Clinical Quality in ASCs: 3 Experts Sound OffAt the 19th Annual Ambulatory Surgery Center Conference in Chicago on October 26, three leaders from the industry shared what they've learned about maintaining sound clinical quality in ASCs.
Darren Smith, RN, director of clinical operations for Surgical Management Professionals; Carla Shehata, RN, vice president of operations for Regent Surgical Health; and Nicole Gritton, RN, vice president of nursing and ASC operations for Laser Spine Institute spoke on the panel. Helen Suh, JD, a lawyer with McGuireWoods in Chicago, moderated the session.
Q: When you approach a new facility, please describe your process of evaluating clinical quality.
Mr. Smith: Usually when we approach a new organization whether a new development or if we're coming into help them with operations, we initially do an overview assessment of where they are with quality management. We provide them with a template we've developed to initiate a quality improvement program. We have them take that template and adapt it to their needs. Places have different needs based on specialties and priorities within their organization.
Ms. Shehata: We've developed 13 clinical intensive reviews. They cover everything from quality improvement, OSHA, infection control — a whole gamut of intensive reviews. I'd go into a facility new to us and go through those intensive reviews. Those reviews change every time a new regulation comes out. We have a policy database that has been well-proven to pass all the surveys. A lot of times, when we come into a new place, everyone is trying to do the right thing, but it's a spaghetti bowl and no one knows who is doing what. We come into be part of your team and help you succeed so when that surveyor comes in, you are just showing off.
Ms. Gritton: We break it up into different models. All of the requirements for accreditation are set in stone, so we already know what we need to comply with. The whole point is making it an organized system. Typically, everyone wants to do the right thing. It's not like you walk into the organization and they are blatantly doing wrong thing. You sit with them, conduct education and continuous training, and then reevaluate that process until everyone is on the same page.
Q: How do you utilize benchmarking and quality reporting?
NG: We created a culture of understanding its not to place blame on any one person. We decide as a medical team, 'What are the key clinical indicators we need to look at?' We agree on that, and then through our internal reporting process we gather data. That's where benchmarking comes into play. You have national data to benchmark that data against, and if you have multiple sites, you can compare centers. For us, our internal benchmarking is more competitive than national standards.
CS: We use a scorecard. Our doctors report quarterly, and then that report comes into our system and we benchmark against all 22 of our centers and compare to national data. It is not punitive. We have a fun competition among our centers. We give awards out annually, but we don't score incident reporting or infections or transfers. We want honesty in reporting, so we don't want them to be worried they'll be penalized for that.
DS: We try to take a handful of financial and clinical [reports] and concentrate our benchmarking on those. Three-fourths through the year, we use those indicators to develop an outcomes study based on trends we saw through the benchmarking. This year, for example, we saw trend expanding time needed for pre-op calls.
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