As payers continue to move the healthcare industry toward value-based payment, many physician and nursing leaders are finding themselves in a new role: the unofficial chief value officer of their hospital.
Of course, your actual title might be chief medical officer, medical staff liaison, VP of nursing or another leadership role. But if hospital executives are turning to you to…
- Manage care coordination efforts
- Oversee population health initiatives
- Help develop more cost-efficient delivery systems
- Lead any effort to increase quality while decreasing expenses
…then you are your hospital’s unofficial “CVO.”
David Young, MD and I recently wrote an article on this complex new role for Physician Leadership Journal. In it, we zero in on one particular challenge — the difficulty of managing value in the OR.
A hospital surgery department includes multiple stakeholders, conflicting priorities, complex processes and, not infrequently, difficult personalities. New “chief value officers” who do not have a surgical background — and even many who do — are often reluctant to wade too deeply into OR operations and politics.
Our Physician Leadership Journal article is aimed at CMOs, but its concepts apply to every physician or nurse leader who is responsible for increasing quality and decreasing costs in the OR.
In it, we explain six effective actions for achieving dramatic change in perioperative services. Here are three you can start focusing on right away:
1. Propose a new governance structure for the OR
A multidisciplinary department like a hospital OR needs to be run by a multidisciplinary leadership group. Leading hospitals have established collaborative OR governance by creating a Surgical Services Executive Committee (SSEC).
A well-designed SSEC brings together everyone needed to create effective change in the OR — surgeons, anesthesiologists, nurses, administrators and others. This is key to preparing the OR for new payment programs like the Comprehensive Care for Joint Replacement (CJR) model, which requires a high level of cross-disciplinary coordination.
2. Back reform of the block time schedule
In most hospitals, OR time is allocated in blocks. Unfortunately, most ORs have poor control over how block time is structured and managed. Group block ownership, short blocks (4 hours or less), weak block rule enforcement and other problems lead to significant waste. In many ORs, utilization is 50% or less.
The solution? Comprehensive block system reform led by the SSEC. Key changes include (a) establishing minimum 8-hour blocks and (b) commissioning the SSEC to create and enforce utilization rules that encourage surgeon accountability.
These and other key changes can increase overall OR utilization to 85% or higher, helping ORs achieve the efficient cost structure that is critical under value-based care.
3. Push for changes in daily OR management
In most hospitals, a nursing manager runs the OR on a day-to-day basis. Unfortunately, a nurse leader alone is unable to make the decisions necessary to ensure smooth operations in perioperative services.
The most efficient surgery departments are run by a management duo consisting of a physician — ideally, the anesthesia medical director—and the OR nursing director. This pair works together to make real-time decisions about the complex operational issues that impact both nurses and physicians.
They assign staffing resources, optimize anesthesia utilization, resolve schedule problems and generally “put out fires” that flare up daily in a busy OR. This arrangement creates the efficiencies that keep department costs down, helping the OR achieve a key goal of value-based payment.
More effective tools for OR change
Changes in OR governance and leadership can set the stage for other effective interventions, including optimizing pre-operative processes and leading the development of clinical pathways.
To explore all of these strategies in depth, read Transitioning the OR from Volume to Value: CMOs Who Know Which Levers to Pull Can Help Transform Surgical Services in Physician Leadership Journal.
CMOs and other clinical leaders who use these tools will help their OR improve quality, control costs and improve patient outcomes. That will increase the value of the hospital’s surgical care while helping to ensure the organization thrives in the evolving world of value-based payment.
For more great insights into how to improve your leadership skills and collaboration, check out this blog post: The Essential Building Blocks of Collaboration in the Operating Room
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