Here are four ways to improve orthopedic and spine practice quality benchmarks.
1. Focus QI studies on measurable outcomes. It is critical that surgery centers choose QI studies that nurses, physicians and other staff members can gather measurable data on. Using national standards and guidelines as a comparison helps define a goal to work toward.
"One example of a QI study we did was intravenous antibiotic administration in the pre-operative area and measuring the time of administration as compared to surgical cut time. This is an example of how a focused problem forces us to look at the enterprise as a whole," Dotty Bollinger, chief of medical operations at Laser Spine Institute in Tampa Fla., says. "There are specific guidelines based on what time you should give an IV antibiotic."
Ms. Bollinger adds focusing a QI study on measurable data will aid the surgery center in achieving better clinical outcomes and identifying operational inefficiencies. "Even though we have the guidelines to work off for IV antibiotic administration, there are other factors prior to the cut time that could delay the time frame [in which] the patient should be receiving the antibiotic. It forces us to look at what happened in the processes all around the IV antibiotic administration, such as whether there was a delay in the OR or a delay in getting a medical chart complete."
From "3 Easy Steps to a More Effective Quality Improvement Program."
2. Invest in software that will streamline the work flow. In addition to training staff on use of various technologies for research and conducting QI studies, an ASC has to make sure the software and technologies are tailored to the needs of the facility.
"We bought various software for the staff to use on their desktops so they can produce meaningful information," John Dooley, MD, an anesthesiologist and administrator at Mississippi Valley Surgery Center in Davenport, Iowa, says. "In some cases, we've had staff members save a document to a hard drive and then someone else accidentally deletes it. We've had to go to a new software system so that accidental deletion doesn't happen. Also, sometimes the data gets too large and bulky to manipulate, particularly patient surveys, so spreadsheets don't work. In that case, we've had to switch to a larger database like Microsoft Access."
From "4 Best Practices for Implementing and Effective Quality Improvement Program."
3. Ensure instrumentation goes through biologic testing. Full sterilization is made up of two parts: sterilizing and then biological testing. Biological testing is done to make sure all the instruments that were previously sterilized have been wiped clean.
"We found that the sterilizer was running just fine, but we tested our biologicals to see how much time we really needed to ensure better sterilization," says Steve Smith, director of Surgery Center of Wisconsin Rapids. "So, our staff ran some tests and found that increasing the length of time resulted in better sterilization. Additionally, we watch where we're scheduling our cases so that we have enough sterilized instruments for other cases. What we do is look at what we scheduled for that day and make sure we have time to sterilize equipment completely between cases. We also have a lot of equipment, so we don't have to double up on anything. The importance of fully sterilizing is that many accrediting bodies frown upon flash sterilizing, which is when a physician needs to sterilize an instrument that, for example, just fell on the floor and they need it right away. The physician will sterilize the instrument but not put it through full sterilization with biological testing. He or she will just drop it in for the convenience of having it right away."
From "Guidance for Using QI Studies for Improved Infection Control: Q&A With Steve Smith of Surgery Center of Wisconsin Rapids."
4. Use benchmarking to foster internal competition /positive incentives to foster improvement/demonstrate better patient outcomes. Similar to other professionals, physicians are inherently a competitive group, says Richard Gilbert, MD, CEO of Southeast Anesthesiology Consultants. No one wants to be on the wrong side of a standard deviation. Individual but anonymous benchmarking to one's peers, or to a standard, often fosters the internal competitiveness to drive improvement. The rewards, however, do not always have to be tied to compensation. High performers are recognized through a quality awards program and banquet. Recognition awards for most improved, best performance or high patient satisfaction pays dividends. Low performers participate in completing required continuing education process improvement tracks or mentoring designed to improve performance. At the end of the day, healthcare providers enter the medical profession to take great care of their patients. CQI systems that enhance their ability to do this and are user friendly generate adoption.
Whether it is healthcare or any other sector, a CQI systems approach will ultimately decrease variability whenever possible. Checklists and standard operating procedures that were once handled singularly will help reduce errors. This is not conformity, but rather standardizing excellence and making those best practices available and accessible to all on a consistent, replicable and scalable basis.
From "7 Steps for Creating a Viable Pay for Performance Model."
1. Focus QI studies on measurable outcomes. It is critical that surgery centers choose QI studies that nurses, physicians and other staff members can gather measurable data on. Using national standards and guidelines as a comparison helps define a goal to work toward.
"One example of a QI study we did was intravenous antibiotic administration in the pre-operative area and measuring the time of administration as compared to surgical cut time. This is an example of how a focused problem forces us to look at the enterprise as a whole," Dotty Bollinger, chief of medical operations at Laser Spine Institute in Tampa Fla., says. "There are specific guidelines based on what time you should give an IV antibiotic."
Ms. Bollinger adds focusing a QI study on measurable data will aid the surgery center in achieving better clinical outcomes and identifying operational inefficiencies. "Even though we have the guidelines to work off for IV antibiotic administration, there are other factors prior to the cut time that could delay the time frame [in which] the patient should be receiving the antibiotic. It forces us to look at what happened in the processes all around the IV antibiotic administration, such as whether there was a delay in the OR or a delay in getting a medical chart complete."
From "3 Easy Steps to a More Effective Quality Improvement Program."
2. Invest in software that will streamline the work flow. In addition to training staff on use of various technologies for research and conducting QI studies, an ASC has to make sure the software and technologies are tailored to the needs of the facility.
"We bought various software for the staff to use on their desktops so they can produce meaningful information," John Dooley, MD, an anesthesiologist and administrator at Mississippi Valley Surgery Center in Davenport, Iowa, says. "In some cases, we've had staff members save a document to a hard drive and then someone else accidentally deletes it. We've had to go to a new software system so that accidental deletion doesn't happen. Also, sometimes the data gets too large and bulky to manipulate, particularly patient surveys, so spreadsheets don't work. In that case, we've had to switch to a larger database like Microsoft Access."
From "4 Best Practices for Implementing and Effective Quality Improvement Program."
3. Ensure instrumentation goes through biologic testing. Full sterilization is made up of two parts: sterilizing and then biological testing. Biological testing is done to make sure all the instruments that were previously sterilized have been wiped clean.
"We found that the sterilizer was running just fine, but we tested our biologicals to see how much time we really needed to ensure better sterilization," says Steve Smith, director of Surgery Center of Wisconsin Rapids. "So, our staff ran some tests and found that increasing the length of time resulted in better sterilization. Additionally, we watch where we're scheduling our cases so that we have enough sterilized instruments for other cases. What we do is look at what we scheduled for that day and make sure we have time to sterilize equipment completely between cases. We also have a lot of equipment, so we don't have to double up on anything. The importance of fully sterilizing is that many accrediting bodies frown upon flash sterilizing, which is when a physician needs to sterilize an instrument that, for example, just fell on the floor and they need it right away. The physician will sterilize the instrument but not put it through full sterilization with biological testing. He or she will just drop it in for the convenience of having it right away."
From "Guidance for Using QI Studies for Improved Infection Control: Q&A With Steve Smith of Surgery Center of Wisconsin Rapids."
4. Use benchmarking to foster internal competition /positive incentives to foster improvement/demonstrate better patient outcomes. Similar to other professionals, physicians are inherently a competitive group, says Richard Gilbert, MD, CEO of Southeast Anesthesiology Consultants. No one wants to be on the wrong side of a standard deviation. Individual but anonymous benchmarking to one's peers, or to a standard, often fosters the internal competitiveness to drive improvement. The rewards, however, do not always have to be tied to compensation. High performers are recognized through a quality awards program and banquet. Recognition awards for most improved, best performance or high patient satisfaction pays dividends. Low performers participate in completing required continuing education process improvement tracks or mentoring designed to improve performance. At the end of the day, healthcare providers enter the medical profession to take great care of their patients. CQI systems that enhance their ability to do this and are user friendly generate adoption.
Whether it is healthcare or any other sector, a CQI systems approach will ultimately decrease variability whenever possible. Checklists and standard operating procedures that were once handled singularly will help reduce errors. This is not conformity, but rather standardizing excellence and making those best practices available and accessible to all on a consistent, replicable and scalable basis.
From "7 Steps for Creating a Viable Pay for Performance Model."