Emergency rooms are indispensable patient front doors for health systems and hospitals, and efficiency improves patient and staff experience.
RWJBarnabas Health has scaled an emergency department efficiency initiative that has generated several positive outcomes including reduced patient wait times.
Emergency rooms are an essential patient front door for health systems and hospitals. When run efficiently, emergency rooms drive positive patient experience as well as staff satisfaction.
"We want our patients to have the best possible experience and best possible outcome when they are seen in our hospital emergency rooms," says Andy Anderson, MD, MBA, executive vice president as well as chief medical and quality officer at RWJBarnabas. "Emergency room care is an important piece of how we are caring for our patients as a whole person, and the efficiency of care in the ER impacts how the patient feels and how the patient does from a clinical standpoint."
Emergency department efficiency should be among the top concerns of a CMO. According to Anderson, a CMO should be an advocate to promote efficiency generally and specifically in the emergency rooms.
"A CMO should help remove any barriers as well as help communicate with physicians, nurses, and others about the importance of emergency room efficiency initiatives," Anderson says. "A CMO should help navigate through approvals at the health system with regard to changes in policies and procedures."
RWJBarnabas saw a need to improve emergency department efficiency after the coronavirus pandemic.
"Coming out of the coronavirus pandemic, we had tremendous wait times and inefficient processes," says Christopher Freer, DO, senior vice president of emergency and hospitalist medicine at the health system. "We needed a reset of how we were looking at care. Once we got out of disaster mode, we focused on many things that we could control such as how we handled the arrival of a patient."
In addition to improving the patient experience in emergency rooms, RWJBarnabas sought to improve efficiency in the emergency department to improve staff experience and well-being.
"Emergency departments are a top setting for burnout among physicians and nurses," Freer says. "Working in an inefficient environment can be taxing on the staff."
Andy Anderson, MD, MBA, is executive vice president as well as chief medical and quality officer at RWJBarnabas Health. Photo courtesy of RWJBarnabas Health.
How RWJBarnabas improve ER efficiency
There were four primary elements in RWJBarnabas' emergency department efficiency initiative, which began at Cooperman Barnabas Medical Center.
First, the health system adopted direct bedding for patients as soon as possible after patients arrived at emergency rooms.
"Direct bedding means as soon as the patient walks into the entrance to the emergency department or arrives via ambulance, if we have open beds the patient is moved to a bed as soon as possible," Freer says. "Then staff members including doctors, nurses, and technicians go to the patient."
Direct bedding can be difficult to execute, according to Freer. It takes a cultural shift, and staff buy-in is essential to changing workflows.
"You need to explain the 'why' of why it is good for the patient and good for the staff," Freer says. "Once you get staff engagement, that is when direct bedding gets clicking, and you start seeing results."
Second, RWJBarnabas streamlined the triage of patients in emergency rooms by applying simple concepts, according to Freer.
"When a patient comes into the emergency room, you take as little information as possible to make the decision to directly bed the patient," Freer says. "You want to connect the patient to the provider and the nursing team as quickly as possible."
Once basic information has been collected, registration and completion of triage can happen after the care is initiated, Freer explains.
"Basically, we looked at how to safely and efficiently move patients into the emergency department quickly, which was critical," Freer says.
The health system also made a staffing change to improve ER triage efficiency by assigning some of the most experienced ER nurses to triaging duty.
Third, RWJBarnabas harnessed real-time data to support the emergency department efficiency initiative.
"When we started this efficiency initiative, we had just finished adopting Epic as our health system's electronic health record," Freer says. "We leaned into Epic and enhanced it to make sure we were as efficient as possible."
The emergency departments focused on several crucial metrics, including left without being seen, arrival to room, and arrival to seeing a provider.
"The data we generate is timed from the time a patient walks in the door, a patient is triaged, a patient is seen by a doctor or physician assistant, and when a medication is administered," Freer says. "We are metric-driven, and we share metrics transparently across all 12 of our emergency departments, which creates a competitive spirit."
Fourth, RWJBarnabas initiated electronic handoffs to improve communication between staff members, including communication between physicians and nurses.
The electronic handoffs have helped to improve the efficiency of admitting patients to the health system's hospitals, according to Freer. Now, there is standardization for a summary of what is going on with a patient for the nurses and for medications.
"There is a standard approach for the doctors, and a timeline for when they need to respond to each other after a patient has been admitted," Freer says. "Transport, housekeeping, and other ancillary services are automatically triggered from the admission order. We make sure patients can get upstairs in a timely manner."
Christopher Freer, DO, is senior vice president of emergency and hospitalist medicine at RWJBarnabas Health. Photo courtesy of RWJBarnabas Health.
Generating results
RWJBarnabas has achieved impressive gains from the health system's emergency department efficiency initiative.
Before the initiative was launched in 2023, the rate of patients leaving without being seen in the health system's emergency departments was 2.64% of patients, and the rate has dropped to 0.50%. The average arrival to seeing a provider time has dropped from 26 minutes to 17 minutes. The time from putting in an admission order to when a patient is in a hospital bed has been reduced by 37%.
The efficiency initiative has improved staff experience as well, Freer explains.
"Engagement and retention of staff has improved," Freer says. "If you have a better environment for the patients, the staff is going to enjoy working and have a better environment as well."
A second opinion in any profession is the best practice. That's why Karmanos Cancer Institute implemented a streamlined process to provide patients with second opinions within seven days of an initial diagnosis.
At Karmanos, a second opinion results in a revised treatment plan or even a new diagnosis up to 20% of the time, according to George Yoo, MD, CMO of the comprehensive cancer center.
"The second opinion allows for a more comprehensive and expert review by a multidisciplinary team of doctors who specialize in a cancer type," Yoo says. "This review includes reviewing the pathology slides and the radiology images."
View the infographic below to get four tips on how Karmanos provides times second opinions to cancer patients. Click here to read the accoompanying HealthLeaders story.
Ensuring patient safety is a top goal at a hospital and a prime responsibility for a hospital CMO.
In this episode of HL Shorts, Thomas Rogers, MD, the new vice president and CMO of Cleveland Clinic Medina Hospital, shares his perspective on promoting patient safety in the hospital setting.
"No matter what we do, patient safety must be paramount," Rogers says. "It starts from the moment a patient checks in at the hospital—making sure we have the right patient at the right time."
View the video below to get Rogers' tips on patient safety. Click here to read the accompanying HealthLeaders story.
The proposed rule would increase the conversion factor used to set physician payments by more than 3%.
The Centers for Medicare & Medicaid Services (CMS) has released the proposed rule for the 2026 calendar year Physician Fee Schedule.
The CMS Physician Fee Schedule (PFS) sets payments for the services of physicians and other healthcare professionals who can bill CMS. The payment policies set under the PFS are for services provided in several healthcare settings, including hospitals, physician offices, ambulatory surgery centers, skilled nursing facilities, and hospices.
Under the PFS, payments are based on the resources required to deliver services. Relative value units (RVUs) are applied for each service for work, practice expense, and malpractice expense. The RVUs become payment rates with the application of a conversion factor.
There are two conversion factors under the 2026 calendar year PFS: a conversion factor for qualifying alternative payment model (APM) participants and a conversion factor for clinicians who do not participate in an APM.
The proposed rule would increase the APM conversion factor by 3.83% in calendar year 2026 as compared to calendar year 2025. The proposed rule would increase the conversion factor for clinicians who do not participate in an APM by 3.62% in calendar year 2026 as compared to calendar year 2025.
The proposed conversion factors include a 2.5% increase included in the One Big Beautiful Bill Act that became law on July 4.
For the first time, the proposed rule for the 2026 PFS would make an efficiency adjustment for some RVUs based on the sum of the past five years of the Medicare Economic Index productivity adjustment percentage, which is calculated annually by the CMS Office of the Actuary. The proposed rule calls for an efficiency adjustment of -2.5% for calendar year 2026.
The AMGA says the one-time 2.5% conversion factor increase established by the One Big Beautiful Bill Act is not a substitute for meaningful reform of the PFS.
"Last-minute congressional interventions to avert further reductions to the conversion factor are unsustainable and obscure the need for lasting structural improvements," the AMGA said in a prepared statement.
AMGA President and CEO Jerry Penso, MD, MBA, called on CMS to modernize the PFS and make payment policy more consistent with value-based care.
"Health systems and medical groups continue to bear the brunt of an outdated and underfunded reimbursement model," Penso said in a prepared statement. "Without systematic reform, Medicare's current fee-for-service framework will remain misaligned with the shift toward high-value care."
In addition to the conversion factor and efficiency adjustment updates, the PFS proposed rule has several other components, including the following:
The proposed rule would create the Ambulatory Specialty Model(ASM). The ASM would hold specialists financially accountable for the treatment of congestive heart failure and lower back pain. The ASM would reward specialists for effective disease management, adhering to clinical guidelines for care, and coordinating care with other providers.
The proposed rule would make significant changes to CMS telehealth provisions. These changes include a proposal to streamline the agency's telehealth services list. Under the proposal, CMS would simplify the process of adding services to the list by removing the "provisional" and "permanent" distinction and focusing the review on whether a service can be delivered via two-way audio-video.
The proposed rule seeks to improve access to behavioral health services, including expansion of digital therapeutics coverage for attention-deficit/hyperactivity disorder.
CMS will accept comments on the proposed rule through Sept. 12.
In a trend across the country, many hospital morgues have been overrun since the first surge of the coronavirus pandemic. Increased decedent release time not only creates a burden for families but also poses an operational challenge for hospitals, which are forced to supplement their morgues with refrigerated trucks.
To combat this issue, NYC Health + Hospitals/Jacobi | North Central Bronx hospital has launched a program to improve decedent release time.
In this episode of HL Shorts, Komal Bajaj, MD, chief quality officer at Jacobi | North Central Bronx hospital share the three primary elements of the hospital's Compassion for the Community: Continuing Care after Death program.
Click on the video below to see Bajaj discuss the program. Click here to read the accompanying HealthLeaders story.
Improved access to care is the most significant value associated with telehealth services, this new chief physician officer says.
Telehealth services deliver value for health systems and patients in several ways, according to the new chief physician officer of MultiCare Health System.
Todd Czartoski, MD, was named chief physician officer of MultiCare in June. Prior to being named chief physician officer, he served as president and CMO of the health system's Neuroscience Institute and virtual health service. Before joining MultiCare, he served as chief executive of telehealth and chief medical technology officer at Providence.
First and foremost, telehealth has proved its value in improving access to care, according to Czartoski.
"In the early days of telehealth, there was concern that people of lower socioeconomic status would not have access to a device that could support a telehealth visit," Czartoski says. "But there is data that shows this population may not have much money, but they still have smartphones that can conduct telehealth visits."
Telehealth is helping health systems cope with a growing physician shortage across the country in multiple specialties, including neurology, psychiatry, and primary care. Czartoski uses stroke care as an example.
"If someone has a stroke, having access to a board-certified neurologist or vascular neurologist via telehealth is incredibly important," Czartoski says. "So, telehealth can take specialized expertise and spread it across a geography."
There are more nuanced ways that telehealth delivers value, including patient satisfaction, cost savings, and a better experience for clinicians, according to Czartoski.
"With telehealth, clinicians often do not need a patient to drive two hours for a follow-up visit to collect information, then they can move on to the next patient," Czartoski says.
Traditionally, physicians have seen patients in a sterile environment at a clinic without any context of what is going on in their life. Telehealth generates value by allowing clinicians to get insights into their patients by conducting visits in a patient's home, Czartoski explains.
For example, if a physician sees a patient with gait instability or cognitive decline during a telehealth visit in their home, they can see the status of the home, such as whether there are rugs on the floor or stairs that have to be climbed.
"A physician can see what real life is like for the patient and see whether there are risks in the home," Czartoski says.
Todd Czartoski, MD, is chief physician officer at MultiCare Health System. Photo courtesy of MultiCare Health System.
Identifying and addressing healthcare inefficiencies
CMOs and other leaders can play a pivotal role for healthcare organizations by identifying and addressing inefficiencies and friction points. While identifying inefficiencies, healthcare leaders should rely on frontline caregivers. Czartoski explains that executive leaders should be cautious about weighing in on operational challenges at a healthcare organization.
"I'm a big fan of listening to people who are in the trenches doing the work," Czartoski says. "There is no substitute for talking with as many people as possible about the experience of providing care and any inefficiencies that may be present."
Listening to patients is also important.
"Patients can tell you what is working and what is not working," Czartoski says. "You need to get patient feedback."
In addressing inefficiencies or friction points, there are two initial steps to follow, according to Czartoski.
"First, I try to quantify the size of the problem and the impact that it is having," Czartoski says. "Is a friction point adversely affecting the performance of team members such as doctors and nurses? Is it adversely affecting patients? If we fix a problem, is it going to improve the experience of our staff and patients?"
"Second, you need to look at the level of effort that is going to be required to fix a problem," Czartoski says. "Is the solution going to require a whole new process or new technology?"
With these two steps in mind, CMOs and other healthcare leaders should focus on fixing inefficiencies with solutions that generate high value and require manageable effort, according to Czartoski.
Once the impact of addressing a problem and the level of effort required to fix it have been assessed, there are three steps to take if pursuing a solution is desirable, Czartoski explains.
The first step is to identify a place to launch a pilot program.
"You want to start small," Czartoski says. "For example, if you decide to fix a clinic process, you should pilot the solution in one clinic."
The second step is testing the results of the solution and looking for opportunities to improve it.
"In most cases, the first attempt at a solution is not going to be perfect," Czartoski says.
The third step is scaling the solution once it is working effectively, and the outcomes such as clinical outcomes and quality outcomes have been documented.
"You take the expertise you developed at one site, and you spread the solution to the entire enterprise because you can show that the solution is better for staff and patients," Czartoski says.
Measuring the success of a solution is crucial to scaling it, according to Czartoski. After a pilot is complete and the solution moves to new sites, CMOs must be able to tell the story of how the solution worked.
"You need to be able to show that the solution benefits providers and patients," Czartoski says. "You need to learn from the pilot, then articulate the results to the new sites where you want to apply your solution."
Operating a successful hospital at home program
Czartoski helped lead an effort to design and implement Providence's hospital at home program. The foundation for the program was established with the health system's COVID at Home program during the coronavirus pandemic. The program was so successful that the health system decided to launch a hospital at home program for other high-acuity conditions.
"For us, it was a matter of increasing capacity in our hospitals at a time when we were overflowing with patients," Czartoski says. "We also wanted to create value by finding a less costly location for care, and allowing patients to recover from an acute illness in their home made sense."
Most of the patients enrolled in Providence's hospital at home program came from emergency departments, and the program gave emergency medicine clinicians a new option to care for patients, Czartoski says.
Prior to the hospital at home program, an emergency room clinician had two pathways for patients. If the patient was very ill, they were admitted to the hospital. If the patient was not very ill, they were sent home with a care plan that could include medication and a recommendation to see their primary care provider within a few days.
"Hospital at home introduces a third pathway for patients," Czartoski says. "You may be sick enough to be in the hospital, but we are going to send you home and bring the hospital to you."
Czartoski emphasized that the most important factor for a successful hospital at home program is ensuring that patients are safe, which addresses skepticism among emergency medicine clinicians, patients, and families about treating acute illness in the home.
"We had to be very thoughtful about creating a hospital at home program from a change management standpoint and doing it safely," Czartoski says.
In a hospital at home program, patient safety starts with enrolling patients selectively, according to Czartoski.
"You want to be thoughtful about who you are choosing to be admitted to the program, [because] it is not for everyone," Czartoski says. "You need to select patients depending on the severity of their condition and their medical history."
The Providence hospital at home program promoted patient safety by having at least one nurse visit for the patients in the home on a daily basis as well as having physicians available to visit patients in the home in person or virtually. Patient monitoring was also a key component, Czartoski explains.
"You can measure patients' oxygen status, blood pressure, and heart rate," Czartoski says. "For congestive heart failure patients, you can monitor their weight to make sure they are not taking on too much fluid."
Patient safety for a hospital at home program also includes having a mechanism in place to get patients to a hospital quickly if necessary, according to Czartoski.
"We had rapid ways of transporting a patient back to the hospital if hospital care was required, which was relatively rare," Czartoski says. "Over 95% of the time, patients did fine at home."
The primary elements of physician development include effective onboarding, education, and mentorship, this new hospital CMO says.
CMOs and health systems need to be intentional about physician development, according to the new CMO of two Oklahoma-based SSM Health hospitals.
Mike Angelidis, MD, was recently named CMO of SSM Health St. Anthony Hospital-Midwest and SSM Health St. Anthony Hospital-Shawnee. He previously held leadership roles at Tulsa, Oklahoma-based Saint Francis Health System, including serving as system medical director of hospitalist services.
"When we talk about physician development, the first thing to note is that healthcare organizations and leaders need to be invested in education," Angelidis says. "Organizations and leaders need to invest in medical schools, residencies, and fellowships."
At SSM Health for example, the health system supports physicians who want to enroll in continuing medical education and degree programs.
"If you are a physician and you want to get an MBA, SSM will help support pursuing that degree with funding," Angelidis says.
Physician development starts with a strong onboarding program, Angelidis explains.
"You need an onboarding process, so when physicians come into your organization, they understand what they need to do to succeed in your organization," Angelidis says. "In addition, as part of the interview process, you want to make sure that you are bringing in physicians who can help build the culture you are trying to achieve."
A good onboarding program helps lay the foundation for physicians to play leadership roles in the organization, according to Angelidis.
"In that respect, you need to have an onboarding process that focuses on culture," Angelidis says. "You need to emphasize the culture of your organization and make sure that physicians are aligned with your mission and values."
Other elements of a good onboarding program include training in the electronic medical record and connecting physicians with a mentor in their specialty, Angelidis explains.
A building block for physician mentoring and coaching is building trust, according to Angelidis.
"You must have two people who want to be engaged in a mentoring relationship," Angelidis says. "As a mentor, it is important to show vulnerability, which helps to build trust."
A mentor should help establish goals for the person they are mentoring, Angelidis explains. With trust and goals established, a mentor should cultivate the relationship with a growth mindset to help mentees continually improve.
"If the goal is clinical, you can encourage a mentee to grow as a clinician," Angelidis says. "If the goal is leadership, you can encourage a mentee along that path such as joining committees and pursuing education in hospital management."
Mike Angelidis, MD, is CMO of SSM Health St. Anthony Hospital-Midwest and SSM Health St. Anthony Hospital-Shawnee. Photo courtesy of SSM Health.
Succeeding in quality improvement
Promoting quality improvement is one of the most rewarding aspects of being a CMO, according to Angelidis.
"You can impact a process. You can improve workflows and the satisfaction of your frontline staff," Angelidis says. "You can improve aspects of quality that impact thousands of people."
There are essential steps in starting a quality improvement project, Angelidis explains. When developing a quality project, the first step is determining the purpose of the project and the ideal end state.
"Then you need support from your organization," Angelidis says. "You need to make sure that the goals you are setting for the project are aligned with the mission and values of the organization."
Once the foundation for a quality improvement project has been set, CMOs and project leaders need to look at how they are going to attack the problem that the project is designed to solve, Angelidis explains.
"You want to determine the data that you need for the project to be successful," Angelidis says. "You want to determine whether there is going to be a single leader guiding the project or a group guiding the project. You want to determine the key stakeholders or champions who are going to help deliver whatever you are trying to accomplish."
CMOs and other healthcare leaders also need to be systematic in choosing an approach to a quality improvement project, according to Angelidis.
"You need to set key performance indicators," Angelidis says. "You need to set a clear path to the ideal state—you try to predict how long it will take to implement a project, set check-ins to monitor progress, and look for early wins."
Transformative leadership
A primary skill for CMOs is transformative leadership, Angelidis explains.
"Transformative leadership involves being the kind of leader who takes people on a journey," Angelidis says. "A transformative leader is someone who has a vision and has the ability to get people behind the vision to accomplish it."
Transformative leadership requires the ability to build relationships, according to Angelidis.
"You must be able to identify the key relationships," Angelidis says. "For example, if you are trying to expand a service line, you must be able to identify who the key players are and the players you need to have a relationship with, so they can believe in your vision."
A transformative leader needs to be a good communicator, Angelidis explains.
"Transformative leaders need to be able to communicate their vision and why it is good for the organization," Angelidis says. "They need to be able to communicate the end goal."
Just like a good physician mentor, transformative leaders have a growth mindset, according to Angelidis.
"A growth mindset includes the ability to think about how you can grow as a leader and how you can look at a problem and come at it with a different angle," Angelidis says.
A New York City hospital has reduced decedent release times with an initiative that includes strengthening community partnerships and providing key information to grieving families.
In a trend across the country, many hospital morgues have been overrun since the first surge of the coronavirus pandemic. Increased decedent release time not only creates a burden for families but also poses an operational challenge for hospitals, which are forced to supplement their morgues with refrigerated trucks.
Average decedent release times have increased from about three days before the coronavirus pandemic to as long as two weeks since the pandemic, according to Komal Bajaj, MD, chief quality officer at NYC Health + Hospitals/Jacobi | North Central Bronx, a hospital with two campuses.
To combat this issue, Jacobi | North Central Bronx hospital has launched a program to improve decedent release time. Jacobi | North Central Bronx hospital's Compassion for the Community: Continuing Care After Death program has reduced average decedent holding time from 13 days to five days.
View the infographic below to learn about the three primary elements of the program. Click on this link to read the accompanying HealthLeaders story.
Healthcare leaders can employ a range of strategies to ensure that patient safety is not compromised when care teams are stretched thin.
Inadequate staffing poses a challenge for maintaining patient safety, whether there is a shortage of staff or patient volume increases and puts pressure on provider-patient ratios.
Patient safety, including avoidance of hospital-acquired infections, is a top priority for health systems and hospitals. But what happens when a care team staff is understaffed?
In this episode of HL Shorts, Kevin Post, DO, CMO of Avera Health, gives his perspective on maintaining patient safety when patient volume increases and strains provider-patient ratios.
Click on the video below to see Post share his views.
To reduce readmission rates, hospitals must consider several factors such as standards for length of stay, medication management, and discharge planning, this new CMO says.
Hospitals need a multi-pronged effort to reduce readmission rates, according to the new CMO of the Orlando Health East Florida Region.
Michael McLaughlin, MD, was named CMO of the Orlando Health East Florida Region in June. The region includes Orlando Health Melbourne Hospital and Orlando Health Sebastian River Hospital. Previously, McLaughlin held several leadership positions at Orlando Health, including serving as CMO of the health system's hospital division.
Hospital-based care is complex, so reducing readmission rates requires a team approach, according to McLaughlin.
"You need team-based care that includes the physician, the nurse, and pharmacy staff," McLaughlin says. "You need to move the patient through a process of care and make sure there is a discharge plan, which should begin soon after a patient is admitted to the hospital."
To reduce readmission rates, hospitals should follow standards for length of stay, McLaughlin explains.
"For every patient that comes into the hospital with a condition or set of conditions, there is a recommended length of stay," McLaughlin says. "We know what the length of stay should be, with a plan of care and early attention to forming a discharge plan."
Exceeding the recommended length of stay poses risks for patients, including falls, medication errors, and hospital-acquired infections. These risks can contribute to readmissions, McLaughlin says.
Before a patient is discharged, care teams need to work with the family, so they know what to look for as far as recurrence of symptoms in the home. If there is recurrence of symptoms, the family can connect the patient with their primary care physician, which can avoid a hospital readmission, McLaughlin explains.
Ensuring that patients have their medications at discharge can limit hospital readmissions.
"Orlando Health has a Meds-to-Beds program, where medications are delivered to a patient's hospital room before they are discharged," McLaughlin says. "What we have found in the past is that patients may not get their medications after discharge because neighborhood pharmacies are closed by the time the patient gets home."
Hospital care teams need to make sure that a patient knows the medications they are taking and knows how to take them, McLaughlin explains.
"Patient compliance with medications is a huge part of avoiding readmissions," McLaughlin says.
Hospitals should have a transition care team, which helps manage patients after hospital discharge, according to McLaughlin.
"The transition care team makes sure that the patient gets follow-up appointments with their primary care physician or specialists such as cardiologists," McLaughlin says. "Follow-up appointments should be held between 72 and 96 hours after hospital discharge."
Finally, patients should know who to call if they are having a problem after discharge, McLaughlin explains.
"For example, we want congestive heart failure patients weighing themselves at home on a daily basis," McLaughlin says. "If they start to see their weight is going up, they should call the transition care team to help manage the situation such as contacting the primary care physician or cardiologist to help avoid them coming back to the hospital."
Michael McLaughlin, MD, is CMO of the Orlando Health East Florida Region. Photo courtesy of Orlando Health.
Improving operating room efficiency
McLaughlin's clinical background is in general surgery, including practicing as a general surgeon at Cape Canaveral Hospital for 28 years. Just as in the case of avoiding hospital readmissions, teamwork is essential to boost operating room efficiency, according to McLaughlin.
"It involves the surgeon, anesthesiologist, nurses, scrub technicians, anesthesia technicians, registration staff, pre-operative testing, and transport staff," McLaughlin says. "The transport staff plays an underappreciated role in getting patients in and out of the operating room in a timely manner."
Turnover teams are essential for operating room efficiency, McLaughlin explains.
"You need a team to move the patient to the recovery unit. You need a turnover team to clean the room before the next patient," McLaughlin says. "An operating room can be down for as long as 40 minutes as the operating room is prepared for the next patient."
One strategy to reduce operating room turnover time is to schedule the least complicated cases to a particular set of operating rooms, so the anesthesia tech, scrub tech, and inter-operative nurse can play a key role in turning over the operating rooms quickly, according to McLaughlin.
"Turning over an operating room is an involved process," McLaughlin says. "You need to remove all of the instruments from the previous case, and all of the instruments must be counted. This process is quicker with the least complicated cases."
How CMOs can balance priorities
A CMO must walk a fine line between promoting clinical care on the one hand and financial considerations on the other hand, McLaughlin explains.
"A CMO must navigate between patient care and the objectives of the business because a hospital that is not doing well financially will ultimately impact the community because the hospital is not going to survive," McLaughlin says.
For example, a physician may want a new robot, and the CMO must weigh the costs and the benefits, according to McLaughlin.
"A CMO needs to look at how much the robot costs and whether there is a true benefit to the patients," McLaughlin says. "If the finances do not make sense and there is no added benefit to the patients, the answer is going to be 'no' as long as there is an alternative that is just as good."
For a CMO, balancing clinical care with financial realities is part of the job, McLaughlin explains. CMOs are responsible for evaluating the clinical aspects of new procedures, new devices, and new technology.
"One of the considerations is whether any of these things benefit patients," McLaughlin says. "Another consideration is the finances, because without the hospital being financially stable the healthcare is going to suffer."
Andy Anderson, MD, MBA, is executive vice president as well as chief medical and quality officer at RWJBarnabas Health. Photo courtesy of RWJBarnabas Health.
Christopher Freer, DO, is senior vice president of emergency and hospitalist medicine at RWJBarnabas Health. Photo courtesy of RWJBarnabas Health.
Todd Czartoski, MD, is chief physician officer at MultiCare Health System. Photo courtesy of MultiCare Health System.
Michael McLaughlin, MD, is CMO of the Orlando Health East Florida Region. Photo courtesy of Orlando Health.