Terry Woodbeck, CEO of Tulsa Spine & Specialty Hospital, discusses seven ways his hospital has improved patient satisfaction and decreased healthcare costs. 1. Close nurse-to-patient ratio. Tulsa Spine & Specialty Hospital has a one-to-four nurse-to-patient ratio, which has significantly improved the patient experience. Nurses are able to focus more closely on individual patients and fewer patient problems arise as a result.
"With a close nurse-to-patient ratio, you are catching a lot of problems early, so it increases your patient satisfaction," says Mr. Woodbeck. "You are able to fix problems patients have before they become major problems and spend more time on patient education, which we think lowers readmission rates and is cost effective. This makes for a better experience for someone going through surgery."
Mr. Woodbeck reports that patients often thank surgeons for bringing them to Tulsa Spine & Specialty Hospital because they've been at other hospitals and appreciate the enhanced experience.
2. Automation with EHR. Electronic health records often initially breed inefficiencies, but once staff and surgeons can utilize the equipment effectively, hospitals can gather data to improve the patient experience and cut costs where possible. Tulsa Spine & Specialty Hospital has implemented NextGen's EHR and is working with the company to develop enhancements that will make the technology even more useful to the hospital.
"We are growing with NextGen and working on developments we think should be incorporated," says Mr. Woodbeck. "They are listening and moving forward with our ideas. We've been using the data to reduce costs of hospital stays and now we are able to provide services in other areas because we've been able to lower our costs drastically."
3. Understand cost structure. With the increased information flow and automated technology, you can break down global costs to understand how every day decisions can raise and lower the cost of care. Surgeons should know how much it costs to keep patients in the pre-op area, operating room and overnight at the facility so they can partner with the hospital to lower those times and reduce costs.
"You can gather information on how much procedures are costing per patient, and give it to the physicians," says Mr. Woodbeck. "You can show them what it costs their peers to do the same procedures. It doesn't mean they will change, but one surgeon might want to talk to another to see what he is doing and why he can perform a procedure for $1,500 less than his partner."
Hospital administration doesn't dictate how surgeons should provide care, or mandate changes based on cost data, but we do share this information with surgeons to let them decide for themselves.
"The more knowledge the physician has about the workings of the hospital and what goes into the costs of care, the better partner he/she can be," says Mr. Woodbeck. "The lack of alignment between physicians and hospitals is one of the real problems in healthcare today. However, one of the benefits of a physician-owned hospital is the two groups are totally aligned."
4. Focus on lowering implant costs. Implants are one of the highest costs associated with spine surgery and many providers are focused on initiatives to lower implant prices. These initiatives include purchasing commoditized implants direct from manufacturers, purchasing in bulk to negotiate better per-unit prices and eliminating waste whenever possible.
"The new technology is very expensive, but not necessary for many of the cases," says Mr. Woodbeck. "Many patients require standard instrumentation. We have a system where we can go directly to manufacturers and purchase this hardware."
Tulsa Spine & Specialty Hospital has trained in-house technicians that act as device company representatives to order, restock and set up equipment. This system has incurred for a 30 to 40 percent savings on implant costs.
"Those are huge dollars because many times implants can cost more than all other expenses for that stay combined," says Mr. Woodbeck. "When you purchase wholesale implants direct, they are FDA approved, you are just removing the middleman. Many other types of businesses sell and purchase direct, so orthopedics should be able to do that too. We've done it for four years and had great results."
5. Positive relationship between surgeons and staff. Surgeons should have a positive relationship with hospital or surgery center staff members to really communicate and coordinate patient care.
"The nurse should feel very comfortable walking up to the doctor and asking questions," says Mr. Woodbeck. "That helps the patient. Our doctors work very nicely with staff members. As a result, the staff has become very well trained in how to care for our patients."
Tulsa Spine & Specialty Hospital has even developed a unique way to transport patients from the operating room to their post-surgical stay room to reduce the risk of complications.
"We take the patient's bed from the floor to the operating room so that when the patient comes off the surgical table they go directly on the bed and back to the recovery area rather than transporting from the gurney to the bed," says Mr. Woodbeck. "That's one less move our staff has to make for the patient, and one less opportunity for them to injure themselves, so it's beneficial for everyone. However, it takes a lot of inter-department cooperation.."
6. Enhanced communication with patients and family members. Patient education is an important aspect of patient satisfaction, but providers must also pay attention to the patient's families. Explaining to everyone how the surgery will work and communicating with family members during and after surgery about the patient is very important.
"Having any surgery at the hospital isn't like buying a car, furniture or clothes," says Mr. Woodbeck. "There is apprehension from the family, nervousness from the patient and people are generally anxious because they don't know how everything will turn out. You have to take that into consideration when speaking with patients and family members, especially if it's a child going into surgery. There are a lot of unknown questions you have to consider when you are talking to patients and family members."
Explaining what patients and family members should expect and going over different potential outcomes. While patients are in surgery, keep family members updated on their progress and continue to communicate until the patient is ready to leave the hospital.
"It's a total process that makes the experience," says Mr. Woodbeck. "When you have a break down in one area, it makes for a bad experience even though everything else was fantastic. You are always making sure the entire experience was as good as you can make it."
7. Energize staff for a patient-focused culture. Staff members should be trained on employee culture when they are hired, but training should also continue throughout their employment with your hospital. Employees need time to re-energize and focus on providing a great experience for everyone who walks through your door.
"The reputation of the hospital isn't just the bricks and mortar; it's the staff, surgeons, receptionist and house keepers — everyone has to have the same culture in order to stay together and make the experience right," says Mr. Woodbeck. "You spend a lot of time trying to cultivate that type of culture within the facility. You might have a beautiful facility and still not have good patient satisfaction and care."
Hold continual refresher courses and additional training, and periodically gain employee feedback on how you can make the patient experience better. "There is nobody who knows how to do it better than the staff members who are listening to patients and doing it every day," says Mr. Woodbeck. "They come up with fantastic ideas."
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