Publish Date: September 25, 2019
Working within a highly competitive marketplace for surgical volume and surgeons in Dallas/Ft. Worth required perioperative leadership at Baylor University Medical Center in Dallas to take a fresh look at ways to attract cases, improve satisfaction, and advance safety, according to Patricia DeFrehn, DNP, MBA, RN, NEA-BC, vice president of surgery and neuroscience.
In 2014 DeFrehn and colleagues explored human factors research and found that team consistency is key to operating room communication and patient safety. This consistency was not always the case in the large academic medical center with 1,000 beds, 50 surgical suites, 13 OR service lines, and close to 21,000 high acuity cases annually.
“We knew we wanted to give the surgeons and staff an experience in which they could have the personalization of an ambulatory surgery setting but at the scale and safety of an academic medical center,” DeFrehn shares.
So, they developed a pilot program in 2015 to create surgeon specific teams (SSTs) in which a complete OR team, including surgeon, anesthesia care provider, circulating nurse, surgical technologist, and ancillary surgical technician always work together. These SSTs soon moved beyond the pilot phase and remain an important part of the surgical care approach at the facility.
The SST program includes a financial quality incentive awarded for optimal care that meets all established requirements, which is now included in an overall compensation plan. DeFrehn says this quality incentive program is beneficial for the teams, but the real value is in the strong collegial bonds these teams have established that help them to provide the best care for their patients.
A Closer Look at Surgeon-Specific Teams
DeFrehn shares several key aspects of the established SSTs in her facility, including the following:
- Each SST must achieve set quality and safety metrics for multiple aspects of care delivery to earn the financial incentive, including: 100% first case on-time start, best in class turnover time, team consistency 90% of the time, no SSI, CLABSI, or CAUTI , and no sentinel events. “We are very strict on teams achieving each of these metrics and being accountable to each other—if a member of the team is late to a case, the entire team loses out on the quality incentive for that day.”
- SSTs are only for block surgeons.
- SSTs are set up for very specific types of procedures, such as orthopedic oncology. “We found that just trying to organize teams by service line is not enough, we had to be very specific to keep up with team expertise and case demand in specific areas.”
Some of the top reasons SSTs are maintained at DeFrehn’s facility is that the retention rate is better for these surgical teams, with the highest rate of surgeon satisfaction, she shares. Additionally, case volume is up, as is quality, while case costs are down for these teams.
“SSTs also contributed to our elimination of agency costs over an 18-month period,” she notes.
Considerations for Implementing Your Own SST
DeFrehn cautions that SSTs are not for every facility. “SSTs may not be needed at a smaller facility that already has team consistency.”
She believes SSTs work best for larger hospitals with a wide variety of cases and range of expertise in specialized surgical areas.
For those working in a large health care center ready to implement their own SST model, she offers these suggestions:
- Base your approach on human factors—Choose team members who want to work together. This improves communication and therefore, patient safety. Teams may need to be reorganized in order to get the right personalities working together, she adds.
- Have metrics to measure quality and easily share results—“I suggest leaders create their own database to measure SST quality achievements so you have good data to track—not just a spreadsheet on someone’s computer but something you can easily manage and share.”
- Use safety and experience improvement as goals—SSTs are for growing programs and retaining those nurses as well as surgeons for the scheduled block cases. “It really comes down to creating consistency, which creates a better working environment.”
Often when DeFrehn shares the developments with her facility’s SSTs with other perioperative nurse leaders, they ask to see it in action, but you can’t see it, she explains. “When these teams are successful, it’s invisible to see and that is by design. They have the autonomy to make their own decisions, and they just work so well together.”
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