OASC | PATH TO SUCCESS

Driving Innovation

STRATEGIES FOR THE PURSUIT OF EVER-BETTER OUTCOMES AND EXPERIENCES

BY MARIA SCOTT, MD, AND MICHAEL DUNN, MBA, ASC ADMINISTRATOR

Technology Innovations = Success

EXPERTS SHARE HOW CUTTING-EDGE EQUIPMENT AND A POSITIVE MINDSET DRIVE PRACTICE GROWTH AND IMPROVE PATIENT SATISFACTION

This year at OOSS Perspective 2016, held during the ASCRS/ASOA Symposium & Congress in New Orleans, a group of doctors, nurses, and administrators led an important discussion about what helps to continually rejuvenate their ASCs. For them, an entrepreneurial spirit, frequent innovation, and quality products lead to admirable results.

Here, Maria Scott, MD, discusses technology innovations and staff development. Jeffrey Whitman, MD, explains how an often-used word like ‘quality’ can guide meaningful, long-term success. Larry Patterson, MD, explains how he imbues his work with the same entrepreneurial spirit that led him to build his own ASC.

Employed together, entrepreneurship, innovation, and quality can be a formula for success in your practice.

As we all struggle with increased costs and declining reimbursement, we ask ourselves, How can we innovate? How can we stay current, or ahead of the curve? Is it feasible to be innovative and, if so, is it something we want to do?

The short answer is “yes.” Innovation is critical to providing the best possible outcomes and experience for your patients, while maintaining a healthy business. Some say medical practices can’t innovate in the current economic environment; we say we can’t afford not to. Innovation encompasses all aspects of business, from technology and treatments to patient experience to cultivating an engaged, dedicated team with a shared vision of providing excellence in all areas. With the increased pace of change in our technology-driven society, it’s necessary to constantly evaluate the business and develop innovative plans to drive success.

With the changing landscape of medical care and insurance, it’s important that patients know you are dedicated to finding the best health care available for them. This includes state-of-the-art technology and treatments, a top-notch customer experience, and affordable payment options.

Recent Technology Innovations

I always say I went into ophthalmology because I loved the “toys,” but at the time, I was too naïve to realize I had to pay for them. Although these toys cost money, many of them provide a revenue stream that allows us to continually innovate. The ultimate goal is better clinical outcomes for our patients.

The toys have followed suit — all delivering better clinical outcomes and increased patient satisfaction. In 2012, we purchased a LenSx laser (Alcon). Four years later, we’re considering a second one to help serve the growing cataract population and maintain our efficiency. We purchased two new microscopes in 2014 and two new phaco machines in 2015. We now have two ORA Systems (Alcon), which add time but improve results.

Another favorite advancement with our surgical team was the installation of 60-inch flat screen monitors to display EHR records in the operating rooms. LenStar calculations (Haag-Streit), toric lens calculations, LASIK calculations, and topography are all easily and clearly displayed. Transcription errors are reduced, and charts don’t have to be copied and carried to the OR. All the information we need is at our fingertips to make better, timely decisions that improve patient outcomes.

Future Strategies

Looking forward, our primary drivers for innovation are, as always, improved outcomes and patient experience. We don’t dive into any decision; we thoroughly evaluate the impact our decisions will have on all aspects of the business. Will this deliver improved outcomes for our patients? Will it help us deliver a better customer experience? How will this impact our staff, including chair time, patient flow, patient education, scheduling, and billing? How will it impact our financial numbers? To achieve our ultimate goal of serving each patient to the best of our abilities, we must consider every part of the business to be successful.

Because our innovations impact multiple aspects of the business, we have to take a very mindful, stepped approach to implementing any new technology, service, or reorganization plan. If we change many things at once, unforeseen problems can arise, such as patient flow issues, and we might not know which change caused the problem. By making changes one at a time, we can better evaluate the impact of each change on each area of the business. Implementation is just as critical to our success as the innovation itself.

Currently, we’re considering acquiring a Cassini (i-Optics) instrument so we can differentiate anterior and posterior corneal astigmatism from lenticular astigmatism. This will allow us to make more accurate arcuate incisions and toric lens placements. Cassini is one of the earliest devices to measure posterior corneal cylinder.

We’re also reevaluating the postoperative drops we use. To improve compliance and reduce costs to the patient, we’re evaluating a new compound of three drops (NSAID, steroid, and antibiotic) in a single drop. This may reduce confusion for patients and increase success with the postoperative drop regimen. We’re also reevaluating our choice of intracameral antibiotic (vancomycin vs. moxifloxacin).

Other future plans include possibly adding a third OR and restructuring our entire check-in process, from structural layout to seating to using iPads to improve the patient experience.

A Team Approach

We are always changing. This means we had to develop a team of people who are comfortable with change, open-minded to new technology, and enjoy learning. When we interview candidates at Chesapeake Eye Care & Laser Center, we look for specific personality traits. We know most skills can be taught, but personality is innate. From the interview process, we set the expectation of being part of a team that likes to innovate and grow.

An essential key to implementing change and innovation is including your team in the decision-making process, rather than simply forcing new things on them. For example, as we look at the possibility of compounding three post-op drops, we examine the time staff spends on insurance calls related to these drops. Is this the best use of time? Will the end result warrant the change?

Recently, we took our nurses on a site visit to evaluate a new laser. Initially, they didn’t want a laser that had a fixed bed because they thought it would require their staff to move the patients too much. When they saw the laser and patient flow, they realized the benefits and supported the decision to acquire this equipment. Running a smooth, efficient, successful ASC means maintaining a team environment; therefore, it is important to get buy-in from everyone at the very start. Then, we can get on with the next change.

A Simple Goal

In today’s economic environment, the question is not should we innovate, but rather, how do we innovate? And although ASCs must make smart financial decisions, ultimately, the desire to innovate is about providing better patient outcomes and a fantastic patient experience. ■

Safety and Quality from the Ground Up

DESIGNING A NEW ASC TO SUPPORT BETTER OUTCOMES

BY JEFFREY WHITMAN, MD, NIKKI HURLEY, AND DAN CHAMBERS

In March 2016, Key-Whitman Eye Center, an established practice with five locations in North Texas, opened a new ASC facility. Jeffrey Whitman, MD, and his associates designed the ASC from the ground up. Here, they explain how their new facility promotes safety, quality outcomes, and efficiency while creating an inviting environment for patients and surgeons alike.

Nikki Hurley, surgery center director: Excelling at infection control and patient flow

When we planned our new ASC, we decided at the very beginning to hire CMS architects to ensure that everything about the design was done correctly from a compliance perspective. Knowing those requirements were covered, we could focus on how to build exceptional patient safety into the design, as well as create an environment that would support staff and attract surgeons.

Although our policies and procedures govern many aspects of patient safety, there are ways we can promote safety in the physical environment, particularly with regard to infection control. We planned to incorporate as many features as possible in an effort to meet the highest infection control standards. For example, cumbersome curtains in the prep and recovery areas must be cleaned regularly to maintain high standards. Plus, they get in the way, and don’t provide much privacy. We replaced them with KwickScreen dividers, which are portable, easy to clean, and can be customized with soothing nature photographs. These dividers reduce the risk of infection while improving the patient experience.

In the new facility, we also incorporated automatic doors in our ORs, which allow physicians and staff to move freely with sterile hands by opening doors with kick plates or elbow plates. To meet sterilization standards, we designed the ASC to house a sterilizer dedicated to each OR. Now we can run continuous cycles each day with newer, faster sterilizers.

To create seamless patient flow, we followed the patient journey around our other ASC, noting each interaction with staff. We designed the new ASC to have a one-way flow through the surgical process. To avoid bottlenecks in the OR area, we created one path for nurses and patients entering and leaving the OR, and another path for sterilization techs who carry instruments. Each OR has a front hallway for surgeons, nurses, and patients, and a back hallway for surgical scrub and sterile processing technicians, each accessible by different entry points.

An artist’s rendering of the new surgery center

Finally, we continue to use the same Versus tracking system in the ASC that we use in our clinic. The system follows every patient and staff member throughout the surgery center, so we always know where everyone is and can easily see when and where backups might occur.

Jeffrey Whitman, MD: Creating a safe, convenient, and inviting workplace

Surgeons know that safety leads to the best outcomes, so building patient safety into our ASC immediately sets it apart from other surgery centers. We are better able to attract top surgeons because our infection control planning and patient flow make our process safer and more efficient.

In our new ASC, we created a physician work area adjacent to each OR. Before, after, or between patient visits, doctors can work on notes or use the phone or computer in a quiet, private environment. This also makes the doctors easily accessible when needed.

Making the OR as comfortable and accommodating as possible, we considered many variables to improve the overall experience for surgeons and patients. In the OR, surgeons have the latest equipment, excellent lighting, and new video screens. They also can record any surgery in real time. To allow surgeons to roll their chairs around safely throughout the OR, we placed all outlets for the equipment cords in the ceiling. Surgeons also can play any music in the OR via their smartphone and the Sonos wireless sound system, which is accessible throughout the ASC.

We just recently opened the new ASC, but in the first 2 weeks, feedback from patients and surgeons has been amazing. People stop me in the hall or the elevator to tell me they love the new facility. It’s efficient and user-friendly, and the way we route patients through the center prevents crowding and collisions. By focusing so strongly on safety and quality, we are very confident that we’ve designed an ASC that will serve our patients well.

Dan Chambers, executive director, Key-Whitman Eye Center: Laying a foundation of new technology

As we laid out the technological foundation for our new ASC, we focused on ways to keep the ASC up and running, as well as ways to improve remote monitoring of the climate system. The first solution was a climate failsafe. In the OR, temperature, humidity, airflow, and filtering are critically important. We installed an independent HVAC system in each OR with back-up chillers, so that a problem with one OR air-handler doesn’t affect the other three. The system cost a bit more than others but was a worthwhile investment when compared with the cost of four ORs being down at once. A Primex Wireless monitoring system alerts us anytime, day or night, when climate conditions are out of range.

A second failsafe in the new ASC is the extended reach of our emergency generator. Every ASC has a backup generator, but we backed up other devices, too, as well as our HVAC system, so we can continue to function consistently without trouble here in Dallas, where temperatures can reach 110 degrees in the summer.

Working with the Compliance One Group, utilizing real-time online tools developed by Soleran, Inc., we have tagged almost 300 devices and assets in the ASC that require routine inspection. Whether an asset has to be inspected every day or as infrequently as once a year, the system ensures that we follow through and meet the deadline, and it automatically records the status. One of our inspectors told us the system could reduce a 2-day inspection by several hours.

Finally, we have implemented a new EMR system in the ASC. We found that we could tailor the iMedicWare system to be responsive to activities that are necessary for our safety and quality needs. As experienced EMR users, we’re finding the change to this very advanced system to be revolutionary in the ASC. ■