Sacred Heart Medical Center, Spokane, WA Perioperative Services Initiative

Greater efficiency in all perioperative processes
Greater case scheduling flexibility with improved access for surgeons
On-time sequencing of events, with a substantial reduction in perioperative cycle times
Visibility for preoperative preparation, intraoperative patient progress, physician presence and availability
Greater surgeon satisfaction with OR operations
Enhanced staffing practices with redesigned roles and responsibilities
Improved patient care and customer satisfaction
Increased volume, net revenue and market share

Increased Preoperative Screening from 35% to 92%
Improved on-time starts from 37% to 80-90% for first cases and from 38% to 65% for non-first case starts
Decreased OR Room Turnover from 30 minutes to 21 minutes average for all ORs
Press Ganey Scores improved from 10th to 75th percentile in the Ambulatory surgery setting
Improved physician access to the operating rooms, on-time case starts and faster room turnovers have significantly improved satisfaction and increased surgery case volume by 15%.


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	Expand Volume & Market Share Build Physician & Staff Loyalty Increase Patient Satisfaction Our Guarantee		President's Award for Excellence PROVIDENCE HEALTH & SERVICES PRESIDENT'S AWARD FOR EXCELLENCE 2006 Sacred Heart Medical Center, Spokane, WA Perioperative Services Initiative In 2004, the Perioperative Services department at Sacred Heart Medical Center (SHMC) in Spokane, WA was at a critical juncture — make major improvements in operations, or continue to lose its surgeon base, reputation and market share. The OR had low surgeon and patient satisfaction scores, was losing patient volume and its good standing in the community, and despite tactical initiatives over the two prior years, the situation continued to worsen. In 2007, SHMC won the Providence Health & Services President's Award for Excellence 2006 for its Perioperative Services project. This is the story of Sacred Heart's work with EMPATH and the 180º turnaround in its OR operations. In 2004, SHMC identified several key drivers of dissatisfaction for surgeons: difficulty in accessing the OR's schedule; unfinished patient preparation, resulting in cancellations and delays; incomplete case carts and equipment; low percentage of on-time starts; and slow room turnovers between cases. Customer satisfaction for Ambulatory Surgery was in the bottom quartile of all hospitals. Surveys showed that 75% of surgeons were dissatisfied with the hospital's perioperative services. There was wide variability in execution of core processes and no clear ownership of those processes. Surgeons perceived the OR staff as insensitive to their needs. In due course, Ambulatory Surgery Press Ganey patient scores dropped to the 10th percentile nationally. SHMC lost market share when the community's largest orthopedic group took its cases to its own Ambulatory Surgery Center. SHMC's neurosurgery group informed the hospital that it was going to initiate a similar strategy. Over the two prior years, there were four separate tactical initiatives to improve room turnover and on-time starts, without significant change in overall performance. When SHMC's Perioperative Services "looked in the mirror," it saw a service line with no clear expectations or methods to achieve results, ensure patient preparation, monitor work effort, or reallocate resources when needed. They had no operational metrics, thresholds or formal backup systems, and no measurement of managers' performance. They monitored activities through resource intensive processes, and had wide variability in how the work tasks were accomplished. Clearly, SHMC was at a crossroads, with no roadmap for improvement. To fix this magnitude of issues required a project of equal scope. SHMC undertook a comprehensive design and implementation project, Positive Impact, and gave itself a clear stretch goal — to improve perioperative processes so as to achieve top decile operational performance and 90th percentile for customer satisfaction, and become the hospital of choice for scheduled and unscheduled surgical care in its community. SHMC hired EMPATH Consulting for this initiative. Together, they developed the scope of Positive Impact, which included designing consistent perioperative processes to improve patient care, scheduling, pre-surgical screening, case-day throughput, surgical access and utilization, and to simultaneously decrease non-productive staff time. The target was to achieve a level of performance excellence, across the perioperative enterprise, equal or superior to the top 100 hospitals in the US, and to do so without more staff. The staff's work focused on physician satisfaction by decreasing case cancellations, improving on-time starts and turnover times, and ensuring optimal efficiencies. Over a 24-month period, the perioperative frontline staff led the project, fully supported by management, EMPATH Consulting, and the company's IT division. They designed and implemented new patient care processes throughout the perioperative continuum, and developed and implemented real time monitoring IT systems to help measure, manage and sustain their work. They literally rebuilt the entire perioperative continuum of processes. SHMC achieved best-in-class performance in all areas of perioperative operations, with results such as: Greater efficiency in all perioperative processes Greater case scheduling flexibility with improved access for surgeons On-time sequencing of events, with a substantial reduction in perioperative cycle times Visibility for preoperative preparation, intraoperative patient progress, physician presence and availability Greater surgeon satisfaction with OR operations Enhanced staffing practices with redesigned roles and responsibilities Improved patient care and customer satisfaction Increased volume, net revenue and market share Some of the quantifiable results of this project include: Increased Preoperative Screening from 35% to 92% Improved on-time starts from 37% to 80-90% for first cases and from 38% to 65% for non-first case starts Decreased OR Room Turnover from 30 minutes to 21 minutes average for all ORs Press Ganey Scores improved from 10th to 75th percentile in the Ambulatory surgery setting Improved physician access to the operating rooms, on-time case starts and faster room turnovers have significantly improved satisfaction and increased surgery case volume by 15%. With this project, SHMC now is aligned with the mission of the PH&S system, achieves best-in-class operations performance, offers operational efficiencies unmatched by its competitors, and is the provider of choice for its community's surgeons and patients.