In Dr. Lombardi’s OR, proactivity, as opposed to reactivity, is the order of the day. Such is the case with the preference cards at Mount Carmel New Albany. “If Surgeon X likes osteotome Y…or prefers a certain needle driver, then that is put on Surgeon X’s preference card so whoever is pulling the case for the next day has that information. The cards are very specific, and say, for example, ‘John Doe is undergoing a right TKA with Dr. Lombardi using the Vanguard system.’ And then everything I need is there when I need it.”
Also catering to convenience is the object deemed the “minibar” says Dr. Lombardi. “In the event that a surgeon drops an instrument and the central sterilization department is on another floor, just imagine having to run down to get a rongeur mid-surgery. With the minibar, you can grab a new one and leave a note saying that it was removed so that it gets replaced.”
One way to inject an air of ongoing seriousness into the process is to formalize things with a regular meeting. Dr. Lombardi: “Every month we bring together surgeons, anesthesia staff, someone from medicine, and nursing, to discuss what needs to be changed or even overhauled. This keeps us all on our toes and keeps our processes up to date.”
Enter the efficiency wizard…
One of the participants in the monthly meeting is the aforementioned Diane Doucette, a healthcare veteran who for 25 years had a consulting business comprised of establishing total joint replacement programs.
Doucette, who has built five hospitals centering on efficiency, told OTW, “It is critical to surround yourself with people who can manage the various parts of the process so that the surgery happens—and happens on time. Work with the anesthesiologist to develop a plan of care for preop diagnostic testing so there are no delays on the day of surgery—or cancellations.”
“Sometimes it is the hospitalist or the medical clearance person who will cancel a surgery. Thus, the more people who undergo preadmission testing and the more input you have from those specialized in perioperative medicine, the better. These are the individuals who know how to optimize patients and ensure that they can withstand surgery.”
Invest, standardize, simplify…
“Develop your team to expect excellence. Invest in them—and standardize and simplify all processes. For example, you may have 100 instruments in a hip set, but do you really need all 100 of those instruments? Why make the sterilization department do all that work when it’s not necessary? Another example of efficiency is if you teach your team to properly position, prep, and drape the patient. Then you can go out and communicate with the family, write orders, mark the surgical site, and then walk in and start the case…and you have saved approximately 20 minutes.”
Me? The cog in the wheel?
Diane Doucette: “From the moment patients walks in, every aspect of their journey is catalogued and posted with the time of each event. Each staff member can readily see what time XYZ happened and if we hit our marks along the way. If not, was it the nurse, the surgeon, or the patient who was the hold up? This transparency regarding execution works well because no one wants to be the variance…and nobody thinks they are the variance.”
For a patient facing surgery, nothing is more frustrating than to arrive at the agreed-upon time only to be told to wait. Doucette: “Patients say, ‘I was told to be here at 5AM and now it’s 5:30. Why am I sitting around?”
Not at our hospital, says Doucette. “We tell patients, ‘We’ve been expecting you! You’re having a right total knee with Dr. Lombardi. Come right in.’ All the best companies, from the Ritz Carlton to Disney, know that part of satisfying people involves keeping them moving.”
