Delighting Patients in Day Surgery

Day Surgery is rapidly becoming the default pathway for elective surgery. But in the pursuit of hyper efficiency it is crucial that hospitals keep the patient journey central to the structuring of their operations. In this article we explore how Delight Thinking can open multiple opportunities, both immediate and longer term, for optimising the patient experience and patient outcomes.

Day surgery has come a long way since its founding father, James H Nicoll, reported in 1909 in the British Medical Journal that he had performed 8.988 operations on an outpatient basis in a Glasgow clinic. Today, thanks to advances in anaesthesia and surgical techniques, day surgery has become the standard pathway for an increasing range of routine but also increasingly complex procedures.?

The Rise of Day Surgery

The practice developed rapidly, firstly in the US and UK during the 70s and 80s and later worldwide. By 2001 the UK government had already set the?ambition?that 75% of elective surgery should be performed on a day case basis, and in 2019, the UK’s Association of Anesthetists (AA) and the British Association of Day Surgery (BADS) suggested a full?paradigm shift?towards day surgery – meaning that “if inpatient surgery is being considered, it is important to question whether any strategies could be employed to enable the patient to be treated as a day case.”??

Over the past 20 years, day surgery has taken off across Europe, Canada, Australia and Asia, as?evidence?mounts that day surgery is on the whole better for:

• Patients: shorter waiting times, less risk of hospital infections, less stressful for patients and higher patient satisfaction
• Hospitals: efficient scheduling, efficient use of capacity, numerous cost savings?
• Payers: containing?costs

Looking ahead, day surgery centers will likely further streamline their operations, relying on a new breed of digital solutions that are focused on optimizing operations using advanced data analytics (e.g.?DEO,?CareSyntax), benchmarking (e.g.?SpecialityCare), process simulation (e.g.?FlexSim,?Simul8) and workflow orchestration (e.g.?MySphera).?

Already many day surgery centers are adopting the principles of modern factory assembly lines where hundreds of patients are processed daily in highly efficient workflows where not a minute of physician or machine time is wasted. While that is mostly good news, there is a danger that in the pursuit of ever more efficiency, we lose sight of the patient’s perspective and experience. As the time spent on each patient continues to shorten, there is a risk that clinics cannot properly accommodate patients’ need for information and support across their patient journey – which is far longer than the declining minutes they spend in the day surgery center. Such support is crucial to addressing the intense?anxiety?that many surgery patients experience, which in turn is associated with post-operative pain and poor patient?satisfaction.?Fortunately, creative use of digital (and non-digital) tools can enable clinics to radically extend the time they care for patients, in a virtual sense, and thereby create opportunities to truly surprise patients with ‘delight’ in the patient journey.

Delight Thinking applied to the Day Surgery

At Healthskouts, we recently had the pleasure of working with a regional hospital to apply our Delight Thinking methodology to their new Day Surgery center. In brief, we use a combination of technology scouting, literature screening, stakeholder interviewing and creative ideation methods to map and envisage the patient journey, in detail at every step, from 5 different perspectives:

1. Activities: description of the patient’s activities in this step
2. Frictions: the pain points from the patient’s perspective. What is difficult, cumbersome or painful?
3. As-Is approach: how the clinic is currently addressing – if at all – the frictions
4. Pragmatic improvements: concrete, practical solutions that could be implemented in the short term
5. Future inspiration: what could be feasible in the mid- to long term and should on the radar of the clinic’s management

By using this approach we were able to present a menu card of opportunities for improvements in every step in a multipronged patient journey.?

To illustrate how this works I’ll zoom into one step of a typical Day Surgery patient journey: the consultation with a specialist or surgeon where the decision is made to schedule the procedure.?

Frictions

Common?frictions?for the patient in this step could include:

• Mental frictions: the patient is likely concerned and worried about his or her condition and the procedure. He or she may also feel uncertain and be in need of information about the procedure and how he or she can best prepare.??
• Task frictions: possible waiting times for the appointment and in the waiting room immediately before the appointment. Also potential additional appointments for pre-op assessments.
• Medical frictions: is the specialist fully aligned with the working principles of the Day Surgery? Is the medical decision based on evidence-based clinical guidelines or on the idiosyncratic opinions of the individual physician? Will the patient undergo a thorough pre-operative assessment to minimise the risk of complications??

As-Is Situation

In the?As-Is?situation, the patient may firstly experience long and unpredictable waiting times. During the consultation, the physician may provide the patient with a brief explanation about the procedure (in the confines of a 15-20 minute consultation) and send him or her home with a written set of instructions about medication and fasting, and possibly a brochure about the workings of the Day Surgery. The patient may also be unaware that the decision to operate – or not – was not based on evidence-based clinical guidelines and that had she seen another physician another decision might have been taken.??

Pragmatic Improvements

Applying our Design Thinking methodology to this scenario, we can systematically address every friction, exploring & co-creating novel solutions to improve the care process in this step. Here is a selection of “pragmatic improvements” that we would recommend in this scenario:

• Reduce and manage?waiting times?by preparing the patient better for his or her appointment, to avoid delays or no-shows, and avoid unexpected issues that may lead to longer appointments. Patient Engagement platforms can be used to send patients multiple reminders about their appointment and a solution such as?Bingli?can be used to kick off the medical interview at home before the consultation. Screens in the waiting room that show expected waiting times can reduce the perceived waiting time and reduce frustration.?
• Provide a detailed,?visually engaging brochure?(print and web) about the Day Surgery, covering topics such as “a look inside” the Day Surgery, physician profiles, explanations about common procedures, how to prepare for surgery and recovery.?
• Refer patients to a?Fit4Surgery?or?prehabilitation programme?to help patients get physically and mentally prepared for their surgery. Such programmes have been?shown?to reduce costs and get patients home faster.
• Provide a?procedure-specific booklet?(print & online) with detailed and visually engaging information about the specific procedure, with lists of tips, to do’s and reminders. Such a booklet could also be used by the patient and healthcare provider to make notes and provide specific advice (similar to the pregnancy booklets that many maternity health clinics give to their patients). Also, the patient could be provided access to a?digital care path companion?(e.g.?Buddy Healthcare) that guides the patient along the entire patient journey.
• Give the specialist access to a library of?medical visuals and video, so that he or she can better explain the procedure.?
• Ensure the patient undergoes a systematic, thorough?pre-operative assessment?with a trained nurse, immediately after the consultation, and ideally inside the Day Surgery center, so that the patient can become familiar with the environment.
• Ensure the physician relies as far as possible on?evidence-based clinical guidelines, by for example integrating such decision support tools in the electronic medical record. For full transparency, the patient could also be informed that the decision they made together was guided by a clinical guideline.

Future Inspiration

Looking at?Future Inspiration, Day Surgery centers should consider the following opportunities to take a leadership position in creating patient delight:

• Provide the patient with access to a digital care path companion that provides highly personalised educational content, appointment reminders, medication and diet instructions, and pre and post-op questionnaires. Future surgery-specific Patient Engagement platforms that utilise mixed reality user interfaces (such as digital humans/holograms) could, in this way, serve as?digital extensions of the physician?providing a virtual presence across the patient’s entire journey.?Looking ahead we expect such platforms to become increasingly intelligent (AI-driven) and engaging, and include a wide range of customisable “fit4surgery” programmes.
• Design the recovery room using inspiration from 1st class airlines seats, where patients have access to?personal pods?with adjustable beds, personal multimedia setup, soft lighting and non-cumbersome continuous monitoring.
• Let the physician use?mixed-reality tools?(e.g.?Brainlab’s AR tools) to explain the procedure to the patient in a super-immersive manner.
• Use?AI-based risk assessment?software to analyse patient data (combining data from the patient’s full medical record and data collected through pre-operative questionnaires) to assess the risk for complications (e.g.??Kela Health) and thereby enable pre-emptive interventions to prevent such complications.

These recommendations apply to just one step in what is typically a multipronged patient journey (e.g. general vs local anaesthesia), but it illustrates how a Delight Thinking approach can deliver a broad menu card of opportunities for systematically improving the patient’s Day Surgery experience, both in the short and mid- to long term.?If in the years ahead we keep our focus on the patient’s experience and outcomes, the better analogy for the Day Surgery will not be the factory assembly line but a pitstop in a Formula 1 car race.

This article is also published at healthskouts.com.