1. Focus on quality metrics. An orthopedics department must not only produce excellent outcomes, but it must also be able to produce tangible evidence of those outcomes. "In today's world, orthopedics departments need to be focused on outcomes and key performance indictors that drive efficiency and cost," says David J. Jacofsky, MD, president and CEO of Phoenix-based orthopedic group, The CORE Institute. Leaders in an orthopedic surgery department should spearhead the effort to benchmark and collect outcomes data that in turn drives the department's patient satisfaction, efficiency and cost savings.
"We track all of our patients," says Douglas Garland, MD, medical director of joint replacement at Long Beach (Calif.) Memorial Medical Center. "We go over the data gathered and ask how can we improve? We set target numbers and move towards that goal."
2. Minimize variation. A key component to producing reliable, cost effective outcomes is the creation of a standardized environment. "Variation is the enemy of value in healthcare," says Dr. Jacofsky. Each element of the department from operating room protocols to equipment can be standardized.
Standardization, though not a simple process, is an important step towards an effective and efficient department. "Minimizing variation may not necessarily pay financially today, but as we shift towards value-based care those that made the investment early on will be most successful," says Dr. Jacofsky.
3. Create a culture of accountability. An orthopedics department is a complex organization and it can be easy for those upholding it each and every day to feel as if they have been lost in the shuffle. "The creation of a culture of accountability is vital. There needs to be a formal arrangement between the hospital and the department for the rewarding of excellent outcomes. Physicians and management should receive bonuses based on performance," says Dr. Jacofsky. Physicians and employees will recognize that hard work does not go unnoticed.
4. Promote physician teamwork and alignment. Any hospital department will struggle if the physicians that work within it do not have a team attitude. "Make sure that surgeons understand that competition with each other only negatively impacts their leverage in the healthcare system, whereas working strategically as a group allows for far more power in this healthcare environment," says Dr. Jacofsky. Physicians that are aligned with one another will create an atmosphere conducive to an outstanding department. Dr. Jacofsky explains that one way to promote teamwork is by structuring quality bonuses on group metrics, rather than solely on individual surgeon performance.
5. Stress interdepartmental collaboration. An excellent orthopedics department needs to run smoothly on an internal level, but also must form working relationships with the other hospital departments. A hospital is a large facility and departmental interaction is unavoidable and necessary. "In an orthopedics department, you need to work well with the anesthesia department. You have to make a determination on how you want surgeons and anesthesiologists to run the operating room efficiently," says Dr. Garland.
Keeping open lines of communication between everyone within the department and the administration is key to maintaining a department that functions well within a hospital. "We have a monthly meeting with everyone that touches a joint replacement patient. Nurses, physicians, physical therapists, someone from the OR and administration included," says Dr. Garland.
6. Create goal alignment between the hospital and orthopedics department. An important aspect of communicating with a hospital's administration is ensuring that the orthopedic department's goals are on board with the hospital's goals. "In the past, hospitals' and physicians' goals have not been aligned and oftentimes this creates an adversarial relationship," says Dr. Jacofsky. Goals should be built around quality metrics and ultimately quality patient care, which creates goals that are mutually beneficial for both the department and the hospital.
7. Concentrate on patient satisfaction. The main goal of an orthopedics department, and by extension the hospital, should be quality patient care. Create an environment that not only focuses on excellence in clinical care, but also focuses on providing the patient with a positive experience. Dr. Garland explains that his department is built around an attitude of "getting better together." Patients eat with one another and exercise with one another. "The more engaged patients are, the more willing they are to return to a luncheon where patients, families and their coaches share their experiences," says Dr. Garland.
8. Form a long term strategy. In the rush of trying to streamline and perfect day to day activity it is often easy to put off or ignore long term thinking, but this is a mistake orthopedics departments and hospitals cannot afford to make. "Hospitals that are only concerned with quarterly earnings and are unwilling to make long-term financial investments will begin to struggle. Everyone needs to be investing in the future for what will be a very different healthcare environment," says Dr. Jacofsky. Orthopedics departments and hospitals must work together to prepare for success in the future world of healthcare.
"Many people view healthcare reform as a stumbling block, but if you're properly prepared it should be viewed as stepping stone," says Dr. Jacofsky.
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