Checklist for Surgical Services Site Inspection and Interview

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When to use this checklist

When you are conducting due diligence review site visits of your participating  network health facilities, clinics and ambulatory surgery centers.

Who prepared this checklist?

Checklist help you standardize your inspection process as a health tourism facilitator and care coordinator at the approved health facilities in your provider network.

Many health tourism coordinators and facilitators lack any medical background whatsoever. Others have clinical experience but have never worked in the operating theater and have had no reason to learn these nuance protocols. Maria Todd offers coaching and one-on-one training for new facilitators, and this is one of the checklists she shares with them prior to accompanying them on site inspections to teach them how to qualify a hospital, clinic, or ambulatory surgery center. To our knowledge, she is the only coach, worldwide, who will accompany a new facilitator on inspection rounds of health facilities, hospitals, clinics, airports, spas, hotels and wellness centers. She will teach you the inner strategies and the outer best practices you need to become the owner of a thriving, profitable health or wellness tourism business that runs like a well-oiled machine and keeps clients safe and suppliers thrilled to continue working with you.

Maria uses a lean approach to focus on minimizing waste and non-value added activities, (ie, things that take time and/ or resources without direct benefit to the patient). She draws from her previous work experience as an OR Nurse and continuous quality improvement of her own standards and criteria that she established and implemented for Mercury Health Travel and Medical Tourism Journeys, two of the medical tourism care coordination arms of Mercury Healthcare International.

As a consultant and coach, Maria educates health and wellness tourism care coordinators about Lean concepts applied at healthcare facilities worldwide, including:

  • 6S – (Safety, Sort, Set, Shine, Standardize, and Sustain), 8 Wastes, closed-loop process improvement, value stream mapping, value-added vs non-value-added activities,
  • 8 Wastes (defects, excess processing, overproduction, waiting, inventory, moving, motion, under- or non-utilized talent)
  • Closed-loop process improvement
  • Value stream mapping
  • Value-added vs non-value-added activities, and
  • SMART (Specific, Measurable, Aggressive yet Achievable, Relevant, and Time Bound) goals.

Maria knows that if the medical tourism facilitator or care coordinator has any ambition to achieve certification by ISO 9001:2015, they will be required to produce their documentation of standards, inspection criteria, and metrics used for their quality management system. She also knows that if a medical tourism facilitator or care coordinator is paid an illegal or unethical kickback to refer a patient to a provider that results in harm to the patient, that the medical tourism facilitator or care coordinator will be asked for their records, inspection notes, criteria, and other documentation to show that due diligence and duty of care were properly executed.

Questions for your checklist

  1. What percentage of cases are First Case On Time Starts (FCOS)? “On time” is defined as wheels into the room before the scheduled start time; 1 minute after the start time is considered late.  Why is FCOS important? When patients are fasting and nervous and waiting in the pre-op holding area, minutes seem like hours. Late starts diminish the patient experience for both patient and companion and cause the operating team to feel stressed as they struggle to catch up so that all the following cases are not also late starts.
  2. Does the facility use a patient care completion matrix prescribing exactly when critical patient care elements must be completed and by whom, with a deadline of no later than 15 minutes before scheduled surgery time?
  3. Does the facility use colored flags outside of all preoperative rooms to alert team members and providers where the patient is in the preparation process?
  4. Does a registered nurse anesthetist (CRNA) greet and interview each patient with the circulating RN in the preoperative unit? Does a CRNA or an anesthesiologist premedicate the patient without a physician order if necessary?
  5. Has the facility implemented an SBAR (Situation, Background, Assessment, Recommendation) tool or its equivalent required for use by both anesthesia and nursing requirements for a safe hand-off throughout the perioperative experience?
  6. Are all ORs damp-dusted and stocked, and computers booted up by the night shift starting by 4:00 am? Is there a written policy for this?
  7. Are all OR staff expected to begin opening packs and scrubbing 15 minutes before the scheduled case start? Is there a written policy for this?
  8. Does the facility hold a daily after-action review huddle which takes place 15 minutes after cases start in the OR so that preoperative and OR leaders can discuss what went well or what did not go well and requires further action? Is there a written policy for this?
  9. Does the facility hold a daily afternoon huddle to plan for the next day’s cases?
  10. Does the unit management and supervisory staff from the preoperative unit, OR, Post Anesthesia Care Unit (PACU), sterile processing department, and OR scheduling meet every afternoon to mitigate any issues?
    Does the facility use a pod staffing model in which 3 to 4 like specialty rooms comprise a pod with dedicated support staff assigned to each pod?
  11. If yes, are additional float staff are assigned to pods based on the surgical case type?
  12. Does the facility employ a surgical support aide (SSA) whose role has been established with clearly defined and expanded responsibilities for before, during, and after surgical cases?
  13. Does the facility use walkie-talkies allowing immediate response? Or do they use overhead paging or passive phone communication?
  14. Does the facility use job completion matrices for basic and complex case turnovers?
  15. If yes, does the matrix for each define the expectations of who should be doing the work, when it should start, and when it should be accomplished? Is there a written policy for this?

Key Performance Indicators (KPIs) for Turnover Times (TOTs)

  • Overall room TOT  – 56 min
  • Teardown time (close to wheels out)  – 9 min
  • Wheels out to wheels in  – 20 min
  • Setup time (wheels in to incision)  – 23 min

If the hospital or health facility has answered all questions in the expected affirmative, but the KPIs for room TOTs is longer than the above metrics, dig deeper. Something doesn’t add up.

Why these things are important

  1. Quality management and safety. The increased level of engagement among staff, administration, and physician partners allows for tremendous improvements in FCOTS and turnover time between cases. This reduces stress for all concerned, helps mitigate the tendency to rush and overlook safety procedures and risk mitigation steps. When the staff is relaxed and working well together, documentation is completed in on orderly fashion and accountability improves. As a result, the patient doesn’t perceive the stress and is also able to relax more easily.
  2. Financial benefit. When cases run smoothly and on time, and turnover time is decreased, more cases can be scheduled in a day within normal block times for each operating theater. This can have a positive effect on pricing stabilization, internal cost containment, and shorter waiting periods for patients who need surgery and are in pain or stressed by their condition. Each minute saved in the OR adds up to annual opportunity revenue and additional capacity for each OR. These savings can be passed on to patients or accrued for expansion projects that benefit the healthcare facility, the community as a whole and competitive positioning against other hospitals and health facilities.

If you have questions for Maria about this checklist, contact her through the Higowell contact page or call +1. (800) 7274160 during regular business hours.

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