Editor's Note: This is the first in a two-part series about the partnership between Glen Cove Hospital and the National Health Service Elect.
British healthcare leaders recently visited a prominent U.S. hospital to share orthopedic best practices and workforce development—a partnership that both sides say could ultimately benefit their national health systems.
Sponsored by the National Health Service Elect and the British Department of Health, orthopedic surgeons and anesthesiologists from the United Kingdom observed hip and knee replacement surgeries performed by Eugene Krauss, MD. Krauss is chairman of orthopedics at Glen Cove (NY) Hospital, part of the North Shore-LIJ Health System.
Krauss and his team at Glen Cove perform more than 1,100 joint replacements annually with an infection rate of virtually zero. It is touted as one of the premier joint replacement models in the U.S.
"For them to be interested in a cooperative program with myself and my program at Glen Cove Hospital-North Shore was a wonderful opportunity and honor for us," Krauss says. "The goal was 'can we reproduce our efficiency models and can we help them?'"
According to Peter Kay, MD, president-elect of the British Orthopedic Association and one of the UK's representatives in the partnership, the lessons learned from examples at Glen Cove will help as the UK tries to achieve the NHS goal of having wait times for elective surgery reduced to no more than 18 weeks.
Kay notes that as recently as a few years ago, U.K. patients would have to wait two or three years for a joint replacement.
"What we call the patient pathway was getting a bit long and a bit complicated, so the big push has been to rationalize all of that to make it must simpler, and much quicker to get patients through the system," says Kay, who is also a practicing orthopedic surgeon at Wrightington Hospital in the UK. "And obviously in order to do that, we've had to modernize and change what we do."
In addition to observing during the surgeries, healthcare leaders from both sides of the pond discussed surgical methods, efficiency models, and tactics used by the surgical team. The 30 people who visited Glen Cove included representatives from the National Health Service and West Suffolk NHS Trust Hospital.
The program's agenda also included site visits to North Shore-LIJ's Center for Learning and Innovation and its Patient Safety Institute in Lake Success, NY, as well as the health system's Bioskills Education Center, a state-of-the art surgical training center. Discussions took place about workforce development and the role of nurses, nurse practitioners, and physician assistants in delivering orthopedic care to patients in the continuum of care.
"Much of what I've done in our field is related to that continuum of care," says Krauss. "You break down the process to multiple, small quality assurance steps. There is a whole team involved."
This team-oriented process is very important, which he says he tried to get across to the team from the UK. He says Glen Cove has joint replacement teams that have been working together since 1993, allowing for a seamless process from consultation to follow-up care that is best for the patient, as well as the staff.
This team effort allows for Glen Cove to conduct 12-14 joint replacements in a single day—with superior outcomes.
"It's like dancing a ballet with all the same partners—it's not like a pickup team," Krauss says. "People have this idea that if you do a lot of these they must be not as good quality—but the opposite is true. When you do a lot, you have a center of excellence and they are better."
Kay says he is impressed that patients really felt like they were being looked after by a good team, and the staff seemed to be really enjoying their jobs.
"That's quite important, because we've been pushed over the last few years to do more and more, the staff were getting tired, and sometimes it could be the tendency of patients to sometimes feel like they were just being pushed through the system as quickly as possible."
Kay says the UK team went back "buzzing" with ideas to improve efficiency, some of them as simple as reconfiguring how they schedule the operating theater. In the UK, facilities typically have one surgeon and one operating room. At Glen Cove, Krauss moves between four operating rooms, with other surgeons and healthcare workers assisting with preparation and post-operative care.
Differences in staffing could also attribute to the joint replacement efficiency at Glen Cove as well, Kay says. For example, there are very few physician assistants in the UK, and surgeons usually rely on junior doctors to assist with surgeries. New directives to reduce doctor hours are hindering this trait, however, and Kay says the UK needs to transfer their workforce to cope with the reduction in the number of doctors that handle these tasks.
The British Hip Society, of which Kay is the past president, is already working to strengthen the healthcare workforce to include people with extended skills, such as physician assistants and nurse practitioners that are used in the United States.
This extension of the workforce, as well as training them to work together in the joint replacement process, will be invaluable as the UK tries to improve joint replacement efficiency while at the same time maintaining quality, he says.
"What we saw at Glen Cove was some fantastic examples of how these people worked," Kay says. "We've set up a project at the Department of Health to really bring forward the curriculum and the development of the type of workers you have. Anything we can do to improve our efficiency and improve our workforce to deliver more, is the sort of thing we need to be interested in, and Glen Cove was giving us some real ideas on how to do that."
And it is far from a one-sided exchange, Krauss says. North Shore-LBJ can benefit from Wrightington Hospital's innovations in orthopedic care, he says, adding that in the 1950s Wrightington was the site of the world's first hip replacement surgery.
Kay notes that while some U.S. facilities may be more efficient and more production oriented with excellent outcomes, there are many aspects of their system they are measuring to ensure quality—something that will likely become more important as the U.S. continues its health reform efforts.
"Their metrics for measuring outcomes are better than ours, they have national standards, and we don't," Krauss says. "Every joint replacement done in Great Britain goes into a national registry. They can tell you which implant is better, which hospital has better outcomes."
The partnership will continue in the future as well. Representatives from Glen Cove will visit the UK in September to discuss, among other things, how to further the information exchange.
Kay says that if the partnership is successful, the lessons learned have the potential to expand and benefit not just joint replacement, but the structure of health systems in both countries.
"What we're trying to do at the Department of Health is to bring all of this together to see if we can not just change those three organizations, but using those as sort of exemplar sites to develop change across much more of the NHS," Kay said.
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