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.