The operating room is an essential, revenue-generating service line for hospital and health systems. But too often, perioperative leaders don’t have the information necessary to understand performance and make informed decisions, leading to waste and higher costs. 

During this episode of Healthcare Insider, Michael Besedick, engagement director at Surgical Directions, lays out how providers can expertly navigate the complexities of managing OR departments by leveraging advanced analytics. 

Camille Baxter: Hello, and welcome to Healthcare Insider, a sponsored content podcast series from Modern Healthcare Custom Media. I'm your host, Camille Baxter, and today we are excited to be speaking with Michael Besedick, Engagement Director for Surgical Directions. In his role, Michael manages analytics projects that reduce costs, drive revenue and increase ROI for healthcare clients. Michael’s demonstrated experience in advanced predictive analytics, data visualization and machine learning are of practical use to hospitals and hospital systems who appreciate his ability to clearly communicate complex concepts that result in confident, data-supported decisions. Today, we'll be speaking with Michael about the challenges hospitals and health systems are experiencing with procedural services and how advanced analytics and technology can help. Before we dive in, we'd like to thank the sponsor of this episode, Surgical Directions. Surgical Directions is a specialty healthcare consulting firm composed of professionals with deep experience working side by side with clients to achieve the absolute greatest impact and sustainable performance possible. From assessment to implementation to interim or permanent placements within your leadership team, Surgical Directions is more than a consulting firm. They're a collaborative partner dedicated to your success. Michael, thank you so much for being here today. I'm really looking forward to our conversation.

Michael Besedick: Thank you so much for having me, Camille. I really appreciate you inviting me on today.

Camille Baxter: Michael, tell me a little bit about your love for data and how that started.

Michael Besedick: Yeah, like many other people in healthcare, I had a background in the life sciences. From my time in college, I studied chemistry in college and was deeply involved, thought I would pursue research, but realized that my skills had other applications, particularly in the business and the healthcare realm. I saw that there was an opportunity to create value in healthcare, just given the enormity of the challenges that were being solved, both on the life sciences pharmaceutical side, the insurance and the deep mathematical side, but also on the provider side. When I joined Surgical Directions, it was a really unique model because we both handled larger strategic issues that providers were facing across the country, like large health systems, even community hospitals, but we really had a unique approach and that we were both top down, meaning at the executive and C-suite level, but also bottom up, like having boots on the ground, consulting teams working directly hand in hand with people within the organization. And I think my love for data emerged when I first stepped into a hospital into the operating room for the first time, and I went in with the assumption that it was going to be this amazingly efficient system. It was going to be like NASA, everyone was going to be wearing all this protective garb and everything was going to be highly efficient. Everyone would know where everything is and things would run extremely smoothly. I think that's what most people, maybe not most people, but a lot of people envision the operating room to be like, and of course, as soon as I got there, I quickly realized it was not like that at all. It was sort of managed chaos day to day. So it was really interesting, essentially how my perception was turned on its head. And I realized there was an opportunity to help in some small way. I think using data to help fix those challenges was the easiest way to translate the skillset that I had love for earlier on in life, into this setting, within the operating room. That's how it blossomed over the years.

Camille Baxter: Yeah, data is playing such a big role and more and more in healthcare as we go forward. With that, can you talk about some of the biggest challenges facing procedural services today?

Michael Besedick: There are myriad challenges that hospitals and health systems are facing today. And I think some of which are well served by data, but many of which are sort of these deep circumstantial or economic problems that are happening. A great example is the staff burnout issue, these workforce staffing related issues that has really destabilized the day to day operations of the hospital and the health system. When it's the case where a nurse with years of experience can just go down the road and make 30% more than at their parent or home institution, that's going to destabilize your workforce a lot. I think those kind of economic forces have also threatened the viability of these smaller community hospitals that we're already struggling to survive in the wake of massive consolidation that's been happening in the healthcare market, in the provider market in particular over the past decade or so. There's also data integrity related challenges. I think a promise of the EHR was that there were going to be vastly reduced medical errors and complications with improved documentation, but there's still a lot of interoperability challenges. You can visit a doctor in one health system and it can be a struggle to get your medical records from that institution. If you go to a different institution, if there's no interoperability between your EHRs, which is a major issue for patients as they're trying to receive care through the various avenues that they can access care. Then even some day to day operational things like managing a schedule effectively, I think the pandemic has strained resources. Cases can only happen when you have resources to do them. So a lot of institutions, particularly in the operating room, have closed down operating rooms because of staffing challenges, like I mentioned earlier, but that adds an additional layer of complexity for providers that are trying to access that theater. It causes a ripple effect throughout every part of the continuum of care. It's really been an interesting time for us, helping organizations adapt to these issues that have materialized more recently

Camille Baxter: With all these challenges facing health systems, can you outline some of the specific measures that successful health systems use to navigate these challenges?

Michael Besedick: Operating rooms in particular are really a complex business. I think it sort of shocks people when people ask, what are the three things that we need to focus on to run effective surgical services? And I was like, "Well, it's not three, it's more like 30." The unfortunate aspect of that is there's not really ever a simple answer. And I think there's a mixture of incentives in the operating room that require, I think, effective leaders to view the problem from a lot of different angles in order to find a solution. I think the common ones that are out there are traditional metrics, like first case on time starts like, are we starting our day on time? What's the turnover time between my rooms or for certain surgeons? What is my utilization? So how well am I utilizing the OR time that I'm providing to surgeons? How well am I utilizing my staff resources when I'm working, when I'm doing work in the operating room? And then also there are some important intraoperative metrics as a sort of umbrella, like looking at case time, for instance, or like other intraoperative timestamps like from the time the patient's wield into the room till the time is anesthesia is ready to the time the surgeon is cutting. I think everything along that inoperative continuum of care is also worth looking into. Those are some of the high level ones, but I think there are a lot of different ways you can look at those to understand the problem better and be tactical about what you are specifically going to do to address those opportunities that you might have.

Camille Baxter: So how can health systems leverage advanced analytics to address some of these challenges?

Michael Besedick: Like we were talking about earlier, there's been an explosion of information across the globe for everything, but particularly in healthcare, the advent of EHRs, we're tracking a lot more things now. So there's a lot more information available to us, but just because you have data doesn't necessarily mean you have a plan to address your opportunities. So I think you need to do some tactical things to focus what you're actually going to implement in terms of making an improvement. I think a great example of this in one of the examples I mentioned earlier was turnover time. It's an emotional number, particularly for surgeons that are working throughout the day, because to them, it represents how quickly they can go from doing one case and moving into the next case. But for a nurse staff, it's also an emotional number, but for a different way, because they may feel some production pressure in not being able to follow protocol in getting the room ready for the next case, like ensuring that the floor has been dried if they're using a particular cleaning solvent, or if they have the right environmental support to clean the room in an efficient way, or if they have the resources to get the patient out of the room. I think there are a lot of factors that lead to people experiencing different pressures in turning that room around. And I think in addition, there's this other complicating factor where a lot of surgeons are expecting to experience no turnover whatsoever. They want to be flipped or what we call toggled into a different room as soon as they finish putting the bandage on their patient to save them time. And it makes a lot of sense to keep a surgeon highly productive throughout the day, but that is enormously challenging for an operating room because they have to hold another operating room open, ready, and staffed and stocked for that surgeon to be flipped into that room. So now you see all these complicating factors and understanding what seems like a very simple metric, but you need to use different ways of slicing that metric to triangulate where the opportunities exist. I'm getting into the weeds here but one example is, do you want to understand how well a particular operating room in your institution is turning over? So that would involve looking at that operating room, seeing what cases are happening in that room and understanding the time difference between a patient being wheeled out of that room and the next patient being wheeled into that room. That's a pretty standard example, but that may not necessarily represent or reflect the surgeon's experience of their delay, because it could be another surgeon wheeling in a different patient into that room. And the surgeon from the proceeding case is moved into a different room and has a different wait time. So it could be a longer period of wait time from one case to the next in room one, for instance. But the surgeon that was doing the case earlier in room one is now in room five and waited maybe 10 minutes to start their case versus the 45 minutes it took to turn over the preceding case. So you really need both metrics. You need to follow both the surgeon and the room, what's happening in each, to understand where the opportunity exists. The other big one, like I mentioned, is that flip room scenario. This is a big pain point because surgeons want to experience no wait time. So how do you reflect the metric? How do you really understand what that surgeon's wait time is without following them and understanding when they are being flipped into that next room? I think you need some more advanced tools, like the ability to track for a certain surgeon when they have overlapping cases or when they are being flipped so you can represent the number, I think more accurately. I know that there were a lot of what if scenarios that I just mentioned here, but I think it's important to frame it that way, because it gives you an appreciation of the problem where a lot of people want just one number, but one number is usually never enough to really describe what's happening in the complexity that goes on day to day.

Camille Baxter: Yeah, there's so many moving parts behind the data, that most people wouldn't think about, wouldn't realize. So what are some of the common organizational barriers to creating change within an organization, even after advanced analytics tools have been implemented?

Michael Besedick: That's a great question. And I think there's a ton of information out there. There's a ton of analytics that you can apply. There are workflow solutions, there are analytics reporting tools, there's dashboards, but unless there is the correct governance structure in place, we've found that organizations, in spite of having everything else, still struggle to make and sustain effective change. I think that there are a lot of reasons for that, but one of the big ones, like I mentioned earlier, was a mixture of incentives depending on the stakeholder that exists in surgical services. I think there are a lot of different incentives that exist for different stakeholders. So just an example, a surgeon wants to remain as productive as possible with their time in their ward. They're extremely busy people. You know, they have a very, very challenging schedule, both in the operating room and in their office. They want to keep their gloves on basically all day so that they can do the cases that they set out to do with minimal interference. Then there's anesthesiology, which supports the day to day operations of the OR, but they also want to remain really productive, but not necessarily at the expense of predictability in their day to day schedule. I think it's very challenging because they have frequently very difficult call schedules that require specific skill sets, like if there's only a few pediatric anesthesiologists at the institution or a cardiac anesthesiologist and cardiac surgeons want to work at a certain time because it's an urgent case, then they're roped into supporting those cases at times that may not be optimally convenient for them. Similarly, nursing faces similar challenges. They deal with a lot of flavor of the day challenges. If a patient hasn't been optimized for their procedure, they're the ones that are helping ensure that that case goes well and that it goes safely, but their incentives are not perfectly aligned with those of surgeons or anesthesiologists. And then finally, the other major one is the hospital administration. The hospital administration in many instances would love for the operating room to run indefinitely all day long and all night long because it's the financial engine of many hospitals. Well, the challenge there is people don't necessarily, they can't work 24/7, essentially. And understandably, I don't think any hospital administrator would be like, okay, we want to work people to the bone. But I think the incentive structure that exists is such that they want to maximize the amount of money that they can make, or the value that they're getting from surgical services, because it is such a vital part of their financial success and longevity. So I think there's subtle differences, but you need the right governance structure in place, using data to find the overlap and find out where you can make compromise. A great example of this is a surgical block schedule. I think block schedules are not necessarily managed effectively all the time, but if you can get each stakeholder aligned on the plan and the vision for the organization and design an access system for surgeons that are coming to work there effectively, I think that is a great way to use both the data and information that you're gathering about the day to day operations of your institution, but also leverage a better governance structure, getting each stakeholder aligned on what the plan is, essentially to run the OR.

Camille Baxter: So it really sounds like in order to successfully implement these advanced analytics, you're really driving behavior change within the organization. That's so interesting to see the broader scope of that. So how can data be used to effectively overcome some of these organizational barriers?

Michael Besedick: I think it goes down back to what I said earlier. It's interesting. I think going into an institution and setting up a governing structure that is comprised of surgeons, anesthesiologists, administrators, nursing and staff, and showing them three numbers for what we think will improve their operating room, has never been effective for me. Giving them a simple answer has never been effective. What I've found to be effective is treating the problem, I think more appropriately and appreciating the nuance and complexity of each one of those stakeholders. I think in order to do that, you need more than three metrics. It's just not that simple. I think surgeons, anesthesiologists being scientists appreciate the detail and the nuance because that helps tell their story more effectively. So I think data, it doesn't necessarily need to be complex, but it needs to be representative and needs to represent the variance that is inherent within the system that people work within. And I think that helps level the playing field because people begin to develop a common understanding that maybe didn't exist before when they were just being handed a report that didn't necessarily make sense to them. I think you need to have a curated set of analytics that help tell a story for the organization that I think is more nuanced than just high level statistics that maybe someone might read in a quarterly business review. You need something that really tells the story of individuals or of groups, that tells the story of each stakeholder and is representative, I think, of the problem. I think that is just the foundation, because once that's understood people can act and can take action once they understand the problem I think a little bit better. I think that there are a lot of technology solutions out there that try to fix very, very small subsets of problems. Some are effective and some are not as effective. So solving one specific problem does not necessarily touch every stakeholder that needs to be involved in enacting change in the organization.

Camille Baxter: I love your reference to data and storytelling. I've always felt that data should tell a story and really that's how people understand it and interpret it, otherwise it's just data. So I think that's so helpful within an organization. Michael, how do you feel that technology is changing the landscape of procedural services?

Michael Besedick: I think technology is having a profound impact on the surgical services landscape right now. I think that there are a lot of platforms and solutions that are cropping up to solve some of the issues that I mentioned earlier, like staffing related challenges, operational related challenges, financial challenges. But a lot of these technology platforms solve very specific things. It could be effective discharge planning, which is an enormously complex problem, but it has a very clear value proposition for organizations. I think that there are a lot of platforms out there that are hoping to disrupt I think the status quo in that the promise of EMRs it did some things, but it didn't necessarily do everything that we thought it was going to do. What we really need is a technological approach to using the data assets that we have. And I think a lot of these platforms, like I mentioned, are trying to create signal from noise and some are, some aren't. A lot of organizations struggle to see the direct value, but the reality is the value is usually captured some amount of time after the technology has been implemented. think this speaks again to another thing that I mentioned. There's not really a quick fix. There's not a three things that you can do to turn your operating room around or your health system around. It's a process, and I think it comes down to changing process effectively so that you can drive the culture that you want to see within your organization. I think in some ways, the right kind of technology that helps tell a story that brings people together and unites them towards changing processes within their organization helps foster a culture of change that is more effective for long term success. I think technology platforms that can't do that, or aren't aiming to do that will struggle, I think, long term, to prove their value within the organization. So there's a lot out there. Some are really good, some I think we'll see whether they withstand the test of time.

Camille Baxter: As we finish up, Michael, what solutions does Surgical Directions have to manage the issues you've outlined here today?

Michael Besedick: That's a great question. So Surgical Directions, I think is principally a consulting firm. We work directly with organizations to establish effective governance, make sure that there are processes in place to sustain the change. But like I mentioned earlier, what we found is we really needed a tool, particularly for institutions that didn't necessarily make the investment in analytics or data and resources long term, to help them sustain that change and hardwire that change. So after years of working directly with hospitals, we developed a technology platform called Merlin, which helps surface a lot of these perioperative analytics that organizations use very commonly. And I think there are some really high level metrics that'll be familiar to people, like tracking first case on time starts turnover time, utilization, block utilization. But I think what it also enables you to do is it really helps you contextualize the problem for individual surgeons, for groups of surgeons tracking their in block usage, their out of block usage, their flip room usage, their turnover time between cases, their non block usage, so when they're working on days where they don't have block. It really gives you a comprehensive view of what's happening in your operating room. And we've designed the experience of using Merlin to be usable for people that don't commonly use reporting software or technology. A lot of times, OR directors in particular will be tasked with producing all the analytics for their business line that they're charged to run, but don't have nearly the amount of support required to do that effectively and repeatedly. That causes a lot of these issues with lack of trust in data. If surgeons aren't seeing consistent definitions of certain metric time in and time out, you can produce a report and they won't trust it because it's done differently each time. So a platform like Merlin allows you to have consistency in viewing and understanding that data and contextualizing the information because you can drill in. It's also very easy to use because we put it in the hands of people that can use it every single day. I think it's important to remember given all these challenges that we talked about earlier, people that are working in the operating room are extremely crunched for time. They don't have really any slack in their day. So they're quick to abandon tools that get in their way. And a lot of times software that's built into EHRs or other reporting tools that are out there are a little cumbersome to use. So we tried to design the user experience to make it as easy as possible to get to the information that they needed quickly and make sure that that information was contextualized for the organization as a whole, like I mentioned, having each stakeholder be invested in essentially the numbers that they see to drive change.

Camille Baxter: Thank you Michael so much for your time today and for helping our listeners to better understand the broader scope of advanced analytics and how it helps to drive healthcare delivery efficiency.

Michael Besedick: You're welcome. Thank you so much for having me today.

Camille Baxter: This has been a sponsored episode of Healthcare Insider, created in collaboration with Surgical Directions. For more information about Surgical Directions, please visit surgicaldirections.com. I'm your host, Camille Baxter. Look for more episodes of Healthcare Insider at modernhealthcare.com/podcasts or subscribe at Apple podcasts or your preferred podcaster. Thanks for listening.  

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