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Achieving “systemness” in perioperative care

  • Ashley Walsh, MHA
    Ashley Walsh, MHA

    SVP, Client Services, iQueue for Operating Rooms & Inpatient Flow

COVID-19 has taught the healthcare industry many valuable lessons. It has especially highlighted why health systems must work efficiently as “one system,” from an operational and financial perspective. Given the many challenges modern health systems face, however, this is easier said than done.

Enter “systemness,” or the practice of providing consistent patient, provider and staff experience across a health system driven by common operational processes, tools, policies and procedures. Why is this beneficial for the health ecosystem and essential? We’ll explain.

Defining “systemness”

Imagine if Delta Airlines had a different way of operating at every single airport. Aircraft maintenance, baggage check-in, the ticket counter experience, the boarding process — all local to one particular airport. Every passenger would have a different experience and be constantly confused by the travel process. Outcomes such as delays, lost bags, lack of meal availability and many more would be unpredictable and frequent. Costs would also be astronomical.

This is exactly why airlines, as well as transportation and package delivery companies like Uber, Fedex and UPS, spend so much time, effort and training to achieve the goal of systemness — “looking, feeling and behaving like one system no matter where you interact with them across the customer’s journey.” Within the healthcare space, health systems often struggle to provide that same uniform, high quality patient experience.

“Systemness” in healthcare

“Systemness” across a health system, and within a specific department such as perioperative care, means a patient’s outcomes, experience, costs and expectations should be as similar as possible no matter how and where they interact with the system. The main challenge here is that hospitals are inherently hyperlocal, and many have grown inorganically through acquisition. As a result, many separate hospitals, each possessing their own tools, processes and people, have often come together under a “system” umbrella but still differ widely from each other in the patient experience they provide.

Some health systems approach “systemness” from a branding standpoint, working to ensure consistency in the look of various facilities within the system, but this is not enough. Others mistakenly assume that integrating all hospitals onto the same EHR will automatically create “systemness,” but the EHR is only one of multiple legs on the “systemness” stool. For example, CommonSpirit successfully deployed Cerner across more than 34 locations, but were not able to achieve the desired level of “systemness” until they addressed a cohesive set of policies, procedures, tools and methodology across locations.

Standardizing surgery and treatments is certainly much harder than the type of “systemness” Delta can provide in every airport and the process Uber can support in multiple cities. Additionally, operational and financial standardization is much easier than clinical standardization because of course, no two patient bodies are the same. While clinical standardization is more difficult to manage, it is still possible to be consistent in the way all facilities follow up, bill, document and monitor readmission rates across their facilities.

Embark on the “operational systemness” journey

Once a health system makes the decision to move towards “systemness,” a common misconception is that benchmarking is the true first step, but that’s actually not true, especially within the perioperative department. If facilities don’t first come together and agree on how they will measure and define care, health systems cannot achieve “systemness” because variability will continue to have an impact. Health systems cannot identify best practices until they are already thinking and operating like a system.

The true first step is to ensure all leaders develop a relationship across departments, and to incentivize them to share and learn best practices from one another. The sense of connection and togetherness is critical, but the next step involves teams setting mutual goals, whether related to billing, scheduling or how the system will measure efficiency.

As CommonSpirit experienced, once the goals are set, “systemness” in perioperative operations requires a common set of policies, procedures, tools and training. All of these components should tie back to the agreed upon goal, whether it involves providing clarity into backlogs to create more open surgical time, implementing electronic scheduling for clinics of non-employed physicians to drive revenue or activating system-wide accountability for block management.

The bottom line — why “systemness” matters

“Systemness” positively impacts the bottom line, but even more importantly, surgeons and patients. From the clinician perspective, due to increased communication across departments, surgeons are able to schedule more cases because time isn’t getting wasted and health systems that have “systemness” are much easier to do business within comparison, ultimately driving volume. When it comes down to it, the most important factors for patients are the quality and cohesiveness of care. If every surgeon within a health system has similar access to open time, or the ability to schedule patients’ procedures in a more time-efficient manner. The experience is quicker and more streamlined for all parties involved.

Overall, from a perioperative perspective specifically, “systemness” ensures that surgical capacity is most effectively aggregated, advertised and utilized across any given health system. With the right tools and systems, providers can capitalize on economies of size and scale to drive growth.

The bottom line is “systemness” is beneficial for providers and patients alike because it can lower costs while driving increased revenue and capacity, all while reducing variability.

For more on how a healthcare provider successfully applied this throughout its facilities, see our webinar on achieving perioperative ‘systemness’: How CommonSpirit aligned people, process and technology across its ecosystem.

Originally published in Becker’s Hospital Review.

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