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There's No Substitute for Real Data toIdentify Improvements By Ylone S. Xavier Vice President, Performance Management Saint Barnabas Health Care System West Orange, N.J.  Uncovering Root Causes In today's pressure-filled environment, healthcare organizations must stay on their toes to remain competitive. Unrelenting financial demands and ever-shrinking margins require unique solutions to improve efficiency and do more with less. At Saint Barnabas Health Care System, healthcare clinical analytics is the answer. We joined OR Benchmarks® Collaborative (ORBC), a healthcare business intelligence and benchmarking service, to access reliable, objective data on our OR performance against our own organization as well as other national organizations. The collaborative helps us uncover root causes and make critical decisions to improve OR performance and optimize efficiency. Each month, we receive a Web-based dashboard of trended outcomes on key performance indicators. Results are benchmarked both internally and against more than 400 hospitals nationwide. Reliable Data Drives Change Some of our biggest gains have come at Saint Barnabas Medical Center, one of the six hospitals in our system. By leveraging healthcare clinical analytics, the Medical Center improved on-time first-case start times in its 18 ORs from 52% to 68.5% in a single month. It also made strides in scheduling accuracy, turnover time and utilization. Start-Time Accuracy for First Case of the Day. Failure to begin the first case on time creates a domino effect that upends the entire day's schedule. Procedures run late, patients have to wait, and staff must work overtime at tremendous cost. ORBC data revealed that many Medical Center physicians who were scheduled to begin surgery at 7:30 a.m. didn't actually get under way until 8:00 am. Our busiest surgeon was one of the worst offenders. When we showed him the data, he became our champion and raised awareness among his colleagues. In addition, OR directors introduced staggered start times to reduce delays. Scheduling Accuracy. ORBC helped the Medical Center eliminate chronic underbooking and improve scheduling accuracy. Surgeons would routinely minimize the amount of time they needed for various procedures. Our schedulers were able to drill down in the data to determine exactly how long physicians spent in the OR on a case-by-case basis. They used the statistics to implement new, more realistic schedules. Initially, many physicians balked at the change. But again, when presented with irrefutable data, they came on board and worked with us to improve things. Utilization. The Medical Center uses healthcare clinical analytics to ensure OR utilization is as high as possible, especially during the "prime time" hours of 7 am to 7 pm. With reliable data as the driver, we can optimize capacity, open or close rooms, and quickly staff up or down to meet demand. Costs. Running a punctual OR has dramatically reduced overtime expenses. The Medical Center avoids overtime not only for our own staff, but also for contract employees such as clinical perfusionists who must be called in to operate heart-lung machines. Improvement Initiatives We've even been able to leverage data to improve patient satisfaction. Our innovative OR Tracker enables families in the Surgical Services waiting room to follow the progress of their loved one's surgery. Each patient is assigned a number. Family members can track the patient's status on a video screen. They know exactly what is happening at each step in the process — when the patient leaves the prep area, when surgery begins, when it ends, and when the patient is moved to the post-anesthesia care unit (PACU). This popular offering provides peace of mind and has dramatically reduced phone calls to check on patient progress. A Level Playing Field For years, Saint Barnabas Health Care System tried to monitor and assess our own OR data manually. But this do-it-yourself approach never worked. Our facilities couldn't agree on which metrics to measure or how to calculate results. With hundreds of pages of data to analyze, our OR directors were quickly overwhelmed. Joining ORBC has leveled the playing field, eliminated the internal arguments and manual labor, and provided extensive statistical analysis to validate the data. Sharing information transparently within our system creates healthy competition among our hospitals and promotes culture change. When everyone can see everyone else's results, it motivates them to want to be in the top-performing group. Our OR directors learn from one another and apply best practices. As Vice President for Performance Management at Saint Barnabas Health Care System in New Jersey, Ylone Xavier is responsible for all system-wide dashboards, financial and quality reports, physician credentialing data and physician ongoing professional practice evaluation (OPPS). Under her leadership, Saint Barnabas is considered one of the premier sites to use healthcare clinical analytics tools. She has more than 25 years of experience in the healthcare field and holds both a Masters Degree in Business Administration and a Masters Degree in Public Health from Columbia University in New York.   |
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