Cardiovascular Surgical (CVS)
Cardiovascular Surgical (CVS) services have historically been highly visible by healthcare systems. The CVS service line accounts for a large percentage of hospital revenues which aggressively invest in and market these services to differentiate themselves from the competition, but these CVS providers have also been under the scrutiny of regulatory organizations (CMS, STS) to standardize quality and optimize patient outcomes.
The transition from traditional fee-for-service payment models to value-based payment models taking place today has encouraged physicians and hospitals to work collaboratively to deliver high quality, streamlined and cost efficient care. In order to deliver on this goal, healthcare systems have transitioned to a service line approach making use of process improvement methodologies ( ex: Lean Six Sigma / Kotter’s Model).
CVS services are inherently conducive to collaborative management, engaging various stakeholders of the healthcare delivery and operational team. Standardizing cardiovascular surgical programs in hospitals can be a complex and challenging process, as there are several factors to consider:
- Institutional Culture
- Leadership & Healthcare Team Dynamics
- Clinical Variation
- Data Collection & Analysis
In order to ensure each of these are optimized, the implementation of a well-managed service line requires development of:
- Purpose: Mission driven patient-centered culture
- People: Empowered physician leadership of well-coordinated multidisciplinary teams
- Process: Utilization of evidence based protocols
- Operations: Professionally managed operations augmented with analytic data & process enhancing technology
From the gap analysis, over the course of Q3 and Q4 of 2021, we developed a “CABG Excellence Playbook” that standardizes CVS operational & clinical infrastructure to optimize CVS people (leadership, team structure, roles & responsibilities), process (evidence based best practices, processes & protocols) and overall operations (patient flow, vent management, accountability). across the division.
At the end of 2021, we rolled out the playbook initially to the Division’s CV Governance members (a consortium of cardiologists and CV surgeons across the division that represented each facility) getting their buy-in and developed a plan for a comprehensive roll-out across the division. Early in Q1 2022 there was a recurrent COVID-19 surge across our division requiring us to postpone an aggressive roll-out.
Over the course of 2 quarters there was continuous improvements in almost all metrics at all facilities that had implemented the strategies outlined in the CABG Playbook.
By the 4th quarter of 2022, the impact of our interventions was becoming evident internally on our dashboards. This was also validated on the STS harvest by the end of the year which showed dramatic impact, all 12 Facilities Improved Overall & Mortality Rating, all facilities received 2-★ or better Overall Score and Mortality Score.
