Building the Skeleton: Creating a Dedicated Orthopedic Service Line
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7/2/22 Creating a Dedicated Service Line Sandy Nettrour, PA-C
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Orthopedics will see huge volume increases in the next 20 years. Is your hospital poised to capitalize on this growth market? OrthoServiceLine.com invites you to join us as we kick off a new webinar series that will explore the most important business challenges for orthopedic leaders. In our first event, Sandra L Nettrour, PA-C, DFAAPA, Orthopedic and Neurosurgery Service Line Coordinator at Butler Health System, will explore how to start to build a cohesive team of leaders to improve patient care, efficiency, and cost containment within a surgical subspecialty. Specific learning objectives: • Creating a program vision • Identifying a surgeon and administration champion • Choosing key stakeholders and building a team • Early operational implementation steps to position the ortho service line for success About the Speaker: Sandy Nettrour has specialized in orthopedics for 30 years. She is the Neurosurgery and Orthopedic Service Line Coordinator for Butler Health System, providing oversight of the business aspects of Neurosurgery and Orthopedics, while continuing to first assist in the operating room and provide patient care at the bedside. Sandy graduated from Alderson Broaddus College in 1980 with a Physician Assistant degree. She has been awarded the Distinguished Fellow Recognition by the American Academy of Physician Assistants, the Hu C. Myers Award for lifetime professional achievement and community service, and the Pennsylvania Society of Physician Assistants Humanitarian of the Year 2013.
Transcript of Building the Skeleton: Creating a Dedicated Orthopedic Service Line
April 9, 2023
Creating a Dedicated Service Line
Sandy Nettrour, PA-C
April 9, 2023
Butler Health System:“We exist to make a positive difference in the lives of our patients by providing compassionate, high quality care and comfort and inspiring health and well being.”
Serves as a way to build consensus for all parties
Hospital Vision Statement
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Administration and Surgeon Support
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Surgeon Champion
• Traits– Energetic– Motivated to increase volume and improve
efficiency– Team player (with administration and staff)– Interested in controlling hospital costs– Supported by other orthopedic surgeons on staff
to represent their interests
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Administration Champion
• Able to understand the surgeon’s perspective • Willing to work creatively to overcome
obstacles• Willing to invest time, money, and personnel
to develop the service line• Expects to see Return On Investment through
increased volume and decreased costs
April 9, 2023
• Surgeons can not– Divide their focus between patient care and
hospital management – Personally fix all the problems
• Administrators have difficulty– Seeing past costs to initiate the service line– Are working with an ever shrinking budget– Must trust the surgeon to increase volume
• That is why goal alignment is key!
Core Conflicts
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Elements
Program Vision
Surgeon Champion
Administration Champion
Program Director
Operations Team
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Non-surgeon (background can vary)• Favorable traits:
– Good organizational skills– Good communication skills– Ability to facilitate alignment of goals– Analytical skills-attention to details– Ability to see the larger picture
Orthopedic Service Line Director
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The right people have to be at the table together.
What solves for one can increase issues for another
Prevent the “hospital salute”
Take Down the Silos:
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• Physician(s) • Administration • Service Line Director• Nursing (floor manager)• Operating Room (ortho team leader)• Physical Therapy• Pre-Admissions Representative• Case Management/Social Services
Team Composition
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• Anesthesia• Sterile Processing• Pharmacy• Billing and coding• Outpatient Rehabilitation• Home Health • Physician office staff
Ad Hoc Team Members
Getting Started
• Listen to all of your team members
• Start with individual interviews
• What are the common issues?
• How can the service line team improve these issues?
April 9, 2023
• What is reality? Go and See: observe the problems
• What are the strengths and weaknesses of each department?
• What will show quick success over the most areas? “Pick low hanging fruit.”
Investigate
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• Variability in surgeons’ care pathways• Inconsistent and late OR start times• Slower than ideal OR turn over times• No unified total joint patient education• Poor discharge planning pre-op• Inconsistent patient expectations• High variable costs
Issues Identified
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• Work to fix the common problems– Start with small projects- streamline order sets,
progress notes, patient education, pre-op testing
– Early success will spark team interest• Assign action items with clear deadlines and
accountability• Engage and empower frontline people• Meet every 2-4 weeks to keep the team engaged
Early Implementation
BHS Total Joint CampOur first team project
• Covered all departments-including physician office
• Streamlining patient education revealed redundant work
• Improved patient expectations• Reduced length of stay (1.5
days first year)• Unified the operations team
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• Operating Room Efficiency– Streamlined OR trays; Improved on time start
• Length of Stay management-D/C planning• Patient satisfaction- improve expectations with
consistent message• Variable Cost Control• Constantly look for further improvements• You will have to revisit prior issues to keep them on
track.
Later Process Improvement Projects
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Be the solution, not the problemYour team should want to work with you
How can YOU create a dedicated team?
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Pearls and Pitfalls
• Be open to feedback• Turn criticism into
positive action• Small initial successes
will help to gain momentum
• Changing culture takes time-Resistance is natural
The Importance of Team Building
• Consider both rewards and recognition
• Give credit where credit is due
• Small things have a big impact (pizza, milkshakes)
• Social activities as a team– Ortho Nurses Day, – Ortho Christmas party
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In Conclusion
Action Items:• Provide supportive
team leadership• Engage and empower
front line people• Show profitability• Listen • Praise and Thank
