A large California surgery center achieved 99% scores on a question asking whether patients would recommend the center, partly due to the center’s focus on patient education and quality improvement (QI).

“Our net promoter scores are 99%, and our patient response rate is 33%,” reports Tom Wilson, CEO of Monterey Peninsula Surgery Center – Ryan Ranch in Monterey, CA. “Our system did 17,000 cases in 2018. We had four inspections, 25 readmissions, and 41 ER visits ... we measure quality through the outcomes, and service through net promoter scores.”

Monterey Peninsula Surgery Center was involved in a pilot program for total joint surgery, collecting outcomes data for the Centers for Medicare & Medicaid Services (CMS). This information helped CMS decide to allow total joint surgery in ambulatory surgery center (ASC) settings.

The surgery center’s success in patient and case outcomes is partly due to its focus on comprehensive patient education, Wilson notes. “We provide an educational program to patients that is mandatory,” he says. “They meet with a physical therapist and nurse educator and go over anatomy and the actual procedure. Patients learn which exercises they should be doing ahead of time.”

The educator talks with patients about the procedure and recovery process. Patients learn that a coach can help around the house after surgery. “We have people going to their homes and looking for hazards, like throw rugs,” Wilson notes.

The program follows strict admission criteria, with 10 items that are predictors of whether someone is a good candidate for total knee or hip or major spine surgery on an outpatient basis. “We select our patients carefully,” Wilson says.

The surgery center trains new staff over a six- to eight-week period, including online competency testing and shadowing existing staff, says Carrie Millsap, COO at Monterey Peninsula Surgery Center. “We invest a lot of time and money into educating the team, allowing them to grow and be in the operating room,” she says. “We make sure they know how to use the equipment properly. We feel this has been very helpful to keeping infections down, and making sure physicians are satisfied with patient care.”

Another part of QI involves improving the facilities. “Two years ago, we spent $2 million to expand the operating room, putting in new systems, air filtration, and substerile corridors,” Wilson says.

Improving quality and efficiency is an ongoing process, Wilson notes. “Whenever we find a breakdown in our system or a complaint from a patient, it goes to our quality improvement committee,” he says.

The QI committee consists of nurses and physicians. They study issues to see if these were related to a policy that could be adjusted to avoid future problems. For example, five years ago, the surgery center saw the need to perform cholecystectomies. “We brought in general surgeons, and asked them what we could do to handle these cases,” Wilson says. “They said to train staff, so we brought in surgeons on the weekends with our team for training.”

The surgery center also purchased all necessary equipment. Today, they perform hundreds of cholecystectomies per year. “We do so many of these surgeries that we’re just as skilled as local hospitals, and it’s because we trained our staff and made the investment to do it,” Wilson offers.

The center initiated endoscopic spine surgery in the same way, starting with training staff and investing in the equipment, including fiber optics and cameras. “Now, people in the community can get their back surgery done endoscopically,” Wilson adds.