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Use National OR Benchmarks to Focus YourImprovement Efforts By James DeFontes III, MD Assistant Executive Medical Director Perioperative Services Kaiser Permanente Southern California Region  An Unbiased View of Our OR Performance At Kaiser Permanente, our vision is to be the safest place to have surgery. We want to achieve the highest quality outcomes, but we also need to be as productive as possible. We bridge these goals through a culture of safety coupled with a laser-like focus on performance, quality and outcomes. When we joined the OR Benchmarks® Collaborative (ORBC) in 2007, we were seeking an unbiased, external view of our operating room (OR) performance. We wanted information on volume, utilization, efficiency, start times, case accuracy and turnaround that we could use to benchmark our performance against other ORs across the nation. Because Kaiser Permanente is a large organization, we tend to look internally. ORBC has given us a chance to see what the rest of the country is doing. It shows us what we need to do to improve and where we are performing well. In addition, it enables us to benchmark "apples to apples." Our tertiary care centers compare themselves to other tertiary care centers, our small community hospitals to like-sized facilities, and our ambulatory surgery centers to similar outpatient centers. This helps us identify, set and meet realistic performance goals. ORBC data is accurate, timely, comparable and accessible. The format is easy to use, and we can drill down to reveal facility-specific or surgeon-specific details and make appropriate adjustments. Improved Throughput Eliminates Backlog In just a few years, ORBC has helped us achieve notable improvements in OR access. As a result, our patients now receive their elective surgeries, such as total joint replacement, complex spine and cataract procedures, much sooner — in some cases waiting only a few weeks, instead of up to six months. Our most impressive gains include:  A 30% improvement in throughput of elective cases A 34% increase in elective access, with 80% of cases now performed within six weeks Elimination of a six-month backlog in all elective surgeries A 44% increase in cataract throughput, with six-week access improving by 116% A 22% increase in total joint replacement throughput, with three-month access improving by 56% In addition, by cleaning up our elective backlog, we are now able to perform nearly 100% of our urgent and emergent cases within two weeks. Scheduling accuracy has improved as well. Using ORBC data, our Ambulatory Surgical Center in San Diego reinvented its work culture, improved room turnover time and increased its caseload by 10 surgeries each day. Better Balance Yields Safer Care ORBC data has helped us focus our performance improvement energies on areas that actually need fixing. This has boosted morale and enhanced patient safety. Before we began national benchmarking, we didn't understand how well we were doing. Senior leaders pushed for better performance in all areas. But when presented with irrefutable, industry-wide data that showed we were in the 90th percentile for many metrics, their attitude changed. Instead of challenging us to do better, they told us what a good job we were doing. This had an immediate positive impact on morale. Everything became more balanced. Because we were no longer pushing the envelope to improve performance in areas where we already excelled, the risk of safety shortcuts decreased. Developing a Supportive Team Structure Physician reaction to ORBC ranged from early adopters who asked, "What took you so long?" to those who insisted, "Nothing's wrong, why change things?" You can't let the naysayers drive you, but you can't dismiss them either. You must work to develop shared strategies, goals and metrics that protect quality and safety above all else. Once surgeons see this commitment, they begin to appreciate what you are trying to do and work with you to make it happen. They want to join the high-performing culture and, in many cases, be the ones to drive the change. ORBC data has helped us move away from an environment of crisis management to a supportive structure of highly reliable teams. Now, 80% of our sites are meeting or exceeding standards. Teams work together to overcome obstacles and improve performance. Kaiser Permanente's participation in the collaborative continues to promote this positive behavior change, which improves our internal and external image, and guides us to where we need to go. We know we are headed in the right direction. James DeFontes III, MD, has been a board-certified anesthesiologist with a specialty in critical care medicine for more than 25 years at Kaiser Permanente Orange County. He received his Doctor of Medicine from the University of Texas, Southwestern Medical School and served as Assistant Clinical Professor of Anesthesia and Critical Care at the University of California, Irvine Medical School. Dr. DeFontes is a national expert in patient safety and was the first recipient of the David M. Lawrence, MD, Chairman's Patient Safety Award in 2003.   |
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