On November 10th, I published Part 4: Hospitals Need Product Managers-Pathologists in a series of my own personal experiences and the need for leaders in healthcare to think differently. Part 3 and 4 highlighted the importance of radiologists and pathologists in confirming if a patient has or does NOT have cancer.
Part 5 is going to focus on another team member, the surgeon.
As I stated in Parts 1-4 of Hospitals Need Product Managers, again I took the time to understand the role of the surgeon in the care of the patient, both before and after a patient is told that they have cancer.
As you expect, I found a lot of the same findings. A lot of calls. A lot of paper. A lot of information traveling between physicians, labs, clinics, hospitals, and patients. Many times the information did not arrive at the same place, at the same time, and rarely was all of the information complete.
There was frustration with some of the surgeons due to scheduling of the operating suites, office visits, and clinic hours. I discovered the added pressure on surgeons to travel between their own offices, outpatient clinics, and the hospital to perform surgeries. Some of the metrics that surgeons were being measured on such as number of patients/day, surgical procedures, surgical times, inpatient stays, and readmission rates were not always directly related to clinical guidelines or patient experience. There was also an overwhelming feeling of “control or responsibility” for directing the patients care.
When we spoke to other members of the healthcare team and patients about surgeons we heard similar comments. Some nurses and physicians were very proud of the surgeons but mentioned the difficulty in accessing. Many patients and families said that they chose their surgeon based on “reputation” but felt that they couldn’t “bother or ask for additional time” because they were always so busy. We heard from many stakeholders that many times their conversations were interrupted by beepers, pagers, calls, or knocks on the door.
Another aspect that I had to take into consideration was that the surgeons were in private practice.
In sharing the findings with the various surgery groups they were all in agreement.
We began with the end in mind, that we were building a team that produces the right care, at the right time, for the right person, in an easy to understand and accessible manner. Our team produces care for patients diagnosed with cancer.
We worked with the surgery groups and placed all of the insights into one of the 3 buckets:
We then began to prioritize which insights had the biggest impact and the amount of work it would take to accomplish each task. The criteria was that the impact had to be felt by our customer(s), the patient. If it was not directly impacting a patient, then the next priority were the other members of the team.
We placed it on an impact effort matrix. It looked something like the below matrix:
We made changes in scheduling. For example, in most schedules a patient is assigned to a block of time. In all of the offices, we saw that a patient would be scheduled for 1.5 hours. This would appear on the surgeons schedule, but the surgeon knew they were only needed for 30 minutes, so they would go ahead and allow themselves to be double and triple booked.
We ended that practice.
Each member of the surgeons team, that had a job to play in caring for the patient during a 1.5 hour appointment time, we scheduled specifically to that patient. For example, an appointment begins at 10am with the lab technician drawing blood. At 10:10 the nurse is scheduled for 30 minutes to do their intake and education. At 10:35 (5 minutes of overlap) the surgeon is scheduled for their 40 minutes (an additional 5 minutes of overlap on the end of their time) until 11:15. The nurse spends the last 5 minutes with the surgeon as overlap to ensure questions are answered and next steps are articulated. The last 15 minutes of the appointment are with either the scheduler or navigator to coordinate the next steps as agreed by the patient and surgeon. (there may be additional time for financial counselor and others, but this is the shift we made in the schedule)
In making the changes to the schedule, we could begin to schedule time for the surgeons to dictate, prepare for their patient appointments, surgeries, calls to other team members, and travel time. We could begin to lay out the full day for the surgeon and coordinate care.
Another outcome we wanted to facilitate was the surgeons ability to participate in prospective multidisciplinary conferences for patients diagnosed with cancer.
Historically there was a push for surgeons to rush patients to the operating room. Based on market insights, patients and referring physicians felt that it was too fast at times. We implemented recurring multidisciplinary (MDC) meetings conducive to surgeons schedules and allowing the team to provide treatment options and information back to patients and families within 3 business days or less.
On days in which surgeons had office hours we held MDC meetings onsite. We developed a framework to allow surgeons to have their own office space, shared, to see their patients in our facility. When patients choose to do so, they could actually see all of the physician team members in the same room, at the same time, or back to back.
On surgical days, we held MDC meetings remotely. We would be able to share radiology, pathology, medical history, and other viable information in a secure manner that allowed everyone on the team to view, discuss, and have input on the treatment options for patients.
An outcome we experienced was a decrease in overall operating times. We found that the more radiologists, pathologists, and surgeons spent discussing the case that the better prepared the team was for the operation.
Another outcome that benefited the patient was that they had the ability to choose the speed in which they processed their treatment options and went to surgery. If a patient wanted to go quickly, they could typically have an operation within 3 business days. If a patient wanted to take more time, they had that ability too. Patients had a choice.
The surgeons also worked to develop a robust hand off situation with the navigators, or our “coaches.” It allowed the surgeons to still direct and have responsibility over the conversation with their patients, but it allowed the coordination of schedules for surgery, appointments, follow up, and questions to be performed by other team members.
We decreased the amount of calls to the surgeons office. We decreased the number of incomplete medical records prior to a patients office appointment or consultation. We reduced the travel time for surgeons. We alleviated some of the stress on surgeons with less interruptions and allowed more time for direct dialogue amongst physician to surgeons and patients to surgeons.
I believe the biggest achievement came when other surgical groups approached us to become part of the team. Patients within the community began to ask competing surgery groups why they were not able to produce the same level of communication, coordination, and choices that the surgery groups in our team were performing.
We made our investment in understanding what the current challenges were for our surgeons and the perception our patients had about surgeons. In defining the problems we made smart “bets” to produce the care patients with cancer expected.
In order for a surgeon to operate…they first had to participate, coordinate, and communicate.
As always, you can feel free to contact me at: CANCERGEEK@GMAIL.COM or follow me on twitter @cancergeek