adopting innovation in the or: leading and managing change...digital and the culture is shifting •...

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Adopting Innovation In The OR:

Leading And Managing Change

Michael Meyer, MD, Board of Directors - Pulse Heart Institute, Physician Executive and OR Leader

Sanjeev Agrawal, President and Chief Marketing Officer, LeanTaaS

Session 256, February 14, 2019

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Michael Meyer, MD, has no real or apparent conflicts of interest to report.

Sanjeev Agrawal is employed by and holds equity in LeanTaaS, Inc.

Conflicts of Interest

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• Learning Objectives

• About MultiCare Health

• Motivation to Change

• 2017 Goals

• What We Did

• Increased Access and Results

• Enforcing Accountability and Results

• Adding a Single Source of Truth

• Enabling Innovation and Change

• Comparing the Past with Today

• Q&A

Agenda

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1. Discuss why focusing on traditional metrics like block utilization

and first case on-time starts do not improve patient access, OR

utilization or revenue

2. Recognize how predictive analytics and the same mobile

technologies we use as consumers every day can be leveraged

to improve OR utilization

3. Assess how to convince surgeons to embrace change and

innovation in the OR

Learning Objectives

MultiCare

West Pierce Region

• Tacoma, WA

• Level 2 trauma center, community

hospital, children’s hospital,

and an ambulatory surgery center

• 35 ORs across 4 locations

• 1700+ cases a month

• 100+ active surgeons

• Epic

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• Expensive, “perishable” OR capacity

• Block “reservation” system creates winners and losers

• Process gridlock in enforcing accountability for blocks

• Inconsistent definitions and no single source of truth

Fixed Supply Of Expensive OR Capacity…

Motivation to Change:

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…And Significant Demand VariabilityAmong Block Owners

.. Significant Demand Variability Among Block Owners

• Clinic volume variation

• % surgical cases

• % that can be fit on day of block

• Variability in case length

• Vacation, clinic conflicts,

conferences

• Limited mechanism to create

and broadcast open time

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OR Time Is Precious

and Never Available….

Yet “Reserved Time”

is Left on the Table

Each Day…

• Each operating room minute is worth

$100 - $300

• A 500-minute day is worth $50,000 -

$150,000

• 1% improvement is worth $125,000 -

$375,000 per operating room per year

• On average, for a 20-operating room

hospital, improving utilization by 3% is

worth $15,000,000 per year

Demand/Supply Mismatch = Large Paradox

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Create more ACCESSIBILITY to open time,

right-size blocks to increase ACCOUNTABILITY,

and create credible VISIBILITY into performance metrics

2017 Goals

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Accessibility Accountability Visibility

No such thing as a perfect

block allocation - Block time

will never be used exactly

as planned…

How can we ensure

advance time release,

create visibility into open

time, and make it simple to

request time – “a liquid

marketplace for open time”

The current process for

right-sizing blocks is

broken… “Block utilization”

is not actionable

”Collectable time” is far

more surgeon-centric and

actionable

Is reporting “admiring

the problem” or driving

decisions? Are providers

and administrators

engaged in credible

data?

Becoming more data-

and hypothesis-driven

and bring reporting into

the 21st century?

What We Did

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• Easy to release time with

proactive interventions

• Transparency into open

time for surgeon clinics

• Easier process for OR

scheduling has allowed

schedulers to work

remotely

• Effective use of robot

End-to-end release and request process streamlined

Marketplace for Open Time

Increased Access

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• Easy to release time with

proactive interventions

• Transparency into open

time for surgeon clinics

• Easier process for OR

scheduling has allowed

schedulers to work

remotely

• Effective use of robot

End-to-end release and request process streamlined

Marketplace for Open Time

Increased Access

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110 70

50% 15

Blocks Per Month

Released

Blocks Per Month

Requested

Requests From Surgeons

Without Allocated Time

Average Release

Proactivity (days)

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• Surgeon-centric,

defensible, and actionable

methodology

• Enables conversations

with underperforming

block owners

• High defensibility of data

mitigates back-and-forth

for quick decisions

Collectable Time made it easier to take blocks away

Identify the right capacity,

and then put it to work

Enforcing Accountability

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• Surgeon-centric, defensible, and actionable methodology

• Enables conversations with underperforming block owners

• High defensibility of data mitigates back-and-forth for quick decisions

Collectable Time made it easier to take blocks away

Identify the right capacity,

and then put it to work

Enforcing Accountability

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7+ 20+Block Owners

with DecisionsBlocks Per Quarter

Collected

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Deep Visibility Into Metrics

• Formalized and standardized

set of KPIs

• Accessible across mobile

and web

• Comprehensive, accurate,

and timely information

• Deep drill-downs into the

data to granular level

• Used by individual care line

leaders and hospital

leadership

Adopting a Single Source of Truth

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Deep Visibility Into Metrics

• Formalized and standardized

set of KPIs

• Accessible across mobile

and web

• Comprehensive, accurate,

and timely information

• Deep drill-downs into the

data to granular level

• Used by individual care line

leaders and hospital

leadership

Adopting a Single Source of Truth

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Open

Marketplace as a

Recruitment Tool

Better Capacity

Identification for

Tighter Allocation

Diagnostic

Insight into

Current State

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Enabling Innovation and Change

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The Past

OR and Clinic Scheduling was a Manual, Cumbersome Process• OR schedulers and clinic

schedulers dealt with fax,

emails, calls, sticky notes etc.

• Clinic schedulers had no

visibility into true open time

inventory

• OR schedulers had no visibility

into true patient flexibility

• This imbalance created

inefficient back-and-forth

conversations

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Today

OR and Clinic Scheduling is a Highly Streamlined, Centralized, Digital Process

• Clinic schedulers now have full

visibility into open time, and can

self-balance based on patient

flexibility

• OR schedulers can now focus

on managing OR constraints and

outlier cases

• Back-and-forth conversations

significantly reduced through

digitization

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Today

Scheduling Workflows are Becoming Digital and the Culture is Shifting• Some OR schedulers have

started working remotely!

• Cardiovascular volumes are up

by 40% YoY

• Initially resistant CV schedulers

now feel left out – they still have

to deal with arbitrary release

times and outdated scheduling

methods

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The Past

Surgeons Were Not Active Participants in Data-Driven Conversations• Reports were being sent out,

but definitions were often

decentralized

• The data was not surgeon-

centric, and scattered over

different sources

• Information was disseminated

through email or paper, which

was inconvenient for busy

surgeons

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Today

Surgeons are Actively Engaging with Personal and Institutional Data• Access to performance metrics and

leaderboards

• Weekly text summary of KPIs –

linked to a mobile web experience

for deeper engagement

• Surgeons often interact, challenge,

and directly engage with the data

• Surgeons are active participants in

having data-driven conversations

about their own performance

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Today

Surgeons View Direct Data Engagement and Visibility as a Differentiator

• Facilitated the successful on-

boarding of new surgeons – without

allocating any permanent block

• Easy access to open time is a hiring

differentiator

• Newly hired surgeons have been

picking up time from Exchange as

needed, including a plastic surgeon

from the Franciscan system and a

new Colorectal surgeon

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The Past

Practice Leadership Had Limited Insight Into Their Practice/Service Line

• Difficult to balance demand (from

their surgeons) and supply (from

the OR)

• Poor visibility into the state of

their practice (KPIs, performance

metrics by surgeons)

• Broken accountability

mechanisms meant it was difficult

to balance existing schedules

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Today

Practice Leaders are Empowered Through Digital Visibility Into Metrics• Able to make data-driven

decisions through the

Collectable Time methodology

• Deep visibility into practice-

specific metrics

• Allows practice leaders direct

supervision over intra-service

allocation efficiency

• Allows OR leadership to take a

decentralized role in allocation

management

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Today

Decision-Centric Approach to Block Right-Sizing• OR Committee meetings stopped

reviewing requests – all based on

data now

• If data supports it, time is taken away

• In the past, people looked at

utilization and TOT data – with better

visibility some surgeons have recently

been voluntarily giving up time

• 80-20 rule: One CV surgeon is 2

sigma over time in their length of

cases. Contracts with insurance

companies can be impacted because

he skews their cost per case

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Q&A

Dr. Michael Meyer, MD

Physician Executive and OR Leader

Pulse Heart Institute, MultiCare Health

msmeyer@multicare.org

www.multicare.org

Sanjeev Agrawal

President and Chief Marketing Officer

LeanTaaS

Sanjeev@leantaas.com

www.leantaas.com