Jackson Surgery Center

1. Jackson Surgery Center Sarah Starr, Kendall Watson, Nicole Wiesneth, Xinyu Zhu (Sam) Auburn University

3. Jackson Surgery Center • The first surgery was performed in 2008. • 1000 cases performed a month in: • General Surgery • Gastroenterology, Urology • Orthopedics • Plastic Surgery • Ear, Nose, Throat • Often called the “Wal-Mart” for surgeries • 50% of the Surgery Center is owned by Jackson hospital, the other 50% is owned by physicians

4. Endoscopy procedure room

5. General Procedure Operation Room

6. Goals of the Unit • Overall: To be “the place patients ask their doctors to perform surgeries at” in the Montgomery and the River Region • Daily: The Surgery Center strives for customer satisfaction by providing safe, efficient, and financially responsible care.

7. Culture of the Surgery Center • A mixture of family… • “Family comes first and communication is always open from the employee and management sides” • And work • “We have a business to run and although we do like to talk to each other about things other than work, if those things begin to interfere with the nurse’s work, they may be asked to leave those things outside of the unit.”

8. Conflict resolution strategy • Communication is the primary method used to resolve conflict • The nurse manager states that almost all conflicts are result of miscommunication

9. Targeted National Patient Safety Goal • Preventing wrong site, wrong procedure, and wrong person surgery • Verify the patient before surgery using two methods • Mark the site • Perform timeout before surgery • NPSG.01.01.01- use 2 patient identifiers • Universal Protocol (UP.01.01.01, UP.01.02.01, UP.01.03.01)

11. Assuring patient-centered care

12. It is important to establish continuous standardize care for the patients • “as a general rule, we do it the ‘same way each time.’” • One example of patient centered care ismarking surgery site on the patient in pre-op, creating a “time-out” before all procedures to ensure accuracy, and always have an updated patient history and physical available.

13. Measures to ensure continuous quality improvements

14. Quality Standards • It is important to review and report quality standards each month • Some example of reviewable events include: • patient falls • antibiotic timing • hand washing compliance • patient cancellations • return to surgery rates • hospital admission • post-op infection rate

15. Other quality improvement projects • Other measurable improvement projects come from documentation, observation, and physician requests • One project they are looking at are “turnover times” which is how long it takes to get a patient out of the OR and a new patient in ready for surgery

16. Challenges facing the unit

17. 1. Financial circumstances • Payroll and supplies make up the highest cost • They are currently reviewing ways to reduce supply cost instead of lowering payroll • Some ideas… • Staff is required to take directed time off if the center is not busy • Surgeries may not be performed on a patient who is not able to pay due to the for-profit nature of the surgery center

18. 2. Low patient volume • Jackson Hospital surgery center only takes elective surgeries from patients who have some form of health insurance • Due to economic hardships, patients are more likely to delay elective surgeries or avoid them all together • Patients either do not want to spend the money for the deductible or do not want to take time off work for healing

19. 3. Scheduling • Dealing with staff “call-ins” is challenging for the environment • Every person’s job is unique and when individuals call in, it throws off the dynamic of the group • At the surgery center, only the necessary staff are hired so there are no extra staff around to handle when someone decides not to come to work that day

20. Forces for Change in Unit Shift to “cost-effective patient-centered care” • Driving forces • Employees have great scheduling compared to other nursing jobs. • Staff works M-F daytime with no holidays, weekends or on-call time. • If there is a new change that does not work, managers are flexible to listen to valid arguments and make amendments as appropriate

21. Restraining Forces • Physicians are one of the most difficult groups of people to facilitate and maintain change among • New changes in healthcare reform are forcing doctors to be willing to change • However, there is hope. These physicians are financially invested in the facility, and therefore more willing to change

22. Staff at The Surgery Center

23. The Surgery Center’s Unit Manager • The unit manager has an “open door” policy and encourages staff to voice their opinions and concerns with her when needed • Her office is strategically placed in between the pre- and post-op areas so that she is in the middle of the unit instead of separated from the staff • She expects the staff to treat each other and the patients with respect

24. She encourages communication between staff in her office, even if the situation may become confrontational “I would rather have it happening in my office than on the floor and let if affect the way patients are treated.”

25. Current recruitment and retention efforts • JSC rarely has staff leave, unless it is for retirement or moving to another area • The percentages representing how many employees lost due to various causes is around 2% for JSC • Does not take long to fill the empty position • the flexibility of the hours and the pay make it a coveted place to work for those with families

26. Staffing process • Applications are submitted online through the Jackson hospital website • The team • Administrator • only get involved if there are problems • 4 team leaders (ENDO, PACU, OR, and pre-op) • Each team leader is responsible for staffing or down staffing their area (Call-ins, Leave of Absences, etc.) • Business Office Manager • Director of Quality

27. Questions??