What Is The Correct Staffing Model For An Anesthesia Department? ... The “Best Mix” Of Providers To Maximize Patient Safety And Satisfaction, And Facility Efficiency And Financial Return?

Are The Hospital Treatment Protocols Aligned With The Latest Medical Knowledge?

Do They Improve Patient Care, And Do They Minimize The Cost To The Hospital System?

 C A S E  S T U D Y  1 

Do We Develop A New Service For Patients?

Challenge

Using an FMECA (Failure Mode, Effects and Criticality Analysis, MIL-STD-1629A NOV.24.1980) exercise applied to a given surgery process and patient treatment lifecycle, conducted with the complete clinical team, yielded numerous problems and opportunities for performance improvement.

Determination was made to develop a new, potentially highly profitable service to make it easier to better serve patients and aid in their treatment compliance. The problem was that the undertaking was complex, needed cooperation from ~70 people internally to make it happen, and went unaddressed for 12 months.

Exercise

Analysis - MediTechnix personnel performed an initial business case which isolated and quantified the user populations, interviewed pertinent service line heads to determine the application of this new service for their patients, developed a competition SWOT analysis, and conducted a pro-forma analysis which demonstrated very high gross margin contribution. Working backwards from available meds available under the requisite certification, through extensive interviews with service line directors and CTCs, 12 Patient Populations were identified. The Business Case was approved by Chief Operating Officer within 15 minutes of receipt.

Implementation - Isolated, directed, and worked with Subject Matter Experts from both clinical and support services, and senior administrators to develop (1) Required Certifications, (2) Project Plan, (3) Standard Operating Procedures, (4) Computer Configurations, (5) Accounting Treatments, (6) Delivery Mechanisms, (7) Risk Management and Stabilization Strategies, (8) Personnel Responsibilities, Authorizations, and Performance Measures, (9) Managed and ensured accurate submission for requisite $275 MM surety bond, (10) others, which were required to make this undertaking a reality, and make it sustainable.

Result

MediTechnix personnel’s’ SWOT (Strengths, Weaknesses, Opportunities, Threats) and other strategic analyses demonstrated that the new service could (was feasible) and should be undertaken to increase (1) patient outcomes through better treatment compliance, (2) patient satisfaction, (3) and enormous gross margin contributions to the hospital.

MediTechnix personnel designed complete implementation strategy to make this new service a reality.

  C A S E  S T U D Y  2 

Do We Forgo A Certain Service Line Because It Appears To Be Unprofitable?

Challenge

Determination of whether to keep a high-profile service due to uncertainty whether it was a net positive economic contributor to the hospital. Per conventional wisdom, it appeared to administrators as though it made 2 discrete gross margin contributions to the hospital.

Exercise

MediTechnix personnel performed a necessarily detailed and complex economic assessment of the service and determined there were actually 19 gross margin contribution events that occurred with the delivery of this service. Thus making it one of the highest gross margin rates contributors out of any service conducted within the hospital.

In order to aid adequate communication of the actual economic effects, a simulation model was developed which clearly showed the differential between the incomplete and complete accounting cases.

Result

MediTechnix personnel’s analysis prevented a gross multimillion dollar strategic mistake from occurring.

  C A S E  S T U D Y  3 

What Is The Correct Staffing Model For An Anesthesia Department; The “Best Mix” Of Providers To Maximize Patient Safety And Satisfaction, And Facility Efficiency And Financial Return?

Challenge

Anesthesia departments are often a mix of anesthesiologists, anesthesia residents, certified registered nurse anesthetists and student nurse anesthetists. The ratio of these resources is most times set arbitrarily rather than based upon financial models or other objective methodology. Questions answered through the exercise included…

• Should specific service lines be staffed differently based on cost and revenue?

• What is the correct mix and schedule of cases that will maximize patient satisfaction, and the hospital’s financial return?

• For academic departments, how should residents be allocated to maximize the department’s academic mission?

• What is the “ideal” number of trainees for a specific department?

• Should additional personnel be recruited?

• How should an anesthesia department negotiate support for additional anesthesia sites or new service lines?

• What type and amount of financial support will be needed?

Exercise

MediTechnix personnel worked with the anesthesia department to develop a full cost accounting model and pro-forma model for the Department. This model included full costs for the Department’s current labor resources, personnel allocation, service scheduling, financial and growth projections. We also detailed the Department’s revenue obtained from each service line that utilized anesthesia services. Next pro-forma models were executed to show the financial impact of different staffing models for different service lines. From these models, specific models of anesthesia resources were developed with the resulting financial implications for each service line. Models were also created to validate and monitor the cases available for trainees.

Result

From this model the new service line was able to increase resource utilization, patient satisfaction and throughput by more than 30%. This led to significant increases to each Department’s finances. The process was also implemented in a more efficient timetable than similar prior projects.

MediTechnix personnel helped the Department chair obtain the financial information needed to negotiate increased hospital support for the Department to support additional anesthesia personnel. MediTechnix personnel’s analysis assisted in a quick and profitable launch of a service line, which increased patient safety, quality and economic return for both Departments and the hospital.

  C A S E  S T U D Y  4 

Are The Hospital Treatment Protocols Aligned With The Latest Medical Knowledge, Do They Improve Patient Care, And Do They Minimize The Cost To The Hospital System?

Challenge

The current treatment protocols for Chest Pain and COPD are believed to be outdated and require additional tests and treatments that are no longer indicated in the latest medical literature. Current methods were believed to add needless nonvalue-added expenses to the hospital, as well as dilating the treatment time for the patient.

Exercise

MediTechnix personnel conducted extensive research into the latest, proven protocols for both Chest Pain and COPD in order to determine the most effect treatments, the most effective patient flow process and the one that produced the best clinical outcomes. Working with hospital clinicians, new protocols were outlined and tested. The new protocols were vetted throughout the clinical leadership of the hospital and adopted. All medical staff were then trained in the new protocols and the results evaluated.

Result

The overall results were the elimination of 3 unnecessary tests, the administration of treatment moved to a more clinically appropriate time, and an overall improvement in clinical outcomes. COPD patients received more appropriate care. The Chest Pain patients were properly diagnosed sooner in the evaluation process which enabled the patient to receive more timely treatment.

  C A S E  S T U D Y  5 

Do We Adopt A New Technology?

Challenge

Determination of whether to introduce a new technology to replace a current technology.

Exercise

MediTechnix personnel isolated and performed an assessment of 4 major utilizations of the technology, the estimated likely annual demand in the service area for the first five years, estimates of increased marginal gross margin contributions per year from the new technology, and assessed any internal impediments that were likely to be encountered during its introduction. We then conducted a “project financing” pro forma investigation with risk factors noted for management purposes and presented findings to executives.

Result

Relying upon MediTechnix personnel’s analysis, the technology was adopted, is serving clinicians and patients well, and has proven to be a net economic benefit to the hospital. The exercise also increased prospective patient mindshare for the hospital when considering sources of treatment.

  C A S E  S T U D Y  6 

Should We Be Expanding, Contracting, Or Keeping The Same Physical Plant And Clinical Capacity For A Given Service?

Challenge

Determination of likely demand for a surgical procedure over some time horizon, and required capacity to meet that demand.

Exercise

MediTechnix personnel isolated the user population attributes for a given service. We then normalized those data relative to pertinent demographic parameters of the population in the service area.

Using a proprietary population growth simulation model developed by MediTechnix' parent company, which has proven to have high accuracy for use in forecasting numbers of persons in a locale (service area) in future years, we were able to predict the demand level for the service over the time horizon of interest.

Result

MediTechnix personnel analysis determined, all other factors being equal, that demand for that service would drop 30%+ over the next 5 to 7 years. Resultantly, it was advisable not to increase physical plant capacity, and to take options on clinical service contracts, rather than extending them for the foreseeable future.

  C A S E  S T U D Y  7 

How Do We Manage The Supply Of Critical Drugs That Are In Short Supply To Prevent Case Cancellations?

Challenge

Anesthesia Departments and Intensive Care Units rely heavily on drugs like Diprovan for patient sedation and anesthesia management. Recently, the drug Diprovan has experienced unanticipated shortages on a nationwide level due to coming off patent protection.

These shortages, combined with non-predictable supply delivery, led to the cancellation of elective procedures and increased use of more expensive alternative drugs for others. These cancellations and increased utilization of more expensive drugs resulted in decreased patient satisfaction, lost revenue, and increased cost for the hospital.

Exercise

MediTechnix personnel were asked by the chairman of the department of anesthesia to develop models of supply management to eliminate critical shortages of key drugs. Obtaining data from hospital pharmacy, which included both delivery and utilization of key drugs, we were able to model patterns of usage across Departments.

With this information we next looked at supply order history, and vender completion rates. Using this data we were able to build a reliable model of supply management to prevent critical shortages. We also identified patterns of usage across Departments to allow for further opportunities for better utilization management.

Result

MediTechnix personnel were able to work with the Department of anesthesia to develop a new drug supply strategy to eliminate shortages while minimizing costs. The model can also be expanded to assist in the management of other critical resources.

  C A S E  S T U D Y  8 

Why Have We Seen A Decline In The Number Of Patients In A Service, Yet Why Do We Always Seem To Have A Capacity Problem?

Root Cause Analysis determination to correct effects of compound problems, with planning considerations.

Exercise

MediTechnix personnel isolated that the decline in the numbers of patients was due in large part to patient dissatisfaction with their processing in-house. Development of a Standard Operating Procedure (SOP) for correct and efficient handling of each of 10 different types of patients was produced so that all clinicians, techs, and administrators knew the procedure and their roles for each type of patient introduced to the process.

A large contributor to incorrect and inefficient patient processing was the discovery that all pertinent personnel were working from 5 different static and real-time data sources, which were generated and kept in different places, and were never in agreement.

Further, a utilization calculation was performed to demonstrate that there was no problem with capacity, however the utilization was inefficient due to several factors. A hybrid scheduling model using static and stochastic elements to handle both scheduled and unscheduled patients was developed for guidance into the future to better satisfy patient processing.

Result

MediTechnix personnel analysis isolated the major root causes of patient dissatisfaction, and resultant decline in the use of the service.

MediTechnix personnel capacity and utilization analysis demonstrated the need for better utilization of the facility, rather than inefficiently adding millions of dollars of capacity.