Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.
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5 0 O U T P A T I E N T S U R G E R Y M A G A Z I N E O N L I N E | N O V E M B E R 2 0 1 5 Though it sounds like a tedious process to create and implement the pathways needed for a standardized approach to surgery, the biggest challenge is getting staff and sur- geons on board with the changes. For our staff, the increased efficiency and lack of downtime in the OR meant that the overtime pay they were used to was dramatically reduced. While unhappy at first, after our employees saw that the focused factory meant their jobs were a little easier and less stressful, they quickly warmed up to the idea. Surgeons, though, were a tougher sell. They weren't keen on losing the "freedom" they had to use resources and dictate care as they pleased. One way we tackled this resistance was to have leadership help drive change and continually provide the results and evidence supporting this approach. While mandating the changes was a crucial step, our increased efficiency — and ability to book more cases that resulted in better patient outcomes — was a big boost to surgeon adoption. One of the biggest critiques you hear about this focused factory approach is that it only works for a cherry-picked group of patients. And that's true, especially in hospitals or larger multispecialty facilities. Show a surgeon a standard pathway, and he'll show you how that would fail on his last sick, complex case. That's why we advocate for a hybrid approach — our smaller surgical "factories" fit within the clinic's larger solution shop model, which relies on our providers' expert- ise. Our simple cases can be moved quickly and efficiently through the system, while physicians can spend more time tailoring care for our more complex cases. How you adopt a focused factory model can vary based on your needs and patient population. Whereas a small ASC may have nearly 100% of patients placed on a path- way, a hospital may only use it for 50% of its patients in a given specialty. If your physi- cians are hesitant about using standard care pathways, it's best to start conservatively. Set your patient criteria to include only the most-likely-to-succeed cases at first. As you start seeing results, revisit the criteria and liberalize it to fit more patients, as appropriate. — David J. Cook, MD OVERCOMING RESISTANCE Selling the Focused Factory Concept