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Want content surgeons? Try efficiency benchmarks
By Stephen W. Earnhart, MS
President and CEO
Earnhart & Associates
None of us would get in our cars and go to a movie without knowing what time the show started or drive to the airport for a flight unless we knew the flight time. And we certainly wouldn’t cook a roast unless we knew at what temperature to set the oven. Yet we are more than willing to perform a surgical case and have no idea what it costs, and we are content to staff the facility without an idea of what staffing levels really are needed.
As a company, Earnhart & Associates performs many operation and process audits a year, and we no longer are surprised by the number of hospitals and surgery centers that simply do not benchmark their data or have any idea what things cost or what is expected of them. I don’t see how a business can function without guidelines. Granted, we have financial benchmarks. We know, roughly, what is acceptable for equipment replacement, rent, etc. But very few of us have efficiency benchmarks.
Efficiency benchmarks strike at the heart of how good we are doing our jobs; ergo, if you don’t know what your benchmarks are, how can you be assured you are doing your job well? Before you get angry, I must tell you that there are more than 4,000 surgery centers, with more than 200 under development right this minute because someone else is not doing his or her job!
We all can delude ourselves and say that the reason there are so many surgery centers is because the surgeons are greedy and want it all, but that is not the case. With more than 4,000 face-to-face physician interviews performed by my company, I can tell you that the No. 1 reason there are so many surgery centers is because there are so many hospitals that do not understand or practice efficiency benchmarking. OK, now you can get mad at me.
Most understand that turnaround time, start time, and cost per case are important, but for some reason, most do not track them. If you do not track your turnaround time between cases, I can tell you exactly what it is: It is the longest time between the most difficult cases you have ever had. That is the time your surgeons will say that it is.
Their perception of your turnaround time is reality. Unless you can prove them wrong with charts and graphs, those numbers are what are in their minds, and those numbers are what they are going to scream to your CEO.
So what benchmarks should you look for? At the very least, track the following:
• Percentage of on-time start of case. This term usually refers only to first case of the day or a time-scheduled case.
• Reason for case delay. Reasons include missing paperwork, patient late, etc. Track it and benchmark the reasons.
• Turnaround time between cases. Define this time within your organization. Typically, it is referred to as the time one patient leaves the room until the time the next one is brought in. However, most surgeons time it from the time they leave the room and the time the next patient is brought in, which is a big difference. Make sure you report it properly.
• Pre-incision time.
• Surgical time.
• Post-incision time.
There are a number of others that should be tracked. What are they? Fill in the blanks, above. You could make it a staff meeting exercise.
The bottom line? Time is money, and time saved is often more valuable to surgeons than money. If you take my advice and let your staff go home after their rooms are complete, you will see your efficiency benchmarks improve. Try it for a month. Make sure you get base benchmarks first, or your data will be worthless. See if it makes a difference in your center. Ask you surgeons if they noticed a difference. If it works, see if you can make it permanent. You will be pleasantly surprised.
(Editor’s note: Earnhart & Associates is an ambulatory surgery consulting firm specializing in all aspects of surgery center development and management. Contact Earnhart at 5905 Tree Shadow Place, Suite 1200, Dallas, TX 75252. E-mail: firstname.lastname@example.org. Web: www.earnhart.com.)