Surgical Productivity Unveiled: A Call to Action for Hospitals and Policymakers
Jean-Pierre Eskander
Deploying Advanced Business Science (AI/ML) to Transform Health System Operations
The recent announcement by the Ontario Government to expand the role of private surgical centers has ignited discussions about the potential impact on healthcare and Ontario Hospitals. However, the real elephant in the room may not be the introduction of private facilities but rather the underutilization and productivity challenges faced by existing surgical centers.
As someone deeply involved in healthcare innovation and transformation, I recognize the need for both within-the-box and out-of-the-box solutions to alleviate the strain on hospital surgical centers.
While considering innovative approaches, it's essential to address the current underutilization issue within these centers, operating at a mere 70% utilization rate.
This raises critical questions about efficiency, resource optimization, and the overall sustainability of our healthcare system.
Private Surgical Clinics: The Productivity Wild Card
Private outpatient surgical centers are being explored as a potential solution to the productivity challenges faced by existing surgical centers. These specialized clinics, designed for high-volume procedures such as cataracts, joint replacements, and endoscopies, have demonstrated impressive efficiency gains. However, their deployment comes with unintended consequences, particularly in a geographically dispersed system like Canada's, potentially exacerbating service inequality between urban and remote communities.
While private clinics offer benefits such as workflow optimization and elimination of variability, their proliferation may lead to increased complexity for existing surgical centers. The shift of complex cases back to these centers, coupled with reduced funding and heightened staffing demands, paints a challenging picture for traditional hospitals.
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Bridging the Productivity Gap: A Call to Action
The bright side is that hospitals are recognizing the need to improve productivity within existing surgical centers. The underutilization of staffed hours, costing $20/minute, is a clear economic incentive to improve productivity. To address this, Ontario hospitals can leverage existing 'Pockets of Excellence' and scale best practices to enhance surgical department efficiency. This approach allows for improvements in patient care, reduced wait times, boosted staff morale, and the establishment of a financially sustainable healthcare system. The main drivers of productivity improvements in surgical centres are:
Pockets of Excellence: A Glimpse into Possibilities
Reviewing 89 orthopedic surgical sites in Ontario that conduct 160,000 procedures yearly uncovers performance differences among providers. The range in some of the basic operating metrics (See Chart Below) shows the size of the opportunity when scaled across all providers and other surgeries. While no single hospital excels in all metrics, each demonstrates excellence in specific areas. Scaling these 'Pockets of Excellence' across programs and hospitals could potentially triple or quadruple the volume of surgeries within existing operating hours and staffing models - see Breaking Barriers: How One Hospital Redefined Surgical Efficiency.
A Comprehensive Approach to Future Success
To achieve these outcomes, a comprehensive approach is essential, encompassing technology adoption, process optimization, and collaborative strategies. Anticipating the current burning platform, many hospitals now have the opportunity to transform productivity and safeguard themselves, staff, and patients from the unintended consequences of more specialized surgical clinics.
Co-Founder, Chief Operating Officer at Canadian Ambulatory Surgery Centres Inc
10 个月The reality is the Ministry of Health decides where procedures can be done, in hospital or out of hospital, by controlling fees paid. The Ministry provides an annual operational budget to each of our hospitals. Cost of any surgery at the hospital comes out of that budget, and hospital admin decide how to allocate its funds between the various surgery departments. This covers the facility costs and consumable costs of surgery. The surgeon is paid a professional fee from OHIP.? The Ministry DOES NOT provide funds to cover the costs of surgery in a non-hospital setting (except in a very small number of Independent Health Facilities - IHF, of which there are fewer than 10 in the Province that perform actual surgery - not including endoscopy). You are absolutely correct that your ulnar nerve surgery would have been more efficiently performed out of hospital. But if the surgeon wanted to do your ulnar nerve or carpal tunnel or knee arthroscopy, hernia repair, out of the hospital, the cost of the surgery, the nurses' salary, sterilizing the instruments, anaesthetic drugs, sutures, drapes, would all come out of the surgeon's professional fee, which is $150 for a carpal tunnel release, and $215.35 for the ulnar nerve decompression.? Then deduct rent, utilities, office staff, insurance, and there's not much left. That's why so little surgery is actually done outside hospitals, except for private pay, uninsured surgery such as cosmetic, dental, weight loss surgery. Bill 60, if done correctly and with proper oversight, would eventually provide this facility funding outside hospitals and could make surgery much more efficient and accessible.?
Co-Founder, Chief Operating Officer at Canadian Ambulatory Surgery Centres Inc
10 个月The problem is that Ontario hospitals have no real incentive to change or improve. There is a financial incentive to do more hip and knee replacements because these receive additional, direct funding from the Ministry of Health. Most other surgeries are not funded this way and hospitals lose money on each surgery they do. There are currently no accountability outcome measures across the province and no real financial or reputational consequences to inefficiency, except bundled payment procedures such as hip and knee replacements, and some arthroscopies, which are tracked by the province. That's why almost all "efficiency" studies look at hip and knee replacements. No one is talking about the 3 year wait times for bladder incontinence surgery, or the 1 to 2 year wait time to consult specialist surgeons. I've been a surgeon here for over 20 years. Let's have a conversation with the surgeons and anesthesiologists who actually understand how surgery is funded and prioritized. We don't have a true healthcare "system" in the province. Access, standards and outcomes are not uniform. Rather, we have a provincial health "insurance system" but care is delivered by over 140 independent, stand alone hospitals, each setting its own standards and protocols.
Over 60 years in Residency and Practice
10 个月Had my ulnar nerve compression repaired in the hospital. No reason why it could not be done in an office
Venture Capital | Executive MBA
10 个月Thanks for sharing . I was surprised to learn inaccurate surgery time estimations is part of the problem!