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Surgical Servicespresent state and how did we get here..SIP 5 report 3/1/05 Renae Battie, Peter Buckley, Judy Canfield, Shelley Deatrick, Mark Schierenbeck, Helen Shawcroft

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And then we started to grow. 1978 Addition of SCOR OR 15-16 1985 addition of OR 8-14 (13 shelled) 1990s OR 13, 17 opened 2001 Addition of OR 20 2002 R2 ASC opened with 2 OP ORs 2003 Nov--Pavilion Surgery Center opened with 6 ORs (5 shelled) (4 main ORs closed) 2004 (Feb) 2 Main ORs using 2 Pav rooms 2005 (April) Pavilion Short stay opens 7 new beds

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UWMC Ambulatory Surgery Center at Roosevelt 2 OR ASC Geographically separate from Hospital Ambulatory only Parking in the basement Narrow spectrum - Eyes/Hands/ENT/Plastics Closed Surgical Staff Unique/designated staff Unique leadership initially Equipment - site specific Instruments shared Supplies shared Sterilization off site

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R2 ASC Retro fitted into existing Medical Office building Planning start 10/00 Construction start 06/01 15 MONTHS Open for business 01/02

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JOINT CLINICAL PLANNING TASK FORCE - 1998 Charge: Identify and evaluate program options for the 160,000 gsf pavilion. To Consider: external factors, projected clinical growth service requirements of the UWPN clinics, current effort to examine near-term options for decanting ambulatory surgery volumes, impact of reductions in GME support. Data Sources Analyzed: Current volumes Forecast future volumes External environmental scan Experiences of other academic medical centers Internal survey of potential need

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JOINT CLINICAL PLANNING TASK FORCE (Contd) Recommendation on core services to be included in building: - Ambulatory Surgery - Pre-admission testing - Minor procedures - AM admit - Observation unit List of other candidate programs

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JOINT CLINICAL PLANNING TASK FORCE (Contd) Recommendation on core services to be included in building: Ambulatory Surgery, Pre-admission testing, Minor procedures, AM admit, Observation unit List of other candidate programs Project Goals: Provide capacity to meet increasing demand for services provided in an ambulatory setting Provide significant additional OR capacity Provide a single site for all surgery check-in Create an ideal patient experience Provide an ambulatory teaching setting

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PROGRAMMING COMMITTEE - 1999 - Robert Muilenburg, co-chair- Mika Sinanan, MD, co-chair - Peter Buckley, MD - Rick Matsen, MD - Judith Canfield - Al Moss, MD - Alex Clowes, MD - John Olerud, MD - Mickey Eisenberg, MD - Jim Ritchie, MD - Jim Fine, MD - Bruce Rothwell, DDS - Ben Greer, MD - Kathleen Sellick - Paul Ishizuka - Dan Silbergeld, MD - Mike Kimmey, MD - Preston Simmons - Paul Lange, MD - Ernie Weymuller, MD - Eric Larson, MD - Steve Wilson, MD

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PROGRAMMING COMMITTEE (Contd) Reviewed Joint Clinical Planning Task Force work Solicited future plans and projections from clinical services Reviewed demand forecasts for surgery (inpatient and outpatient) Agreed upon building theme and occupants Agreed upon sizing of OR suite, based on demand forecast and room utilization model

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PROGRAMMING COMMITTEE Vision Create a facility to compete with the best in the region Create the ideal patient experience Create the ideal faculty and staff environment Be the principal site for ambulatory surgery Design for operational efficiency and flexibility in patient care Create new academic opportunities for programmatic development, education and research

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PROJECT MANAGEMENT COMMITTEE Oversee final design and construction phases of project Advise on budget/ project scope issues Communicate about project progress to colleagues - Eric Larson/Ed Walker, MD & Mika Sinanan, MD, co-chairs - Peter Buckley, MD- Paul Ishizuka - Judith Canfield- Mike Kimmey, MD - Patch Dellinger, MD- Tom Trumble, MD - Bill Ellis, MD- Barbara Zuelzke

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Functional Unit (OR)Forecast Methodology Workload Forecast X Proc Length + Clean-up / Operating Hours/Year / Goal Utilization Rate X Scheduled Procedures = Operating Room Forecast

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Washington State Population Forecast Percentage Change Per 5 Years Annually ~1% Annually ~1.5%

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King and S. Snohomish Counties Pop Projection 2000-2020 % Growth % Change 2004-2015 = 11%, just over 1% per year

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Surgery Workload Forecast Currently for fy05

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Surgery Caseload Forecast Currently at 14653 for fy05

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Like Institution Benchmarks UWStanfordUCLAUSCUCSF Cases11,50 0 23,00021,00017,00010,000 ORs19334132450 Cases/ OR 600700500530450 % OP47%59%43%24%21% IP Mins/ Case 235196255203247 OP Mins/ Case 11310378114109

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WORKLOAD SCENARIO DEVELOPMENT

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SUPPORT SPACE VERIFICATION

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Pavilion Services and Departments Third Floor Pre-Surgery ClinicImaging Surgery ClinicGI/Endoscopy Second Floor 11 Operating RoomsAM Admission OP Surgery Check-inSurgical Short Stay Pre & Post Procedure Holding and Observation First Floor Urology Clinic/Prostate Center Food Service/Conference Center Building Support Services

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Ready go--- Built from the ground up Planning start 05/99 Construction start 10/01 54 MONTHS Open for business 11/03

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UWMC Surgery Pavilion 11 OR ASC using 6 ORs One floor ORs, two floors Clinic /Endoscopy Connect to Hospital via skybridge Ambulatory (70%), LS (15%), IP (15%) Sole site for DOS admits Parking in the basement Broad spectrum practice Unique/designated staff Unique leadership

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Other Goals Increase sq footage of ORs increase # of ORs using latest in technology infrastructure for digital age support next ten years of development of technology and growth

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What other changes with the new site? All preop patients in one site Standardization of rooms, PLs, processes schedule boards compliant with HIPAA automation of pharmacy and implants pleasant environment for patients, families, staff create a new culture of efficiency

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Pre + Post Op Pre + Post Op HOME Patients pulled check by system controller Patient Flow Admit to Hospital Admit to Hospital Main Pre-Op Main Pre-Op OR OR Check-In Check-In OR OR Pre-Op Procedure s Pre-Op Procedure s Straight Back Straight Back PACU PACU AMBULATORY SURGERY MAIN OR

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Whats the vision? OR

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Standards for Pt flow Attentiveness to patient start times and plan Parallel actions vs consecutive actions (next pt ready by end of current case) Case prep done day before; minimal schedule changes Pt preparation complete on arrival Comfort/flexibility of shared tasks by team Adjusting amount of teaching time to goal of on time starts Develop standardized, lean setup cases

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Tracking Metrics On time surgical (starts within 15 min) Room turnover (20 min or less) % surgeries completed as scheduled (95%) Case cart accuracy (95% of all items present) Standardization of care (50% reduction in case variation among top PLs) Patient readiness (all ready at arrival) Patient wait time (less than 30 minutes wait)

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Stryker Integrated OR Information System- Endosuite Sony Video Archiving System Pavilion OR Front Desk Conference and teleconference Sony video archive

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UWMC OR Forecast

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R2 ASC opens Jan Pav SC opens Nov.

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R2 ASC opens Jan Pav SC opens Nov.

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Anne x opens Short stay opens

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4NE Midnight Census Trends September 2004 August 2004 October 2004

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4NE Midnight Census Trends December 2004 November 2004 January 2005

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4NE Midnight Census Trends February 2005

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* Annualized

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Visionor Hallucination? Exceptional leaders cultivate the Merlin- like habit of acting in the present moment as ambassadors of a radically different future, in order to imbue their organizations with a break-through vision of what it is possible to achieve. Charles E. Smith, management consultant