Hospital leadership at the MemorialCare Health System in Southern California use a term to describe their plans for efficiency, physician alignment, and improved patient outcome in orthopedic care: Cruising to Recovery.
The phrase signifies not only the locale of the hospital system, not far from the ocean, but also its revamped method of care for orthopedic patients. Hospital leaders discussed the changes Tuesday at a HealthLeaders Media Rounds event, "Orthopedic Leadership Strategies: Engage, Measure and Perform" at the Orange Coast Memorial Medical Center in Fountain Valley, CA.
They discussed the development of a joint replacement center, with a patient-centered focus that was the result of many internal system changes within the system. Using Lean principles, hospital officials also developed patient-education coaching models to attain what they term better outcomes and efficiencies, while focusing on improved physician leadership strategies for improved alignment and engagement.
The hospital's physician structure has been and continues to evolve in importance. "Our ability to partner closely with physicians is critical as we prepare for healthcare reform, with stronger partnerships, shared decision-making and innovative leadership models," says Marcia Manker, CEO of the Orange Coast Memorial Medical Center.
Hospital collaboration is especially important with the MemorialCare Physician Society, which consists of more than 2,000 physicians, developed in 1996, and IPAs (independent practice association). "It's the foundation of our physician alignment that is critical to meet the needs of our doctors and the changing face of our delivery system," Manker says. "The physician society teams up with our employees to drive clinical standards in performance resulting in exceptional outcomes."
California's restrictions on ownership of medical practices and systems allow the medical foundation model for "greater alignment and shared efficiencies," Manker says. The MemorialCare Health System also includes the Long Beach Memorial Medical Center, Miller Children's Hospital, and the Saddleback Memorial Medical Centers in Laguna Hills and San Clemente.
As hospital officials evaluated changes in care, orthopedics was identified as an appropriate service line for Lean approaches due to the complexity of patient flow, as well as the high cost and significant volume, whether it was hip, knee, bilateral, or other focus, says Pamela Chevreaux, vice president, ambulatory services, for the Long Beach Memorial Medical Center.
Moreover, while there was a dedicated staff for orthopedic surgery, it was not specifically for joint replacement, Chevreaux says.
A major change involved revising focus to patient-centered care, says Douglas Garland, MD, medical director of the MemorialCare Joint Replacement Center and co-chair of the orthopedics, neuroscience and rehabilitation units at Long Beach Memorial Medical Center. The hospital system's previous approach was not considered patient-centered, and the care team was not united under a common philosophy of care, says Garland. As a result, it lacked focus and effort on defined outcomes. For instance, post-operative goals, he says, were considered "clinician-centric, not patient-centric."
Making a swath of changes, including implementing a Lean system, Chevreaux says they were able to improve procedures for patients prior to surgery by expanding education programs, streamline patient interactions, while establishing a family and patient selected "coach" used throughout the process. Patients also were assigned a joint center coordinator to review their procedures.
Developing a total joint center, says Garland, "is not as easy as you think. It's very difficult. First you have to have identifiable goals and you have to select the proper leaders."
As far as Garland is concerned, partnership with orthopedic surgeons became a key element in the overall changes, beginning with sharing data. Changes within the system resulted in direct improvement in patient care, he says.
Under a previous system, patients who had orthopedic surgery would not get out of bed until the day after surgery, would stay in the hospital for at least four days and probably be off work for three months, and would take at least six weeks to get into a car to drive. There was also uncertainty for the patient about obtaining physical therapy.
The changes allowed for a streamlined approach where planning occurred in plenty of time before surgery that allowed patients time to know their exercises, discuss local instead of general anesthesia, had a single point of contact for questions, had scheduled surgery, therapy, and was taught to get in and out of a car safely. A guidebook issued to the patients allows them to monitor their exercise program.
A joint coordinator "is the patient's advocate. If there is a nursing problem, they will tell her. If (the patients) they don't like the physician, or not happy with the therapist, they will tell (the coordinator). It is really truly value added and empowerment at that point of service," Garland says.
Increasing education for the patient has reduced "fear and confusion" among patients, Garland says. Improved collaboration among physicians and staff has reduced the possibility of turf wars, he adds.
The joint replacement procedure changes have resulted in significant improvements to patient care as well as ROI, according to Chevreaux.
For instance, she says, the system has seen decreased length of stays, from 4.35 to 2.96 days; improved distances that the patients are walking, as well as improvements in overall recovery. The number of patients sent directly home increased from 12% to 81%. As for costs, implant expenses were reduced lower than the national average, and the number of private pay patients increased 31%, she says.
"It is truly a paradigm shift how we are delivering health and wellness," Chevreaux says.
Joe Cantlupe is a senior editor with HealthLeaders Media Online.
