ConCensis | Overcoming Challenges in Perioperative Services and SPD Management
[Music] hello and welcome to this episode of consensus a podcast brought to you by Censis Technologies I'm your host Michelle Dawn Mooney and today we're speaking with Brian Dawson of common Spirit Health Brian it's great to have you here today can you start us off with a brief introduction and talk a little bit about your role at common spirit so um Brian Dawson um I um I spent 28 years in the Navy as a Navy officer nurse uh or nurse uh Hospital executive uh and then system executive um I was a hospital CEO and then CEO and in my last two years I was the chief of staff and uh EA to the Navy Surgeon General uh so got to see a lot of things coming and going uh the impact on Navy Medicine which in Navy Medicine Army medicine Air Force it's like a very large Health System just like come and spare it um with common Spirit uh um I started about five years ago working for Dignity Health as their system leader for perioperative services and when we merged with Chi my job expanded for all of our facilities so I'm kind of the leader but more so the director of perioperative things and when I say things quality patient safety policy um Capital Equipment uh it third party items that impact on our care um we coordinate you know local and system changes for epic Cerner and meditech um I'm also kind of a the Clearinghouse for standards and practice for or for pacu uh for SPD um and then in this case two of the hats that I wear one has to do with Capital Equipment management and the other one has to do with productivity across the perioperative department so how well are we utilizing our staff based on the workload and those two things really come into play when we talk about senses and tell us more about the facilities and teams that you work with so or wise we've got a 142 operating rooms across the system and so they range in uh size from two ORS that are being utilized to 60 ORS that are being utilized we have uh critical access hospitals uh we have community-based hospitals and then we have about five very large teaching hospitals uh one in Phoenix a couple in the midwest in the Nebraska area Omaha we've got Baylor St Luke's which is in Houston which is a massive teaching hospital um and and so the the cool part about common Spirit as a faith-based health system is we run the gamut you know from inner city hospitals that are the only Hospital in that inner city Long Beach is an example downtown LA is an example Glendale uh uh along with some of our other facilities to the only Hospital in a rural area so we have critical access hospitals in in um uh North Dakota in nowhere Nebraska Texas you know between the Washington and Oregon uh uh state line between the California and Oregon State Line we've got hospitals that have two or rooms and they're in in literally a farm community so we the coolest part about us is we serve that population and we might be the only provider in that population so you know our spds run the gamut from like I said from staff that run the or that also support SPD to facilities like St Joe's uh in Phoenix where Robbie Miller was just uh highlighted in or magazine uh about SPD for January and Robbie runs an SPD that serves six operating rooms in the facility on top of endoscopy cath lab ir and supports other things in the division as well so we kind of run the gamut in size which makes us unique um and and kind of a fun challenge how do you come up with a solution like senses that can help us in all of those types of facilities so what are some of the challenges that you face in your day-to-day interactions with all those facilities you know I really think it's just because it's me and and I I have a great partner in crime um one of the individuals who works for me uh Charlene rutella is is not not an administrative assistant she's truly like my right hand uh she's working on her PhD in a healthcare business and organizational development um and she helped me manage everything um because it's it's really just me kind of hurting all of those individuals in the same direction we have a great perioperative Council which is made up of or leaders from every Division and if a division crosses state lines from every state in that division uh and then we have a larger group of perioperative collaborative Group which we invite members from every or whether they be the director whether they be an educator uh the business manager we have subcommittees one of very important subcommittee is our SPD subcommittee which is again made up of SPD leaders from across the system uh we've got an educator group a policy group and so between Charlene and I and and others who who have helped us or taken on the those leadership roles in the system that have other jobs uh you know my thing is you know how many fingers can I stick in the dike to keep things running well it sounds like you've got a good group of people there helping you manage everything so what part of your role do you enjoy the most what's the most impactful to you um helping teaching um solving the big riddles of big puzzles uh and and being that Steward of our dollar um because again Healthcare is getting tight um you know you hear and and you know in local uh media National media you know there's talks that are you know people are worried about taking place soon within Congress about cutting Medicare Medicaid um you know that used to be the golden check that every hospital got from the government and and now you know you're not getting that type of reimbursement you know a lot of hospitals were impacted due to covet but because of a lot of the uh legislation you know the federal government was giving facilities and Health Systems dollars to offset the cost of covet well now that that stopped and now that we have you know covet serious flu uh um um the the new respiratory illness that's impacting children a lot you know those things are all impacting on areas in our hospital where we generally lose money and what I mean by that is the longer a patient stays in the hospital the less insurance covers and the way we had of generating Revenue was through our outpatient and our elective surgery schedule well People based on the economy based on what's going on health-wise you know in our communities there are less and less people coming to the hospital for elective surgery so for me what's important is how do we increase the use of our operating rooms which means how do we how do we make sure that instrumentation for surgery is made readily available um how do we do that in the most cost efficient manner possible and how do we make sure that the quality in patient satisfaction is top-notch because that's what draws people uh to a facility not just the patient but that draws the providers our surgeons to a facility where they know they're going to have what they need when they need it um and the quality that's provided by the staff by the nursing staff by the assistant staff you know by anesthesia it's going to be top-notch so their patients are going to have a very positive outcome so those are the things I I think what keeps me up up late at night is watching uh MSNBC or Fox and listening to the commentators talk about what's going to happen you know is the government going to shut down if the government shuts down or are we going to increase the debt ceiling because all that impacts on you know Medicare Medicaid on companies you know downsizing on availability availability of products so all of that has an impact impact on those things Brian I think you touched on this a little and what you just talked about so let's dive a little deeper in terms of providing the optimal outcomes can you kind of walk us through how you measure productivity in your facilities yeah so so let's talk about SPD specifically the longer I've been in this job the more and and when I say in this job in healthcare the more we've changed the way we measure things and so productivity in the operating room across the country is measured in different ways I taught a leadership course for orn about uh six six seven years ago and one of the classes was about measuring how do we measure productivity and when I asked that question I got a thousand answers I got well we measure it by the number of admissions we measure it by the number of bed days we measure it by the number of surgeries we do and then somebody hidden on the head and said we use minutes of service and that's what we do in common Spirit the best hospitals measure or productivity through minutes of service how many minutes is the patient in the OR and then so from Wheels in to Wheels out we look at how many minutes are there that are they there and then how many people are needed to care for that patient and then based on that how many total minutes did the or use today and how many total staff that they have and then we say okay it balances or we're over or under by you know X number of Staff members we also want to make sure that we and the or is unique we want to take all of the people that we need to run an or the never touch a patient out of that equation so the director the or scheduler the or educator maybe a supply person you know how many people does an or need to run whether they do one case or no case and that's different from a med surgery unit right because the med surg floor doesn't have those types of people so you want to take those people out of the equation but you want to make sure that that number is defined so that a critical access Hospital may have three people a large teaching Hospital may have 10 but the critical access hospitals shouldn't have six and the large Hospital shouldn't have 20. so how do we come up with that agreed upon number of non-productive bodies so that's great for the or but when we get the SPD it doesn't work and and most of our areas are non-productive in SPD because a 90-minute gallbladder might have two instrument sets which might have less than 100 instruments in it a 90-minute total knee might have six instrument sets with 30 instruments per set in it so one might take 20 minutes to do another might take an hour and a half to do so minutes of service in the in SPD don't work what I love about senses is we've worked together to utilize Amy Amy is the association for for SPD and they set SPD standards Amy has come out with levels of complexity so they've listed tasks whether it's putting together an instrument set or whether it's pulling for a case or putting peel packs together or cleaning a robotic arm they've said time frames for all of those tasks and group them between level one and level four level one meaning about 20 minutes level four an hour and a half to two hours and so we've worked very closely with uh with senses to create a way of monitoring all of the tasks that are done in an SPD and then bouncing that off of those four levels of complexity and now we can tell how many staff do I need to take care of the workload that happens in SPD and how many staff do I need throughout the day based on workload I need less bodies in the morning because there's nothing coming out to be cleaned and processed and more bodies in the afternoon because that's when the bulk of the work comes out so so for me that that that's one of the four holy Grails in the or that that I've been trying to solve one you know efficiency you know getting starting on time room turnovers uh we we've done really well on solving that with data another one is solving productivity in the OR then in SPD uh and the and the other two are you know are we ever going to get to a point where we're never using paper anymore it's all done electronically scheduling cases um and then the last would be how do we solve the whole preference card tool without it being person dependent so the nice part about Censis is you've helped us solve that second Holy Grail when it comes to how do we adequately measure productivity especially in SPD based on task and not minutes of service um and to do it with a National Standard which is what Amy established when we talk about productivity we have to take Staffing into consideration have you had any challenges finding and maybe more importantly retaining qualified staff in your spds at any of your facilities yes yes um and and and major uh issues finding staff um and and that's because um it's very hard to find Qualified SPD technologist uh and retain them one there aren't a lot of schools that train them in in doing so um and and then the other problem is um the salary range for those individuals is it fluctuates nationally and in some areas it's it's it's at a level similar to our housekeeping and dietary staff which you know I I get it it's an entry level position but the level of complexity that we now have within that department you almost need a bachelor's degree how to follow the national guidelines on on decontaminating and sterilizing or or high level disinfecting different items uh and SPD handles items from surgical instrumentation to laparoscopic instruments to robotic instruments to endoscopy Scopes um it's across the gamut and you know those individuals have to know how to care for all of that uh appropriately and according to manufacturers recommended guidelines and National standards and we're paying them you know at a level that's kind of Entry uh and so the turnover is fairly significant because if I raise my hourly salary at one of our facilities say in Los Angeles by five dollars I'm gonna I'm gonna pull from every other facility there that's still paying five dollars less and if our competitors do the exact same thing we'll have the exact same problem in Reverse we're gonna lose people uh as a result of that and tell me how does that turnover affect your productivity yeah it does because then the problem is I'm you know I've got individuals that are uh that haven't been trained and it takes me longer to do things because I'm I'm constantly retraining staff when you're dealing with network-wide productivity do you ever have issues with limited visibility into your processes that really like I said because we have such a great group um especially in SPD the SPD leaders I think are the tightest of all the leaders um and so there's a lot of uh conversations sharing of information there's a lot of creation of standard processes standard checklist standard you know education competencies so we're doing a fairly good job at ensuring that we're all at the same level all following the same things now having a standardized tool like senses makes it even better so have you used Censis in your facilities during your entire tenure or is it a recent Edition we've been using the tool I would say for about anywhere between nine to 12 months regularly but we just started working with a leadership at Censis to create the productivity measure that I was describing in the past four or five months three I would say three to four months and now my hope is is that we can deploy that across the system in terms of network-wide productivity do you have any other bottlenecks or maybe efficiency issues with your spds not not nothing that we haven't discussed you know I think the biggest issues we have are you know retaining quality staff members um you know I think that if we can retain you know our staff members we can meet workloads uh I think now that we're able to begin to met to measure workloads in in a more scientific way actually using real data around tasks uh I think it'll get even better and continue to get better um again I think and and this is nationally it's not just with our system the biggest Achilles heel we have is is salary you know as an example say seven years ago when I was uh here in the the Denver area um running one of the level one Trauma Centers um in the Denver Market [Music] um SPD texts we're making about 12 to 15 an hour across the whole Market you you look at housekeepers and they were making 18 to 20. and so if I was in need of SPD tax and I convinced the leadership to say let's do a five or or five thousand dollar sign on bonus I was stealing XP SPD texts from my sister hospitals and then fast forward one of those hospitals would get short and they would have a five you know seven thousand dollar and I'd lose six so we were all robbing Peter to pay Paul and I and I was always saying why you know why because SPD is the backbone of the or and the or drives Revenue why don't we all raise their salaries five bucks you know and and that way we can retain them you know let's pay them for what they're worth here is one of the issues the larger the payroll which is the largest bill that any health system pays the harder it is for them to meet all their responsibilities go back to what I said with that shrinking dollar the the problem is is that and this is just my two cents most health care Executives don't really understand what SPD does and I say that not because you know they're not smart or they're lacking education SPD is usually in the basement of the hospital it's it's it's out of sight out of mind usually near the big warehouse and supply chain and we don't really know what they do well what do they do right we hear a lot about you know old you know such and such Health System had a number of people exposed to you know dirty uh endoscopy Scopes or dirty instruments and so then then there's a focus but they don't really know what they do and so as you said when there's greater turnover when we don't measure productivity by what it is they do and use minutes of service then we're cutting Staffing and SPD because they're not productive which results in I don't have enough time to clean thoroughly clean all of the instruments and people start to take shortcuts and if you take a shortcut I I may leave behind some form of Bio burden that can impact on the next patient and then it becomes a major issue in there you're on the cover of the newspaper and there's a lawsuit and there's millions of dollars that are spent well to prevent that let's spend a couple of hundred thousand and increase the salary and measure productivity the right way in SPD it's it's this you know what came first the chicken or the egg and so one of the reasons why for me you know educating people on this is important is because I've been an or leader uh where SPD Falls underneath my purview and I've also been a hospital executive and a system executive and and you know I would always say to you know leaders hey we gotta focus on the backbone of the department that serves the area where we generate our Revenue you know come down visit SPD see what they're doing and it's so crazy when you bring an executive down to SPD and they watch that decontamination Tech empty cart after card in a very hot sweaty you know area with all the PPE on they go oh my God I never knew that this is what they did and exposed to Blood and Tissue and Bone and all that and on the flip side when you have a large facility like you know I was talking about Robbie Miller and why I'm so proud of the work that he does you know when you process a thousand sets a day 10 000 instruments and there's no contamination no bile burden left on them man that's that's success that's like winning the Super Bowl every day every day you can't take a day off right you know you can't have an off day in SPD and that's why it's so important let's dig into that productivity module that you've been working with what are your thoughts on interactive data platforms I think um that if we are able to work with a manufacturer to capture that data um and that we know that the data is pristine uh and the data uses National Benchmark measures then I think it's uh it's priceless um you know it's it's what we need to appropriately run our departments because it'll tell me you know what time of day does the majority of the work occur and that's where I need to put my staff um when are we the slowest and I need less staff there um am I able to meet the workload with the staff I have or do I need to hire one or two extra people because now I'm basing that off of data not conjecture do you have any advice to give to other hospitals or networks that are looking for a tool to measure their productivity I would say uh you know find something find something that works so that you can have the data to make you know intelligent business decisions to support your your procedural areas business decisions in SPD to support your procedural areas to make sure that you can capitalize on the assets you have to generate Revenue so let's talk about looking into the future what are your long-range goals for tracking productivity yeah I think the goal would be to across our system have a hub and spoke type data sharing um Network for lack of a better term where as I just described I could potentially move staff and move equipment to the need within that division and and when I use the word division I'm really talking about geographically located facilities you know one of our divisions Northern California goes from um San Francisco all the way up to the California border with Oregon So within that there are two hospitals in San Francisco that are like less than six miles apart right there's another hospital that's uh in Sequoia which is which is a little bit farther away from San Francisco and not close enough to um one of our other facilities that's down in um oh I'm blanking on the name of the town um right now but but I would want to make sure that those two hospitals in San Francisco are working together with equipment and Staffing and so that one's not one doesn't have excess staff and the other has you know too little staff but even but but a different idea is let's go to Sacramento there are five hospitals in Sacramento in a circle right so if you if you ride the highway that goes around Sacramento we've got five hospitals in that vicinity all five of those hospitals are part of the same group you know so why not look at where the need is when the need is and move assets and People based on that need another crazy idea is what if we created a centralized SPD amongst those five hospitals and we moved instruments to that area to clean decontaminate sterilize and then move them back to where they were needed and now I've got a centralized Hub where I can take advantage of of that Staffing and that equipment for for five separate hospitals now we have to work out the logistics and move things around but imagine you know uh and and some areas are doing that with you know University Hospitals that have multiple hospitals and a very small geographic area why not do that with the division you know uh in some areas uh Los Angeles I've got hospitals kind of north of Los Angeles and hospitals kind of South so what if I set up two hubs you know so so those are those that's the Nirvana to where I can you know consolidate things take advantage of the consolidation of Staffing and and Equipment save dollars and still meet the same mission now you know what do you do about the crash that happens on the 405 and now the 20-minute Drive takes three hours so those are all things you gotta think about right because it will happen the other thing and even the better possibility is to make sure you know what do I see in the future to make sure that our leaders understand the value of that department and the value of using data to make business decisions to increase efficiencies to save dollars and to utilize the most precious asset we have to its fullest extent and that's Personnel a great conversation Brian I want to thank you so much for joining us today and thank all of you for tuning in and listening today on the consensus podcast brought to you by Censis Technologies once again I'm your host Michelle Daw Mooney thank you again for joining us we hope to connect with you soon foreign [Music]
2023-04-03 11:16
