As hospitals deal with tightening budgets and greater demands on those few dollars, it’s imperative to seek out those new institutional approaches that will build greater efficiency, and therefore cost savings, into different protocols.
For a group of hospitals within the Norton Healthcare system, based in Kentucky, that meant making changes after they determined they were losing money because of disposable items in the OR that went unused. When their new program was implemented, the facilities together saw a savings of 3.2 percent, which translated to $196,351 over the first 11 months.
To find out more about how this program came to be, Surgical Products spoke with Pamela Photiadis, DNP, RN, CNOR, the director of OR Matrix at Norton Healthcare.
Can you tell us about the research related to OR efficiency conducted in your facility?
We shored in the supply wastage that resulted from the staff opening everything in a case cart for a surgical procedure. We embarked on a project called OWN, Open When Needed. It was a quality improvement project that all the operating rooms in our system participated in. And we used the DMAIC (Define, Measure, Analyze, Improve and Control) quality improvement process. We looked at everything from the point of pulling the case cart to the point of opening the supplies in the room, and even inter-operatively what the surgeons required and what was most concerning if we didn’t have it on the table just waiting for them. What we ended up doing is we actually revamped how our case carts were configured so that supplies were separated into “Must Open,” and then “Must Have In The Room But Do Not Open Until Needed.” And that’s how we coined the term “OWN: Open When Needed.” So the case cart was separated out into those two categories. We did get surgeon buy-in; if we had the supply in the room, they were okay if we did not open it until the time of use.
(Image credit: screen grab from Norton Healthcare video)
Was it a challenge to get the buy-in?
Yes, it was. But it was mostly a challenge with the scrub techs, who wanted everything on their table. They did not want to have to wait for a circulator to open it. Their concern was that the circulator would be out of the room when they needed it, and that they would have a delay and the surgeon would become angry. So we did have to work through those challenges. We had a surgeon champion who was a general surgeon. He was also the medical director for our hospital, so he had some influence. And he did a lot of networking with the other surgeons to gain their agreement to at least try the process.
Did that include making them understand the purpose? Was it helpful that you had the data to back it up?
Oh, yes. We had cost data on every surgeon. Down to the person. We worked with our clinical effectiveness team — that is a system group that had access to all that data. So we had cost data for every surgeon. We also could determine what the surgeon used and what we threw away. As part of our measurement phase for the DMAIC project, we actually did gather everything that wasn’t used and put a cost to it.
What have the results been?
Initially, the results were fantastic. We were saving $40,000-plus a month. Now because old habits are hard to break, and because the nursing staff wants the surgery to go as expeditiously as possible and they don’t not want to irritate the surgeon in any way, we’ve seen slippage over time. We have to keep reenergizing. We bring the information back to the table and actually share the data with the staff in terms of, okay, last month was $40,000 savings and this month we’re dropping down to $20,000, and we think it’s because of the practice.
So it’s a constant reinforcement process. You can’t put a solution in and walk away.
In working with some non-nursing people in our system, an easy solution for them was to change the physicians’ practice in terms of what they used at the field. That’s not going to happen, not unless it really is a real win-win for everybody. Because that’s just a really hard thing to do. We decided that if we could work more with changing the nursing staff’s practice and then just instilling that confidence in the surgeon that we’ve got the material in the room. It’s right here. Give me a nod when you need it, and you’ll have it. But you don’t always use it, as we have tracked over this many months, and we don’t want to throw it away.
Do you think surgeons and nurses are coming around to greater understanding of their place in cost management?
I have seen more and more surgeons come to myself or my business manager and request what the cost is of a particular product. We also actively work with our purchasing department in terms of looking at alternative products and doing cost comparisons and doing clinical trial to see if it’s an acceptable product for the surgeon. That has really heightened their awareness because we do openly share costs with them now.
