Case Study: Experienced Leadership Guides Cultural Change to Hospital's Anesthesia Services

Executives at Owensboro (Ky.) Health Regional Hospital want to deliver anesthesia services that exceed the needs of the facility’s three primary customers: Surgeons, patients and payers.

Their renewed focus on customer service stems from the hospital’s need to adapt to new value-based reimbursement models that pay for services based on outcomes rather than on the volume of those services.  For Owensboro, that meant hiring anesthesiologists and certified registered nurse anesthetists who possess a can-do attitude about managing anesthesia services during surgeries, diagnostic procedures and births.

To accomplish these goals, Owensboro executives retained NorthStar Anesthesia—which has anesthesia services management contracts at more than 180 facilities in 20 states—to provide a flexible, customer-centric approach to anesthesia services.

The 477-bed hospital, which is part of two-hospital Owensboro Health, includes a 12-room surgical department, obstetrics unit and catheterization and endoscopy labs.

NorthStar employs eight anesthesiologists and 29 CRNAs to provide anesthesia services to Owensboro’s patients.

Challenges

NorthStar faced a challenging task when it took over anesthesia operations at the hospital on Jan. 1, 2015:  Transforming the culture of anesthesia from one that was entrenched and internally focused to one that is flexible and externally focused.

“It was a very rigid culture,” says Jeffrey Epley, CRNA, NorthStar’s regional director of CRNA services for the Southeast.

Many of the existing CRNAs expressed concern about the hospital administrators’ decision to change anesthesia management to NorthStar from a local group, which had been providing services at the hospital for nine years.

“We were upfront about why the previous contract wasn’t sustainable and why we were brought in to make changes.”

-Jeffrey Epley, CRNA, Southeast regional director of CRNA services for NorthStar Anesthesia 

Solutions

Epley—who has managed seven transitions for NorthStar—used his and his colleague’s well-honed communication skills to build rapport with staff members and to articulate NorthStar’s customer-centric approach to anesthesia-services delivery.

NorthStar implemented changes to daily operating procedures to accommodate the new approach, including:

• A flexible schedule in which the number of anesthetics performed on a given day varies, depending on the daily volume of surgeries, including add-on cases in the afternoon.
• A dedicated, on-site CRNA in the obstetrical unit 24/7 to respond quickly to requests for epidural and spinal anesthesia.
• Two CRNAs with on-call duty each day.

The changes were not easy for the existing CRNAs to make. After years of leaving work promptly at 3 p.m. each day, covering obstetrical rotations from home and never taking on-call duty, the incumbent CRNAs now had to embrace unpredictable hours.

“We were upfront about why the previous contract wasn’t sustainable and why we were brought in to make changes,” Epley says.

In addition to changes in the daily routine, NorthStar also encouraged professional self-governance and teamwork as it does at all its sites.

For example, NorthStar added a CRNA leadership team that not only includes Epley but also a chief CRNA at Owensboro. Both managers and staff members interview candidates to fill open positions and participate in multi-disciplinary hospital committees to improve the quality and efficiency of surgical services.  

NorthStar also gives CRNAs control over their schedules whenever possible. For example, it posts on-call schedules in the OR area, giving CRNAs the flexibility to sign up for as many—or few—shifts as they’d like. And Owensboro CRNAs choose the average number of hours they work in a week, ranging from 32 hours to 48 hours.

“So along with being flexible in our anesthesia services at the hospital, we’re also flexible with our teammates,” Epley says.

Results

The changes in anesthesia services already have led to a dramatic increase in surgical volume. In 2015, for example, Owensboro Hospital performed 21,000 surgeries—23.5 percent more than the 17,000 surgeries hospital executives had projected for that year.

In labor and delivery, anesthesia’s response rates have improved because patients and obstetricians do not have to wait 30 or more minutes while CRNAs drive from home to the hospital.

“We’ve got a really good crew of CRNAs. They are eager to work and eager to make Owensboro a great place,” Epley says.

With the sensitive transition behind it, NorthStar plans to continuously improve how its employees manage patients’ pain and anxiety before, during and after surgery.  For example, NorthStar monitors patients’ and surgeons’ satisfaction with anesthesia services, among other performance measures. The company also plans to adopt a multimodal approach to anesthesia that includes the routine use of regional nerve blocks, which reduce patients’ post-operative pain.

“We want to provide the best customer service to them that we can,” Epley says.