’s Partner, Ask These 4 Questions

For hospital leadership looking to partner with an outsourced anesthesia services group, our best advice is to make sure your goals are aligned with those of your potential partner. In the video below, the CEO and CMO of Jersey City Medical Center discuss four questions a hospital leader can ask to evaluate a potential partner:

  • What is my hospital’s mission? How will a partner help me achieve that mission?
  • Are the lines of communication open in both directions between my hospital’s leadership and the partner’s leadership?
  • Is my partner engaged with what I am trying to accomplish at my hospital?
  • Does my partner have a culture that is focused on safety, hospital efficiency, and quality care?

See their responses in this video:

Watch and read more testimonials from our hospital partners.