US, UK Physicians Team Up to Improve Ortho Quality

"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.