This is a problem in all operating rooms. I don’t know what you have tried already but perhaps offering some non-fiscal benefits to certain surgeons who might be willing to operate later in the week. Perhaps the availability of more than one room or staggered cases to allow greater productivity. Or consider a block time system where certain surgeons who have trouble getting enough OR time can get guaranteed OR time but later in the week. Or perhaps more first assistants on Thursdays or Fridays, or more PA/NPs helping to write orders and take care of patients periop. Also, never underestimate the power of free food on Fridays.
Another equation to consider is if the implementation of a smooth operating system would be worth the risk of losing some surgeons? From your post sounds like you do not think that would be a profitable trade-off. May be worth looking at the numbers.
Are the protocols be embedded in your EMR? There are also several vendors that we are looking into that allow institution-specific protocols and the ability to track compliance, outcomes, costs. Our vendors are mainly focused on the orthopedics and cardiac spaces and include Force Therapeutics, Care Sense, and SeamlessMD.
We are asking ourselves this same question. Our model is explicitly capitated, yet our flagship service lines are growing.
Our system has:
1. Engaged key physician leaders in leading service lines of each hospital to increase quality and patient satisfaction, and decrease cost.
2. Bring key physicians together from around the system in regular meetings to compare quality, patient experience, and cost. These teams meet monthly and have full support of system level finance, quality, and IT analysts to acquire data, disseminate best practices, and design system level changes.
We also have discussed directing patient flow more formally based and efficiently to direct patients to parts of the system with the highest quality, lowest wait times, and lowest costs. This has not been implemented. We are hoping that this type of physician engagement can lead to horizontally integrating care by disease state which could improve quality and reduce unnecessary care.
This is a great question which our organization is struggling with as well. Geisinger is a health system that has done a lot of work organizing teams around disease states and service lines. Penn is another, even larger health system which has committed to developing IPUs for several service lines. They are re-organizing their orthopedic and cardiovascular care across traditional departmental lines and are working through these issues. Health systems seem to often give physicians (and administrators) big system titles without the tools to create change. In order for service line leaders to control strategy and quality, those leaders need to be able to influence budget, salary, and employment decisions. Otherwise, those leaders are just asking for volunteers to change the way things are done.
Definitely keep this person until the project is complete! Since the person has valuable technical skills I would try to train her to improve her communication – this will be difficult but could work. Sometimes people have trouble with particular types of communication such as communicating with direct reports, superiors, or crisis communicating. If that all fails, maybe try to change her role to minimize the necessity for communication. As an aside, maybe the organization as a whole could simplify the team structure. This can be a challenge but can simplify communication for everyone.