ConCensis Overcoming Challenges in Perioperative Services and SPD Management

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[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

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