1. Make sure you can measure your outcomes. A quality improvement project should focus on data that can be tracked and measured over time, Ms. Davidson says. For most studies, the surgery center should aim to collect data for about six months — long enough to convince the surgery center governing board, physicians or staff that a problem exists and change is needed. Ms. Davidson says surgery centers can conduct QI studies around a variety of different topics, from patient pain management to days in A/R to surgery start times.
For example, a QI study on surgery start times will help you to see if there is a trend with one particular surgeon, an anesthesia provider or even one of your staff members. Surgery start times in an ambulatory surgery center can be especially challenging because if your room starts late at the beginning of the day, those few minutes can add up throughout the day and eventually impact patient care and result in staff overtime.
If a pattern of tardiness can be captured with one particular individual — a surgeon, for example — the administrator can share the data with that physician and say, “We’ve noticed a pattern with your start times. What can we do to help improve that? Do we need to make some adjustments to your block time?” When presented with six months of meaningful data, the physician may be more likely to pay attention and will want to help with a solution.
2. Aim to conduct 2-3 studies every year. Ms. Davidson said most major ASC accrediting bodies require surgery centers to perform two QI studies a year: one clinical and one non-clinical. She recommends ASCs take on from 2-3 cases every year, adding more if the projects take less time than expected. “You want to be realistic,” she says. “You don’t want to take on so many that all you’re doing is collecting data.” She says a credible study should probably take at least a quarter to complete, meaning that a surgery center should not be able to complete more than three or four a year.
She says surgery centers should always give priority to studies that impact patient safety and quality of care issues. For example, the center may want to conduct a QI study if there has been an unexpected patient event that either did result or could result in patient harm. That would be a study that should begin immediately, and it would have a much different focus than a study of cost containment. For example, if a patient has to be transferred to the hospital, the ASC might look at the number of hospital transfers in the last year and determine if there is a commonality and see how that number could be lowered with a better preoperative screening process.
3. Involve physicians if the project affects clinical outcomes. If your QI study involves clinical outcomes, you should definitely involve physicians in the process, Ms. Davidson says. “You’ll want to have physicians involved in any kind of clinical study,” she says. “If, for example, all you’re looking at is how to save on duplication of paperwork, you don’t need their expertise for that, but for things that impact patient care, you should always include your physicians.”
For example, if your ASC is trying to save money on supplies, you might track your supply costs per case type over time and compare brand prices. Start this process by talking to your physicians about the project and letting them know you will be looking for cost-saving opportunities. This way, they will feel less blind-sided when you come to them with six months of data, asking them to consider a change.
Ms. Davidson reminds ASC administrators that physician involvement should not be limited to ASC surgeons. “Don’t forget anesthesia because their input is just as valuable as the surgeon,” she says. “If your study is on post-operative pain management, for example, both the surgeon and the anesthesia provider should be involved.”
4. Prioritize patient safety before finances. With only 2-3 projects on the roster every year, surgery center administrators may feel overwhelmed by choices. Ms. Davidson makes it easier to narrow down your laundry list by recommending that you concentrate on patient safety issues first. For example, if your ASC has a high level of hospital transfers, patient infection rates or falls, those studies should take precedence over tracking your days in A/R or your net revenue per specialty.
Once you have decided on one or two pressing patient safety initiatives for the year, turn your attention to finances. “Patient safety initiatives are always number one, so if it has a direct impact on any kind of safety issue, that’s your number one priority,” Ms. Davidson says. “In the ambulatory world, however, another big focus is always on revenue for the center.”
5. Pick a project that can succeed. When you choose a project, pick something that will have a significant impact on your surgery center, Ms. Davidson says. For example, if your days in A/R average around 100, you can improve processes tremendously by lowering the number to the industry benchmark of 35-40. If your patient satisfaction scores are below 75 percent, you have a lot of room for improvement.
Ms. Davidson warns surgery center administrators that some projects — though well-intentioned — are unlikely to produce a great result. For example, if your goal is to request or convince a particular surgeon to change his block time, and you already know he is not likely to budge, you may waste a lot of time collecting data for no reason. “Pick something that will be a win/win for everyone,” she says.
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