Overcoming Challenges in Perioperative Services and SPD Management: Insights from Brian Dawson of CommonSpirit Health

Hello, and welcome to this episode of Consensus, a podcast brought to you by Census Technologies. I'm your host, Michelle Dong Mooney. And today, we're speaking with Brian Dawson of Common Spirit Health. Brian, it's great to have you here today. Can you start us off with a brief introduction and talk a little bit about your role at CommonSpirit? So Brian Dawson, I spent twenty eight years in the Navy as a Navy officer, nurse, OR nurse, hospital executive, and then system executive. I was a hospital COO and then CEO. And in my last two years, I was the Chief of Staff and EA to the Navy Surgeon General. So got to see a lot of things coming and going that impact on Navy medicine, which in Navy medicine, Army medicine, Air Force, it's like a very large health system, just like CommonSpirit. With CommonSpirit, I started about five years ago working for Dignity Health as their system leader for perioperative services. And when we merged with CHI, my job expanded for all of our facilities. So I'm kind of the leader, but more so the director of perioperative things. And when I say things, quality, patient safety, policy, capital equipment, IT third party items that impact on our care. We coordinate local and system changes for Epic, Cerner and Meditech. I'm also kind of the clearinghouse for standards and practice for OR, for PACU, for SPD. And then in this case, two of the hats that I wear, one has to do with capital equipment management, and the other one has to do with productivity across the perioperative department. So how well are we utilizing our staff based on the workload? And those two things really come into play when we talk about census. And tell us more about the facilities and teams that you work with. So OR wise, we've got one hundred and forty two operating rooms across the system. And so they range in size from two ORs that are being utilized to sixty ORs that are being utilized. We have critical access hospitals. We have community based hospitals, and then we have about five very large teaching hospitals. One in Phoenix, a couple in the Midwest in Nebraska area, Omaha. We've got Baylor St. Luke's, which is in Houston, which is a massive teaching hospital. And so the cool part about CommonSpirit as a faith based health system is we run the gamut, you know, from inner city hospitals that are the only hospital in that inner city Long Beach is an example, Downtown LA is an example, Glendale, along with some of our other facilities, to the only hospital in a rural area. So we have critical access hospitals in North Dakota, in nowhere Nebraska, nowhere Texas, you know, between the Washington and Oregon state line, between the California and Oregon state line, We've got hospitals that have two OR rooms, and they're in literally a farm community. So we the coolest part about us is we serve that population, and we might be the only provider in that population. So, you know, our SPDs run the gamut from, like I said, from staff that run the OR that also support SPD, to facilities like St. Joe's in Phoenix, where Robbie Miller was just highlighted in OR Magazine about SPD for January. And Robbie runs an SPD that serves six operating rooms in the facility, on top of endoscopy, cath lab, IR, and supports other things in the division as well. So we kind of run the gamut in size, which makes us unique and kind of a fun challenge. How do you come up with a solution like Sensus that can help us in all of those types of facilities? So what are some of the challenges that you face in your day to day interactions with all those facilities? You know, I really think it's just because it's me. And I have a great partner in crime. One of the individuals who works for me, Charlene Rutella, is not an administrative assistant. She's truly like my right hand. She's working on her PhD in healthcare business and organizational development. And she helps me manage everything. Because it's really just me kind of herding all of those individuals in the same direction. We have a great perioperative council, which is made up of OR leaders from every division, and if a division crosses state lines, from every state in that division. And then we have a larger group, a perioperative collaborative group, which we invite members from every OR, whether they be the director, whether they be an educator, the business manager, we have subcommittees. One very important subcommittee is our SPD subcommittee, which is again made up of SPD leaders from across the system. We've got an educator group, a policy group. And so, between Charlene and I and others who have helped us or taken on those leadership roles in the system that have other jobs, you know, my thing is, you know, how many fingers can I stick in the **** to keep things running? Well, it sounds like you've got a good group of people there helping you manage everything. So what part of your role do you enjoy the most? What's the most impactful to you? Helping, teaching, solving the big riddles or big puzzles, and being that steward of our dollar. Because again, healthcare is getting tight. You know, you hear in, you know, in local media, national media, you know, there's talks that are, you know, people are worried about taking place soon within Congress about cutting Medicare and Medicaid. You know, that used to be the golden check that every hospital got from the government. And now, you know, you're not getting that type of reimbursement. You know, a lot of hospitals were impacted due to COVID, but because of a lot of the legislation, you know, the federal government was giving facilities and health systems dollars to offset the cost of COVID. Well, now that that stopped, and now that we have COVID, serious flu, the new respiratory illness that's impacting children a lot, those things are all impacting on areas in our hospital where we generally lose money. And what I mean by that is the longer a patient stays in the hospital, the less insurance covers. And the way we had of generating revenue was through our outpatient and our elective surgery schedule. Well, people, based on the economy, based on what's going on health wise, you know, in our communities, there are less and less people coming to the hospital for elective surgery. So for me, what's important is how do we increase the use of our operating rooms? Which means how we make sure that instrumentation for surgery is made readily available? How do we do that in the most cost efficient manner possible? And how do we make sure that the quality and patient satisfaction is top notch? Because that's what draws people to a facility, not just the patient, but that draws the providers, our surgeons, to a facility where they know they're going to have what they need when they need it. And the quality that's provided by the staff, by the nursing staff, by the assistant staff, you know, by anesthesia is going to be top notch, so their patients are going to have a very positive outcome. So those are the things I think what keeps me up late at night is watching MSNBC or Fox and listening to the commentators talk about what's going to happen. You know, is the government going to shut down? If the government shuts down, are we going to increase the debt ceiling? Because all that impacts on, you know, Medicare, Medicaid, on companies, you know, downsizing, on availability of products. So all of that has an impact on those things. Brian, I think you touched on this a little in what you just talked about. So let's dive a little deeper in terms of providing the optimal outcomes. Can you kind of walk us through how you measure productivity in your facilities? Yeah. So let's talk about SPD specifically. The longer I've been in this job, the more and when I say in this job, in health care, the more we've changed the way we measure things. And so productivity in the operating room across the country is measured in different ways. I taught a leadership course for AORN about six, seven years ago, and one of the classes was about measuring. How do we measure productivity? And when I asked that question, I got a thousand answers. I got, well, we measure it by the number of admissions. We measure it by the number of bed days. We measure it by the number of surgeries we do. And then somebody hit it on the head and said, we use minutes of service. And that's what we do in common spirit. The best hospitals measure OR productivity through minutes of service. How many minutes is the patient in the OR? And then, so from wheels in to wheels out, we look at how many minutes are they there, and then how many people are needed to care for that patient. And then based on that, how many total minutes did the OR use today, and how many total staff that they have. And then we say, okay, balances. Or we're over or under by, you know, X number of staff members. We also want to make sure that we And the OR's unique. We want to take all of the people that we need to run an OR, that never touch a patient out of that equation. So the director, the OR scheduler, the OR educator, maybe a supply person. You know, how many people does an OR need to run, whether they do one case or no case? And that's different from a med surg unit, right? Because the med surg floor doesn't have those types of people. So you want to take those people out of the equation, but you want to make sure that that number is defined so that a critical access hospital may have three people, a large teaching hospital may have ten, but the critical access hospital shouldn't have six, and the large hospital shouldn't have twenty. So how do we come up with that agreed upon number of nonproductive bodies? So that's great for the OR, but when we get the SPD, it doesn't work. And most of our areas are nonproductive in SPD because a ninety minute gallbladder might have two instrument sets, which might have less than one hundred instruments in it. A ninety minute total knee might have six instrument sets with thirty instruments per set in it. So one might take twenty minutes to do, another might take an hour and a half to do. So minutes of service in SPD don't work. What I love about Sensus is we've worked together to utilize AAMI. AAMI is the association for SPD, and they set SPD standards. AAMI has come out with levels of complexity. So they've listed tasks, whether it's putting together an instrument set, or whether it's pulling for a case, or putting peel packs together, or cleaning a robotic arm. They've set timeframes for all of those tasks and group them between level one and level four. Level one meaning about twenty minutes, level four an hour and a half to two hours. And so we've worked very closely with Census to create a way of monitoring all of the tasks that are done in an SPD, and then bouncing that off of those four levels of complexity. And now we can tell how many staff do I need to take care of the workload that happens in SPD, And how many staff do I need throughout the day based on workload? I need less bodies in the morning because there's nothing coming out to be cleaned and processed, and more bodies in the afternoon because that's when the bulk of the work comes out. So for me, that's one of the four holy grails in the OR that I've been trying to solve. One, you know, efficiency, you know, getting starting on time, room turnovers. We've done really well on solving that with data. Another one is solving productivity in the OR, then in SPD. And other two are, you know, are we ever going to get to a point where we're never using paper anymore, it's all done electronically, scheduling cases? And then the last would be, how do we solve the whole preference card tool without it being person dependent? So, the nice part about Census is you've helped us solve that second holy grail when it comes to how do we adequately measure productivity, especially in SPD, based on task and not minutes of service, and to do it with a national standard, which is what Amy established. When we talk about productivity, we have to take staffing into consideration. Have you had any challenges finding and maybe more importantly retaining qualified staff in your SPDs at any of your facilities? Yes. Yes. And major issues finding staff. And that's because it's very hard to find qualified SPD technologists and retain them. One, there aren't a lot of schools that train them in doing so. And then the other problem is the salary range for those individuals fluctuates nationally. And in some areas, it's at a level similar to our housekeeping and dietary staff, which, you know, I get it, it's an entry level position, but the level of complexity that we now have within that department, you almost need a bachelor's degree, how to follow the national guidelines on decontaminating and sterilizing, or high level disinfecting different items. And SPD handles items from surgical instrumentation, to laparoscopic instruments, to robotic instruments, to endoscopy scopes, it's across the gamut. And, you know, those individuals have to know how to care for all of that appropriately and according to manufacturer's recommended guidelines and national standards, and we're paying them, you know, at a level that's kind of entry. And so, the turnover is fairly significant. Because if I raise my hourly salary at one of our facilities, say, in Los Angeles, by five dollars I'm to pull from every other facility there that's still paying five dollars less. And if our competitors do the exact same thing, we'll have the exact same problem in reverse. We're going to lose people as a result of that. And tell me, how does that turnover affect your productivity? Yeah, it does because then the problem is I've got individuals that haven't been trained, and it takes me longer to do things because I'm I'm constantly retraining staff. When you're dealing with network wide productivity, do you ever have issues with limited visibility into your processes? Not really. Like I said, because we have such a great group, especially in SPD, the SPD leaders, I think, are the tightest of all the leaders. And so there's a lot of conversation, sharing of information. There's a lot of creation of standard processes, standard checklists, standard, you know, education, competencies. So we're doing a fairly good job at ensuring that we're all at the same level, all following the same things. Now, having a standardized tool like Census makes it even better. So have you used Census in your facilities during your entire tenure, or is it a recent addition? We've been using the tool, I would say, for about anywhere between nine to twelve months regularly. But we just started working with the leadership at Census to create the productivity measure that I was describing in the past four or five months. I would say three to four months. And now my hope is, is that we can deploy that across the system. In terms of network wide productivity, do you have any other bottlenecks or maybe efficiency issues with your SPDs? Nothing that we haven't discussed. You know, I think the biggest issues we have are, you know, retaining quality staff members. You know, I think that if we can retain, you know, our staff members, we can meet workloads. I think now that we're able to begin to measure workloads a more scientific way, actually using real data around tasks, I think it'll get even better and continue to get better. Again, I think, and this is nationally, it's not just with our system. The biggest Achilles heel we have is salary. You know, as an example, say seven years ago, when I was here in the Denver area, running one of the level one trauma centers, in the Denver market, SPD techs were making about twelve to fifteen dollars an hour across the whole market. You look at housekeepers and they were making eighteen to twenty. And so if I was in need of SPD techs, and I convinced the leadership to say, let's do a five thousand dollars sign on bonus, I was stealing SPD techs from my sister hospitals. And then fast forward, one of those hospitals would get short, and they would have a five, you know, dollars seven thousand, and I'd lose tax. So, we were all robbing Peter to pay Paul, I was always saying, Why? You know, why? Because SPD is the backbone of the OR, and the OR drives revenue, why don't we all raise their salaries five bucks? You know, and that way we can retain them. You know, let's pay them for what they're worth. Here is one of the issues. The larger the payroll, which is the largest bill that any health system pays, the harder it is for them to meet all their responsibilities. Go back to what I said with that shrinking dollar. The problem is that, and this is just my two cents, most healthcare executives don't really understand what SPD does. And I say that not because, you know, they're not smart or they're lacking education. SPD is usually in the basement of the hospital. It's out of sight, out of mind, usually near the big warehouse and supply chain. And we don't really know what they do. Well, what do they do? Right? We hear a lot about, you know, oh, know, such and such health system had a number of people exposed to, you know, dirty endoscopy scopes or dirty instruments. And so, then there's a focus, but they don't really know what they do. And so, as you said, when there's greater turnover, when we don't measure productivity by what it is they do and use minutes of service, then we're cutting staffing in SPD because they're not productive. Which results in, I don't have enough time to clean, thoroughly clean, all of the instruments, and people start to take shortcuts. And if you take a shortcut, I may leave behind some form of bioburden that can impact on the next patient. And then it becomes a major issue, and you're on the cover of the newspaper, and there's a lawsuit, and there's millions of dollars that are spent. Well, to prevent that, let's spend a couple of hundred thousand and increase the salary and measure productivity the right way in SPD. It's this, you know, what came first, the chicken or the egg? And so, one of the reasons why, for me, you know, educating people on this is important is because I've been an OR leader where SPD falls underneath my purview. And I've also been a hospital executive and a system executive. And, you know, I would always say to, you know, leaders, hey, we got to focus on the backbone of the department that serves the area where we generate our revenue. You know, come down, visit SPD, see what they're doing. And it's so crazy when you bring an executive down to SPD and they watch that decontamination tech empty cart after cart in a very hot, sweaty, you know, area with all the PPE on, they go, Oh my God, I never knew that this is what they did. And exposed to blood, and tissue, and bone, and all that. And on the flip side, when you have a large facility, like, you know, I was talking about Robbie Miller, why I'm so proud of the work that he does, You know, when you process a thousand sets a day, ten thousand instruments, and there's no contamination, no bio burden left on them, man, that's success. That's like winning the Super Bowl every day. Every day. You can't take a day off. Right. You know, you can't have an off day in SPD, and that's why it's so important. Let's dig into that productivity module that you've been working with. What are your thoughts on interactive data platforms? I think that if we are able to work with a manufacturer to capture that data and that we know that the data is pristine, and the data uses national benchmark measures, then I think it's priceless. You know, it's what we need to appropriately run our departments. Because it'll tell me, you know, what time of day does the majority of the work occur? And that's where I need to put my staff. When are we the slowest? And I need less staff there. Am I able to meet the workload with the staff I have, or do I need to hire one or two extra people? Because now I'm basing that off of data, not conjecture. Do you have any advice to give to other hospitals or networks that are looking for a tool to measure their productivity? I would say, know, find something. Find something that works so that you can have the data to make, intelligent business decisions, to support your procedural areas, business decisions in SPD, to support your procedural areas to make sure that you can capitalize on the assets you have to generate revenue. So let's talk about looking into the future. What are your long range goals for tracking productivity? Yeah, I think the goal would be to, across our system, have a hub and spoke type data sharing network, for lack of a better term. Whereas I just described, I could potentially move staff and move equipment to the need within that division. And when I use the word division, I'm really talking about geographically located facilities. You know, one of our divisions, Northern California, goes from San Francisco all the way up to the California border with Oregon. So within that, there are two hospitals in San Francisco that are like less than six miles apart, right? There's another hospital that's in Sequoia, which is a little bit farther away from San Francisco and not close enough to one of our other facilities that's down in, oh, I'm blanking on the name of the town right now, but I would want to make sure that those two hospitals in San Francisco are working together with equipment and staffing. And so that one's not one doesn't have excess staff, and the other has, you know, too little staff. But a different idea is let's go to Sacramento. There are five hospitals in Sacramento in a circle, right? So if you ride the highway that goes around Sacramento, we've got five hospitals in that vicinity. All five of those hospitals are part of the same group, you know. So why not look at where the need is, when the need is, and move assets and people based on that need? Another crazy idea is what if we created a centralized SPD amongst those five hospitals, and we moved instruments to that area to clean, decontaminate, sterilize, and then move them back to where they were needed? And now I've got a centralized hub where I can take advantage of that staffing and that equipment for five separate hospitals. Now, we have to work out the logistics and move things around, but imagine, you know, and some areas are doing that with, you know, university hospitals that have multiple hospitals in a very small geographic area. Why not do that with a division? You know, in some areas, Los Angeles, I've got hospitals kind of north of Los Angeles and hospitals kind of south. So what if I set up two hubs? You know, so those are, that's the nirvana to where I can, you know, consolidate things, take advantage of the consolidation of staffing and equipment, save dollars, and still meet the same mission. Now, you know, what do you do about the crash that happens on the four zero five, and now the twenty minute drive takes three hours? So those are all things you got to think about, right? Because it will happen. The other thing, and even the better possibility, is to make sure, you know, what do I see in the future? To make sure that our leaders understand the value of that department and the value of using data to make business decisions, to increase efficiencies, to save dollars, and to utilize the most precious asset we have to its fullest extent, and that's personnel. A great conversation, Brian. I want to thank you so much for joining us today, and thank all of you for tuning in and listening today on the Consensus Podcast brought to you by Census Technologies. Once again, I'm your host, Michelle Dawn Mooney. Thank you again for joining us. We hope to connect with you soon.