353 - The Price of Collaboration: Surgeon Engagement Is Key to Standardization Initiative
Description: Team: Nurse Program Coordinators, Surgical services leadership, process engineer, supply chain contract analyst, service clinical coordinators, surgeon champion. Prep and Planning: Significant variation amongst surgeon preference cards was identified with opportunity for vast cost savings across our three campus health system. Efforts to standardize or clean up in the past have failed because there was not dedicated staff committed to this process. Senior leadership supported this initiative because the team presented a potential savings of $750,000 and was granted approval for two full time employees. The candidates chosen were selected because of their extensive surgical backgrounds and leadership. A committee was formed to develop the planned approach to standardization and savings. A surgeon champion communicated the savings tasked from senior leadership to all the surgeons, informing them of the planned efforts for standardization and encouraged their participation in the process. It was made clear to the surgeons that their clinical input and expertise would be considered before any changes were made.
Assessment: The team identified the top 80% highest volume procedures to focus these standardization efforts. One service line at a time was addressed. Procedures within the service were grouped together to compare the supplies used. A dashboard was utilized to pull data from 5,824 surgeon preference cards and analyze variation in supplies, usage and cost. Implementation: The process was broken into three phases; phase one was administrative fixes, phase two consisted of suggested changes by operating room leadership, phase three was the surgeon round table meetings. Surgeons from the designated service lines were invited to the roundtable discussions. An agenda and PowerPoint were sent out to all for their review prior to the meeting. Low volume, high cost items was the focus of the discussion with intention to standardize to a lower cost item that the surgeon’s felt was clinically acceptable. This platform promoted peer to peer discussion which resulted in group consensus on proposed changes.Outcomes: Data results at completion of first two service lines showed estimated open cost decreased 7%, PRN cost decreased 33% and unique items decreased 9% with overall cost savings of $770,000.Decisions were presented through newsletters, staff meetings and communication to all surgeons. Monthly usage reports are used to track supplies as the control plan to prevent backsliding. Surgeons identified in these reports are addressed individually by the surgeon champion. Surgeons have reported increased accuracy of cards. There has been improved charge capture for surgical episodes and reduced supply variation.Implications for nursing: This project has had significant impact on staff satisfaction because accurate preference cards led to time & waste reduction. Nurse led process improvements provided a trustworthy forum for surgeon involvement.