2. Program Outline
Listed are the topics that will be
addressed in this powerpoint and
the order in which they will be
presented.
● Executive Summary
● Capstone Proposal
● Nurse Manager Interviews
● Review of Literature
● Project Recommendations
● Market Analysis and SWOT
● Organizational Management
● Financial Projections/Feasibility
● Closing
● References
3. “Appropriate and sufficient
patient education and
assessment prior to surgery can
reduce avoidable costs to the
patient and to the hospital…”
(Pritchard, 2012)
4. Executive Summary
● Promoting patient knowledge through the
use of a presurgical education program.
● Quality presurgical patient education
reduces postsurgical complications.
● Reduced cost to hospital.
● War Memorial Hospital has 1-6%
postsurgical complication rate, based on
surgical procedure performed.
○ Can be reduced through effective presurgical
patient education.
● Competitive Edge
○ Lack of high quality presurgical patient
education program based on our research.
5. Current Patient Education Program
● Patient education is dependent on
the surgeon performing the
surgery
○ According to both nursing managers
interviewed, “some surgeons are better
at educating their patients than others”
● Written material is provided
○ Pamphlets
○ Packets
○ Educational materials possibly higher
than the patient’s literacy level
6. Flaws in the
Current System
● Varied education based on
surgeon
● Disabilities that impact receiving
the information provided
○ Literacy
○ Physical
○ Mental
● Timeframe in which the
information is provided
○ Scheduled office visits
■ 15-30 minutes
“Patient education is the process in
which healthcare providers share
information with patients in order
to alter their health behaviors and
improve their overall health
status…” (O’Brien, McKeough, & Abbasi, 2013)
7. “ Education and preparing the
patient for their surgery in
advance of the surgical day will
help to reduce fear, stress, and
anxiety that can often be
accompanied with surgical
procedures…” (Guo, 2015)
8. Nurse Manager
Interviews
Our group interviewed two nursing managers. Our first interview was with Ms. Valerie
Pfander, a perianesthesia clinical nurse specialist, at Munson Medical Center in
Traverse City. Our second interview was with Professor Carrie Perez, nurse manager,
at War Memorial Hospital in Sault Ste. Marie.
9. Interview with Ms. Valerie Pfander
● Munson Medical Center
○ Currently implementing a new program
● Education should begin in the physician’s office
● Most common concerns of patients:
○ Postoperative restrictions
○ When they can return to work/school
10. “ Most often patients have
concerns about what type of
restrictions they will have after
surgery, and when they will be
able to return to work or
school…”
( V. Pfander, personal communication, March 11,
2016)
11. Interview with Professor Carrie Perez
● War Memorial Hospital’s current program
○ 5 RN’s
○ 2 CNA’s
● Bariatric patient education
● Use teach back method
● Provide ample time to ask questions
● Follow up phone calls
○ Trouble shoot quicker
○ Catch postoperative complications faster
12. Review of Literature
In order for presurgical education to be effective, a well-structured program must be
implemented. All members of the healthcare team must be actively involved, and the
reinforcement of the program must be ongoing.
13. Patient Education Programme (PEP)
● Improved Physical &
Psychological Well-Being
● Strengths
○ Purpose of PEP
● Weaknesses
○ Young in Implementation
○ Assumptions
(White, J., & Dixon, S., 2015)
14. “I Can’t Read
That!
Improving perioperative literacy
for ambulatory surgical patients”
(Liebner, L. T., 2015)
● Understandable to Patients
● Reading Level Among Adults
○ 6th-8th Grade
○ As low as 4th Grade
○ 12% have proficient health literacy
● Pictures with Text
● No Follow Up
15. Adherence to Preoperative Fasting
● Compliance and Understanding
● “it is appropriate to fast from clear fluids
for two hours or more”
● Fasting for too long
● Not a blind study
(Kyrtatos, P. G., Constandinou, N., Loizides, S., & Mumtaz, T., 2014)
16. Project
Recommendations
According to Guo (2015), the level of patient satisfaction increased with preoperative
education while also decreasing the level of anxiety for both the patient and their family. It
also showed that patients had a decreased length of stay compared to patients who did not
receive adequate patient education.
17. Our Program
● Education will begin in the physician’s office
○ How to prepare for surgery
○ NPO status
● Patient’s will attend the presurgical education class prior to surgery
○ Offered 6 days a week
● One-on-one sessions offered
● 2 RNs will lead each class
● Classes will be 2 hours with a 10 minute break after the first 50 minutes
○ Hand out literature will be distributed
○ Videos at the facility
○ Anatomical models
● Ample time for questions to be asked
18. Continuing the
Education The Day of Surgery
● Review of procedure and
expected outcomes by nurses
and physicians
● Time for additional questions to
be answered
Ensuring that the patient is fully
prepared will help alleviate fear,
stress, and anxiety associated with
the procedure and promote
patient confidence with the
surgical process (Guo, 2015).
19. Postoperative Education
● Education focused on:
○ Medications
○ Limitations
○ Wound care
○ Follow up appointments
○ PT/OT
● Additional time for questions to be
answered.
21. Market Analysis &
SWOT
The need for patient education is essential in providing the best patient care, reducing
possible complications, as well as reducing patient anxiety prior to a surgical
procedure. Presurgical education is immensely crucial to the patient’s well being as it
promotes the best patient outcomes.
22. Industry Description & Size
● Healthcare workers involved in a
patient’s surgery provide necessary
information to prepare a person
for what is to be expected.
○ What the surgical process involves
○ What to expect post surgically
○ How to prepare
○ Goal: Alleviate poor patient outcomes
and promote compliance!
23. ~78.2 Million People
Is the estimated amount of surgical patients each year in the United States.
How this was calculated: The CDC states the average number of inpatient surgeries is
roughly 51.4 million people annually (CDC, 2015). AHRQ states that the number of
outpatient surgeries rose to 26.8 million in 2012 (AHRQ, 2015).
24. Target Population
● All surgical patients
○ Pediatric-Geriatric population
○ The families of surgical patients
■ The role of the caregiver during the
recovery period
● Healthcare team members involved:
○ Nurses
○ Physicians
○ Surgeons
○ Anesthesiologists
○ Certified Registered Nurse Anesthetists
(CRNAs)
○ Social workers
25. “82% of people that have
undergone surgical procedures
had expressed that they would
have wanted more information
prior to surgery…” (Gonzales, et. al,
2014)
26. Individual Needs & Demographics
● Gaps in the presurgical education process
○ Patients not having a full understanding of
their surgical process
● Increase patient satisfaction
● Decrease unnecessary complications
● Patients will have ample time to ask
questions regarding their procedure
27. Organizational
Management
When implementing this program, several different aspects need to be taken into
account. Structure helps to set the foundation for the program. Having a clear mission,
vision and philosophy statement is important in conveying the benefits and the aim of
the presurgical program.
28. Resources Needed
● Two Additional Registered Nurses
● Educational training for nurses
○ Use open-ended questions
○ Index of Learning Styles
Questionnaire
○ Teach-back method of learning
● Technology
● Reading Materials
○ Pamphlets, handouts, etc.
● Meeting Room
30. Mission
To provide exceptional presurgical and post-surgical education through the highest quality of care,
compassion, and attentiveness to every patient. Exceptional pre-operative and post-operative
education will ensure optimal outcomes for all patients.
31. Vision
To eliminate preventable post-surgical complications and improve overall patient outcomes through
an extraordinary presurgical education program.
32. “Becoming an effective nurse
educator, the nurse requires
formal and informal education,
elapsed time, and real world
experience.” - (Gardner, 2014)
33. Adaptation Model - Sister Callista Roy
● Environment, health, personal reflection, and
type of nursing
● Bio-Psycho-Social Being
● Adaptation Model & Our Program
● Program Goals
34. Business and Management Theory
● The General Systems Theory
○ Originated in the natural sciences.
○ Takes a broad worldview
○ Looks at all factors that not only
influence the program, but also factors
that the program influences.
○ Three levels of the person:
■ The patient
■ The suprasystems*
■ Treatment of problem or
ailment
● The Transformational Leader
○ Focuses on interrelationships between
staff, organizations, and constituents.
○ Focus is on vision of the presurgical
education program.
○ Will lead by example to all staff
involved in the program.
35. Transformational Management & Leadership
● Facilitate Needs of Staff
● Advocate for Staff
● Staff & Self-Motivation
● Model for Success
● Professional Opportunities
● Staff Feedback
36. Management Style
● Coaching, participative, affiliative
management style
○ Provide support to staff
○ Promotes strengths of staff*
○ Provides professional opportunities for
employees
○ Acquire feedback to improve the
presurgical education program
37. Resistance
● No Threat
○ Rotating Educators
● Delegated Funds
● No Vision for Change
● Emphasis Importance
● Projected Revenue
● Cost v. Savings
● Motivators
38. Time of Implementation
● Beginning May 1, 2015
○ 1 Year Goal
● Identify Problem & Gather Data
○ 3-6 Months
● Implementing Program
○ 3-6 Months
39. Evaluation
● Collected per Individual
○ Monthly
○ Quarterly
● Post-operative complications,
their length of stay in the
hospital, and readmissions
● Success
41. Financial Trends
● Improve patient outcomes by preventing
postsurgical complications
○ Reduces patient cost
● The cost to treat a patient that acquires
complications increases 54%
○ Profit margin of the reimbursements
decreases from 23% to 3.4%
● As the reimbursement rate from insurance
companies decreases, the profit margin
decreases.
(American College of Surgeons, 2015)
42. Financial Projections
● WMH performs ~5,600 procedures annually (Surgical
Services, 2016)
● Fixed costs would be the wages of RN’s
○ $10,000 startup cost that accounts for visual aids and
videos (Anatomical Models, 2016)
● Breakeven Analysis (Moran, 2016)
○ Fixed Expenses
○ Cost for Classes
○ Operating Expenses
○ Margin Cost
○ Breakeven Point
43. Fixed Expenses
● RN hourly wage $25/hr
○ $25/hr x 24 hr/week x 4 weeks = $2,400
(times 2 RNs)
○ $4,800 x 12 months = $57,600 annually
■ $23,040 (fringe) + $57,600 (annual)
● =$80,640 annual cost
● 40% fringe benefits
○ $23,040 annually
● **$10,000 additional for first year
○ =$90,640 first year expense
● 100 tri-fold pamphlets for $45 (Vistaprint,
2016)
○ Ordered about four times per month
● Cost for one class is about $5
● 12 classes held per week at $5/class
○ = $60 weekly
○ = $240 monthly
○ = $2,880 annually
● Patient cost per class is $100
○ Eight patients per class = $800/class
Cost for Classes
44. Margin Cost
● $100 per class x eight patients/class -$5 to
run the class
○ = $795 margin cost
● $80,640 (fixed cost) + $2,880 (cost for class)
○ =$83,520 (yearly operating expense)
● **$90,640 (first year fixed cost) + $2,880
(cost for class)
○ = $93,520 (first year operating expense)
Operating Expenses
45. Total Costs to Run Program
Costs First Year Annual Cost Subsequent Years Annual Cost
One Time Startup Fee for Supplies $10,000.00 $0.00
Supplies Cost $2,880.00 $2,880.00
Nurse 1 Wage $28,800.00 $28,800.00
Nurse 2 Wage $28,800.00 $28,800.00
40% Fringe Benefits $23,040.00 $23,040.00
Total Costs $93,520.00 $83,520.00
46. Breakeven Point
● $83,520 (operating expense) / $795 (margin)
○ = 106 classes (breakeven amount, yearly)
● **$93,520 (first year operating expense) /
$795 (margin)
○ = 118 classes (first year breakeven amount)
● 12 classes/week x 52 weeks = 624 classes/year
○ Hit breakeven point by third month in year
one
● $800/class x 624 classes/year
○ = $499, 200 annual profit
● $499,200 annual profit - $83,520 annual cost
○ $415,680 annual profit
● **$499,200 annual profit - $93,520 first year
cost
○ =$405,680 first year profit
Profits
47. Financial Projections Impact on the Bottom Line
● Positive Effect
● This program will continue to further the financial growth of WMH through
several different avenues
● Average patient hospital stay without complications is $10,978 (American College
of Surgeons, 2015)
● Average cost of patients that develop complications is $21,156 (American College
of Surgeons, 2015)
○ Potentially save ~ $10,178 per patient at risk for complications
48. Reimbursement
● Medicaid
● Private Insurance Companies
● Patients Themselves
○ Flat rate set to ensure patients
without insurance can attend
● Crucial for the physicians to
provide education on program
importance.
49. Cost Savings
● Adequate and thorough education leads to
compliance and patient preparedness
○ Patients who are prepared and know what to expect have a
higher satisfaction rate and lower complication rate (Ellrich &
Yu, 2015)
○ Decreased readmission rates
● Patients with complications increase from an
average of $10,978 to $21,156 (American College of
Surgeons, 2015)
● Average reimbursement rate with no complications
is $14,266 compared to $21,911 for patients with
complications
○ Profit margin drops from 23%, without complications, to 3.4%
with complications
50. “According to Piper (2015), the
average total cost for U.S.
hospital readmissions within 30
days is at least $4.3 billion
dollars each year for Medicare
patients.”
51. Cost Savings (cont.)
● More revenue for the hospital
● Proper patient education can
prevent unnecessary complications
that may lead to readmissions
○ Lead to increased profit and higher
patient satisfaction
53. Role of the Nurse
● The nurse’s ability to effectively educate
patients will directly impact financial success
○ Decrease in patient postsurgical complications
○ Decrease in cost to treat these patients
● Following the patient throughout the entire
process is crucial
○ Help to determine effectiveness of education
○ Help to identify the average cost of treatment without
complications, while trending costs of patients with
complications
● Nurses will help to provide evidence that the
program is effective
55. References
Agency for Healthcare Research and Quality. (2015, February). Surgeries in Hospital-Owned Outpatient Facilities, 2012. Retrieved
from http://www.hcup-us.ahrq.gov/reports/statbriefs/sb188-Surgeries-Hospital-Outpatient-Facilities-2012.pdf
American College of Surgeons. (2015). ACS NSQIP Information Booklet. Retrieved March 30, 2016, from https://www.facs.
org/~/media/files/quality%20programs/nsqip/nsqipinfobook1012.ashx
Anatomical Models. (2016). Retrieved from
https://www.a3bs.com/anatomical-models,pg_65.html
Association of American Physicians and Surgeons, Inc. (2015). Patients' bill of rights. Retrieved April 1, 2016, from www.aapsonline.
org
56. References
Bureau of Labor Statistics. (2014). Physicians and Surgeons : Occupational Outlook Handbook: : U.S. Bureau of Labor Statistics.
Retrieved April 1, 2016, from http://www.bls.gov/ooh/healthcare/physicians-and-surgeons.htm
Calculating your break-even point. (2015). Retrieved from
https://www.business.qld.gov.au/business/running/making-and-managing-money/calculati
ng-your-break-even-point
Centers for Disease Control and Prevention. (2010). FastStats - Inpatient Surgery. Retrieved April 1, 2016, from http://www.cdc.
gov/nchs/fastats/inpatient-surgery.htm
Covill, C., & Hope, A. (2012). Practice development: implementing a change of practice as a team. British Journal Of Community
Nursing, 17(8), 378-383
57. References
Ellrich, M., & Yu, D. (2015). The benefits of presurgical education. Retrieved from
http://www.gallup.com/businessjournal/183317/benefits-pre-surgery-education.aspx
Farlex. (2009). General Systems Theory. Retrieved April 8, 2016, from http://medical-dictionary.thefreedictionary.com/general system
theory
Foss, M. (2011). Enhanced recovery after surgery and implications for nurse education. Nursing
Standard, 25(45), 35-39 5p.
Frandsen, B. (2014). Nursing Leadership: Management and Leadership Styles. Retrieved April 8, 2016, from https://www.aanac.
org/docs/white-papers/2013-nursing-leadership---management-leadership-styles.pdf?sfvrsn=4
Friedman, A. J., Cosby, R., Boyko, S., Hatton-Bauer, J., & Turnbull, G. (2011, March). Effective Teaching Strategies and Methods of
Delivery for Patient Education: A Systematic Review and Practice Guideline Recommendations [Electronic version]. Journal of
Cancer Education, 26(1), 12
58. References
Gardner, S. S. (2014). From learning to teach to teaching effectiveness: Nurse educators describe their experiences. Nursing Education
Perspectives, 35(2), 106-111. doi:10.5480/12-821.1
Gonzales, P., & Et al. (2014). Surgery information reduces anxiety in the pre-operative period. Rev. Hosp. Clin. Fac. Med. Original
Research, 59(2), 51-56.
Guo, P. (2015). Preoperative education interventions to reduce anxiety and improve recovery
among cardiac surgery patients: a review of randomised controlled trials. Journal Of
Clinical Nursing, 24(1/2), 34-46 13p. doi:10.1111/jocn.12618
59. References
Knock, E. (2011). Basic management models and theories associated with motivation and leadership and be able to apply them to
practical situations and problems. Retrieved April 08, 2016, from http://www.healthknowledge.org.uk/public-health-
textbook/organisation-management/5c-management-change/basic-management-models#System_Theories
Kyrtatos, P. G., Constandinou, N., Loizides, S., & Mumtaz, T. (2014). Improved patient education facilitates adherence to preoperative
fasting guidelines. Journal of Perioperative Practice, 24(10), 228-231.
Leupold, L. (2012). Prewriting tasks for auditory, visual, and kinesthetic learners. TESL Canada Journal, 29(2), 96-102. Retrieved from
http://files.eric.ed.gov/fulltext/EJ981503.pdf
Liebner, L. T. (2015). I can’t read that! Improving perioperative literacy for ambulatory surgical patients. AORN Journal, 101(4), 416-
427. doi:10.1016/j.aorn.2015.01.016.
60. References
Moran, T. M. (2016, April 15). Break-Even Analysis Equation [Personal interview].
O'Brien, L., McKeough, C., & Abbasi, R. (2013). Pre-surgery education for elective cardiac surgery patients: A survey from the
patient's perspective. Australian Occupational Therapy Journal, 60(6), 404-409. doi:10.1111/1440-1630.12068
Perez, C. (2016, April 5). Nurse Manager Interview Questions [Personal interview].
Petiprin, A. (2015). Roy Adaptation Model. Retrieved April 06 2016, from http://www.nursing
theory.org/theories-and-models/roy-adaptation-model.php.
Petiprin, A. (2015). Systems Theory. In Nursing Theory. Retrieved from http://www.nursing-theory.org/theories-and-models/neuman-
systems-model.php
Pfander, V. (2016, March 11). Presurgical Education [E-mail interview].
61. References
Pichler, C. (2010). Effective patient communication: enhancing learning styles and language
yields better outcomes. ASHA Leader, 15(4), 5-6 2p
Piper, K. (2015). Hospital readmissions: Conditions, costs, and utilization differences in
medicare, medicaid and private insurance. Retrieved from
http://piperreport.com/blog/2015/01/16/hospital-readmissions-conditions-cost-and-utilization-differences-in-medicare-medicaid-
and-private-insurance/
Ponsky, T., & Rothenberg, S. (2015). Modern, multi-media, advances in surgical information.
Seminars in Pediatric Surgery. (24)3. Pp 124-129.
Pritchard, M. J. (2012). Pre-operative assessment of elective surgical patients. Nursing Standard, 26(30), 51-56 6p. doi:10.7748/ns2012.
03.26.30.51.c9003
62. References
Ronco, M., Iona, L., Fabbro, C., Bulfone, G., & Palese, A. (2012). Patient education outcomes in surgery: a systematic review from
2004 to 2010. International Journal of Evidence-Based Healthcare, 10(4), 309-323. doi:10.1111/j.1744-1609.2012.00286.x
Spector, R. E. (2013). Cultural diversity in health and illness (8th ed.). Boston: Pearson.
Stewart, J. G., & DeNisco, S. M. (2015). Role development for the nurse practitioner (1st ed.). MA: Jones & Bartlett Learning.
Surgical Services. (2016). Retrieved from http://www.warmemorialhospital.org/
Training nurses to be teachers. (2008). Journal of Continuing Education in Nursing, 39(11),
503-510 8p. doi:10.3928/00220124-20081101-02.
U.S. Department of Health and Human Services (HHS). (n.d.). Quick Guide to Health Literacy. Retrieved March 23, 2016, from http:
//health.gov/communication/literacy/quickguide/quickguide.pdf
63. References
Veronovici, N. R., Lasiuk, G. C., Rempel, G. R., & Norris, C. M. (2013, September 15). Discharge education to promote self-
management following cardiovascular surgery: An integrative review [Electronic version]. European Journal of Cardiovascular
Nursing.
Vistaprint. (2016). Retrieved from http://www.vistaprint.com/?GP=4/16/2016 12:41:01 PM
White, J., & Dixon, S. (2015). Nurse led Patient education programme for patients undergoing a lung resection for primary lung cancer.
Journal of Thoracic Disease, 7(2), 131-137. doi:10.3978/j.issn.2072-1439.2015.03.11.
Xu, P. (2012) Using teach back for patient education and self-management. Journal of American
Nurses Association. (7)3. Retrieved from
http://americannursetoday.com/using-teach-back-for-patient-education-and-self-managem
nt/
