Creating a Dedicated
Service Line
Sandy Nettrour, PA-C

December 3, 2013
Hospital Vision Statement
Butler Health System:
“We exist to make a positive difference in the
lives of our patients by pr...
Administration and Surgeon Support

December 3, 2013
Surgeon Champion
• Traits
– Energetic
– Motivated to increase volume and improve
efficiency
– Team player (with administra...
Administration Champion
• Able to understand the surgeon’s perspective
• Willing to work creatively to overcome
obstacles
...
Core Conflicts
• Surgeons can not
– Divide their focus between patient care and
hospital management
– Personally fix all t...
Elements

Program
Director
Administration
Champion

Surgeon
Champion
Program
Vision

December 3, 2013

Operations
Team
Orthopedic Service Line Director
Non-surgeon (background can vary)
• Favorable traits:
– Good organizational skills
– Good...
Take Down the Silos:
The right people have to be
at the table together.
What solves for one can
increase issues for anothe...
Team Composition
•
•
•
•
•
•
•
•

Physician(s)
Administration
Service Line Director
Nursing (floor manager)
Operating Room...
Ad Hoc Team Members
•
•
•
•
•
•
•

Anesthesia
Sterile Processing
Pharmacy
Billing and coding
Outpatient Rehabilitation
Hom...
Getting Started
• Listen to all of your
team members
• Start with individual
interviews
• What are the common
issues?
• Ho...
Investigate
• What is reality?
Go and See: observe the problems
• What are the strengths and weaknesses of each
department...
Issues Identified
•
•
•
•
•
•
•

Variability in surgeons’ care pathways
Inconsistent and late OR start times
Slower than i...
Early Implementation
• Work to fix the common problems
– Start with small projects- streamline order
sets, progress notes,...
BHS Total Joint Camp
Our first team project
• Covered all departmentsincluding physician office
• Streamlining patient edu...
Later Process Improvement Projects
• Operating Room Efficiency
– Streamlined OR trays; Improved on time start
• Length of ...
How can YOU create a dedicated team?

Be the solution, not the problem
Your team should want to work with you

December 3,...
Pearls and Pitfalls
• Be open to feedback
• Turn criticism into
positive action
• Small initial successes
will help to gai...
The Importance of Team Building
• Consider both rewards
and recognition
• Give credit where credit
is due
• Small things h...
In Conclusion
Action Items:
• Provide supportive
team leadership
• Engage and empower
front line people
• Show profitabili...
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Building the Skeleton: Creating a Dedicated Orthopedic Service Line

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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.

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  • Improve hospital profitability, Decrease staff overtime costs, Create a Win-Win
  • So, three major elements early on are having a vision, a surgeon champion and an administrative champion.Questions to surgeonsTell the group about your vision for the joint replacement programTell the group about how you see your role as surgeon championTell the group about how administration is showing commitment to the programAsk the audience for questions related to vision, surgeon champion, administration champion
  • Questions to Sandy, Vanessa, AllenTell the group about your day to day responsibilitiesTell the group about your biggest challenges in your roleQuestion to surgeonsWhat does the role of the joint coordinators mean to youAsk for audience questions as to the role of the joint coordinator
  • Question to faculty What was the first thing you worked on?
  • Question to faculty What are some of your current initiatives
  • Be on time (early) Be helpful Streamline your instruments Provide a sensible case orderHave monthly team meetings to resolve issues and create solutions Provide rewards and incentives (milkshakes, mopping THANK YOU’S)
  • Question to surgeonsTell the group about how you incentivize your teams
  • Building the Skeleton: Creating a Dedicated Orthopedic Service Line

    1. 1. Creating a Dedicated Service Line Sandy Nettrour, PA-C December 3, 2013
    2. 2. Hospital Vision Statement 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 December 3, 2013
    3. 3. Administration and Surgeon Support December 3, 2013
    4. 4. 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 December 3, 2013
    5. 5. 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 December 3, 2013
    6. 6. Core Conflicts • 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! December 3, 2013
    7. 7. Elements Program Director Administration Champion Surgeon Champion Program Vision December 3, 2013 Operations Team
    8. 8. Orthopedic Service Line Director 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 December 3, 2013
    9. 9. Take Down the Silos: The right people have to be at the table together. What solves for one can increase issues for another Prevent the “hospital salute” December 3, 2013
    10. 10. Team Composition • • • • • • • • Physician(s) Administration Service Line Director Nursing (floor manager) Operating Room (ortho team leader) Physical Therapy Pre-Admissions Representative Case Management/Social Services December 3, 2013
    11. 11. Ad Hoc Team Members • • • • • • • Anesthesia Sterile Processing Pharmacy Billing and coding Outpatient Rehabilitation Home Health Physician office staff December 3, 2013
    12. 12. 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?
    13. 13. Investigate • 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.” December 3, 2013
    14. 14. Issues Identified • • • • • • • 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 December 3, 2013
    15. 15. Early Implementation • 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 December 3, 2013
    16. 16. BHS Total Joint Camp Our first team project • Covered all departmentsincluding physician office • Streamlining patient education revealed redundant work • Improved patient expectations • Reduced length of stay (1.5 days first year) • Unified the operations team
    17. 17. Later Process Improvement Projects • 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. December 3, 2013
    18. 18. How can YOU create a dedicated team? Be the solution, not the problem Your team should want to work with you December 3, 2013
    19. 19. 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 December 3, 2013
    20. 20. 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
    21. 21. In Conclusion Action Items: • Provide supportive team leadership • Engage and empower front line people • Show profitability • Listen • Praise and Thank December 3, 2013

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