OR Manager - August 2019 - 22

Process improvement
Continued from page 21
By putting the CQIT committee review
ahead of the VAT committee review,
time to trial and time to purchase
have been reduced, Dr Aloia says.
" In the 34 items we trialed right before
instituting this process, we had
about a 10% complication rate. This is
typical for new innovations in complex
surgery. In the 46 things we brought in
after CQIT review, however, we couldn't
find one complication, " he says.
In addition, MD Anderson began
using this system to vet new procedures.
As nurses became aware of the
CQIT's process, they could reinforce
safety by asking if a new device or procedure
had undergone an innovation
review before being used.
Furthermore, Dr Aloia notes, each
surgeon has to be trained on the new
device. Only after complete training of
attending surgeons are trainees permitted
to interact with the device, even if
they happen to have prior experience in
using it elsewhere, he says.
In a large healthcare system that used
to accommodate a lot of individuality and
surgeon preference, changing the product
review process has increased both efficiency
and patient safety. " Integrated
review of new products and procedures is
the right thing to do for our patients, and
establishing systems to facilitate review
allows for requests to get into the OR
faster, " Dr Caudle says.
Geisinger experience
Like MD Anderson, Geisinger Medical
Center in Danville, Pennsylvania, is a
leader in healthcare innovation.
Geisinger, an integrated health system
with 13 hospitals in Pennsylvania
and New Jersey, has its own school
of medicine-Geisinger Commonwealth
School of Medicine and Diverse School
of Nursing-and more than 1,000 active
research projects, says Jun Amora, vice
president of enterprise supply chain services
for Geisinger Health.
22
OR Manager | August 2019
Changing the governance structure
" In 2016 we began looking at areas of
variation within our supply chain spend, "
says Michael Suk, MD, JD, MBA, MPH,
FACS, chair of the musculoskeletal institute
in the department of orthopedic surgery
and chief physician officer for Geisinger
System Services. Finances weren't
the primary driver, he says, but it was
clear that reducing variation in the product
review process would be beneficial.
" What worked for one major teaching
hospital was turning into something
cumbersome and challenging as we
brought new hospitals into the system.
Our process innovation made us see
there might be a better way to address
variation across physicians and systems, "
Dr Suk says.
Geisinger's chief executive officer at
that time, David Feinberg, MD, reached
out to Dr Suk for help. " We discussed
redesigning clinical programs along institutes
rather than just service lines, and
we merged 29 different service lines into
seven or eight institutes, " Dr Suk recalls.
" We created a position called chief physician
officer in which I partner with the operations
side to bring a clinician's voice
and insight into process improvement. "
Creating the institutes was seen
as a way to ensure physician engagement,
ownership, transparency of process
and price, and a culture of innovation,
Dr Suk says.
" We aren't trained on supply chain as
medical residents. We're not exposed
to price and process. So we had to go
through a process with our institute leads
to get them engaged and understand why
they needed to play a role in managing
these requests within their institutes and
taking ownership of them, " he explains.
The institute leaders are directly responsible
for the clinical use evaluation
(CUE) process, Dr Suk says. For example,
as the chair of the musculoskeletal institute,
he is accountable for all aspects of
clinical use and evaluation for orthopedics,
such as physical medicine, rehabilitation,
physical therapy, and wound care.
Revamping product requests
Amora says when he
Jun Amora
joined the organization
in 2018, he and Dr Suk
discussed the need for
a process based on
transparency. " We
lacked a way to give requestors
the evidence
they needed, " Amora says. Many
times product requests went through
the CUE process without any literature
search or review of competitive items
in the market, he notes.
" We also needed to ensure we had a
simple enough tool to drive the workflow
that we wanted, " Amora says. " We reoriented
our CUE process to flow through
supply chain review, financial review,
and an institute review. We needed a
technology to drive that process. "
In spring 2018, Geisinger deployed
a web-based product introduction
management system developed by Lumere,
a Chicago-based company. The
tool allowed evidence-based comparisons
of clinically and functionally similar
products.
" We require the clinician (usually
the physician but sometimes other
providers) to put the product request
order in because it makes them go
through the process of learning about
the evidence, " Amora says. The tool
searches a product catalog for evidence
related to that product.
" We set out to build a supply chain
pipeline composed of clinical and nonclinical
projects, in particular one for
surgical specialties. We looked at contracts,
price opportunities, expiration,
high benefit/low effort projects, and
prioritized projects that we knew we'd
get clinical buy-in for, " Amora explains.
They began with shoulder arthroplasty,
a fairly new procedure where a
lot of innovation is occurring. " We've
seen a tremendous growth in the number
of shoulder procedures being done
in our system, " Dr Suk says. " We had
six surgeons doing these procedures,
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