Conduct an operational and process audit
By Stephen W. Earnhart, MS
President and CEO
Earnhart & Associates
Dallas
Whether you are creating a new facility, have been around for 20 years, are looking to expand your existing service line, or are just sick of hearing, "Why can’t we be more like the surgery center down the street?" — you need to give yourself a report card on how your facility is doing compared with the rest of the industry.
The best way to do this is to audit your operations and processes. This industry is changing and will continue to change. Computer software buffs would equate this industry to "Version 2." By conducing an audit, you can determine if you need to upgrade your system to "Version 3."
There are many reasons facilities may wish to do an audit. Some of our more recent audits include:
• hospitals that are revamping a surgical wing, for ambulatory surgery or surgery in general;
• facilities that are going to joint venture their center with physician groups and want to ensure that they are up to date on the new methods;
• hospital or private board members who wish to assess the level of competency of their staff;
• those who just think something is missing or that they are too far behind the curve in efficiencies and industry benchmarks.
Why do an audit? You need the results! You need to know how you compare. Your existing staff can easily perform your audit, or you can have an outside firm provide the service for you. It depends on how objective your results need to be. Much of the information from an audit is concrete, but much is also subjective and there can be reporter bias involved in the outcomes.
Essentially, you are grading and ranking yourself in many areas according to your peers, with your peers being the hospital industry (for-profit or not-for-profit), the surgery center environment, or a combination.
We recently performed an audit for a not-for-profit hospital that wanted its operations benchmarked against the for-profit, freestanding surgery industry. A new center was under construction, and administrators wanted to see how they would fare against this competition. The reasons for the audit are many and varied for each facility. Many times the information is used to validate what the institution already knew.
Where do you begin? First, list what you want to measure. Do you only want to know the length of your "pre-incision time" against the industry, or do you want to compare your "clean-up and setup times" for the operating room against the freestanding centers? Do you want to compare your supply cost per case for a dilation and curettage against the hospital industry? What about staffing levels? How do you compare with the rest of the industry: Are you over- or understaffed?
Don’t forget patient and/or physician satisfaction. How do you compare? Does your pre-op testing follow the industry norms, or are you far outside the mainstream?
When you compile your list, be careful. It is like eating peanuts: You keep adding more items to measure. There are a hundred items that need to be measured to achieve a complete picture, but that number should cull out to several dozen significant benchmarks.
Many are surprised to see how well they fare. Many are shocked to realize that they are actually an industry leader (sometimes that’s also scary if they are far outside the norm) or well within the top percentile (a fact that many of them quickly point out to their physicians).
One thing that drives us all crazy in this industry is the isolated case where everything goes wrong. The patient was late; the lab work was missing; two people called in sick. The turnaround time for that case and that surgeon went from a normal 15 minutes to 50 minutes. Well, we all know the end of this story: Your turnaround time for all cases is now considered to be 50 minutes. There’s nothing sweeter than to show the results of your audit and to point out that you are in the top percentage of the industry for turnaround time.
But, suppose you are not. Then you need detailed information on what others are doing to reduce their turnaround time.
The bottom line: Get several people from your department or another department of the organization to conduct your own audit. Compare yourself against your competition and the rest of the industry. Chances are you will soon be strutting your results to your boss and your surgeons.
(Editor’s note: Earnhart can be reached at Earnhart and Associates, 5905 Tree Shadow Place, Suite 1200, Dallas, TX 75252. E-mail: [email protected]. Web: www.earnhart.com.)
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