Saint Luke's Health System is a nonprofit health system in the Kansas City region. It has 16 hospitals and campuses, home care and hospice, behavioral healthcare, dozens of physician practices, a senior living community and more. The health system employs about 12,000 people and generates approximately $1.6 billion in net patient revenue annually.

THE PROBLEM

Saint Luke's was dealing simultaneously with a staffing and resources shortage, a growing demand for surgical services and a need to increase surgical services revenue. It needed to maximize its existing resources while simultaneously reducing staff workload. In short, it needed to be able to do more with less.

"In addition, we are in a highly competitive market with both nonprofit and for-profit operators," said Jane Peck, COO and vice president of service lines at Saint Luke's Health System. "Given these dynamics, we needed an approach that would give us a new strategic advantage.

"And, more specifically, about two years ago, our surgeons told us they were frustrated with not getting more operating room time," she continued. "Many of them were eager to get more OR time beyond their allocated block. A lot of our OR time was going unused, and this was a big friction point for our surgeons."

The root of the problem was that the OR processes and tools were highly manual. The OR schedulers received thousands of phone calls per month from surgeons' schedulers looking for time, and St. Luke's didn't have an easy way to ensure it was prioritizing strategic cases when more time became available.

PROPOSAL

Saint Luke's Health System saw this as an opportunity to move beyond phone calls and faxes – a process that has not changed in years, even with the introduction of EHRs. While other software could provide some visibility into OR calendars and performance, the health system believed it needed a technology that went beyond that.

It turned to artificial intelligence-powered healthcare operations technology vendor Qventus. The vendor analyzed existing workflows, processes and resources, and showed St. Luke's how its Perioperative Solution could be integrated with the provider organization's EHR to address key operational challenges.

"Specifically, it demonstrated the automation that would maximize our resources and free up our staff," Peck explained. "The vendor had an end-to-end solution that could help us create more time and then fill that time in a way that aligned with our specific strategic goals.

"What we particularly liked is how the Perioperative Solution combines AI and machine learning, automation and behavioral science in a way that other software doesn't," she continued. "We saw this as an advantage in many ways."

Peck explained three advantages she and her team saw:

• AI and machine learning models, built on St. Luke's local data, would allow the organization to take more targeted action and make it easier for end users. For example, St. Luke's could move away from a purely rules-based system for block release, because machine learning could identify times likely to go unused in advance and automatically nudge surgeons to release the time. The AI also would make it easier for clinic schedulers to identify the best available times for their surgeons and cases on the OR schedule so St. Luke's could reduce their friction of finding time.
• Automation would help the organization move beyond many of the menial tasks and processes and let it free up staff to perform at the top of their licenses. Clinic schedulers would be able to view and request operating room time automatically so OR schedulers wouldn't have to take as many calls for the cases that are easy to add.
• Behavioral science principles incorporated into the technology also would provide users with the "why" and present personalized information in a way that motivates them to act in ways that other software doesn't. This, ultimately, would help the organization drive the engagement and outcomes it wanted to achieve, such as more early release of operating room time and filling OR time in a targeted way.

MEETING THE CHALLENGE

The Qventus technology is an essential part of how St. Luke's optimizes its OR resources.

"The software integrates with our EHR, and it automates workflows that have touchpoints with our OR schedulers, employed surgeons and their clinic schedulers, and our affiliated surgeons and their schedulers," Peck noted. "In fact, many of our affiliated orthopedic clinics were early adopters and have found the system to be particularly valuable."

The new capabilities with the vendor's technology have enabled St. Luke's to increase OR access and fill available time more strategically, Peck explained:

• The machine learning predicts OR times unlikely to be used, and then, using behavioral science principles, prompts surgeons and their schedulers to release the time earlier. This way, already staffed OR time doesn't go unused, and the time is released far enough in advance that it can be optimized for the best case.
• When new time becomes available, the machine learning models predict the surgeon who's the best fit for newly available OR time based on their practice patterns, past performance and St. Luke's strategic goals. It then automatically offers this priority OR time directly to the surgeon.
• The vendor's technology also lets St. Luke's create an intelligent marketplace for the surgeons and their schedulers to request OR time, without logging in to the EHR. They can view available OR time in seconds, with results prioritized based on their search criteria. When independent surgical practices are looking for OR time, they often turn to St. Luke's first because it's much easier for them to find the time that works for them.
• In addition, the analytics helps OR teams find actionable improvement opportunities now, instead of just providing retrospective views. The EHR provided some PDF reports that were hard to analyze, but with the new technology, the organization can see this data and drill down to see performance by specific service lines or surgeons in order to reinforce engagement.

RESULTS

The results in the first year have been impressive – and better than expected, Peck said.

"I mentioned that our surgeons had complained about access to OR time," she noted. "With Qventus identifying the blocks of OR time that were likely to go unused and prompting surgeons to release them well ahead of time, we saw more than 700 hours of OR block time released early in the last month alone, with more than 45% utilization of that time. We've also had an eight-day increase in OR block release time in advance of the default auto-release.

"In addition, we're now consistently achieving about 80% prime time utilization in our main ORs, which helps make our available resources more productive and also reduces how often our team has to stay late," she added.

As a result, St. Luke's has been able to do 7% more surgical cases despite having to close 20% of its ORs at times. The organization now is meeting or exceeding budgeted volumes.

"We've also increased staff satisfaction," Peck reported. "Our perioperative services are operating at peak efficiency and in a way that is more aligned with our strategic goals, which means increased revenue and a greater utilization of existing resources – all with less of a burden on our teams."

ADVICE FOR OTHERS

"I would recommend that providers not settle for what their EHRs are giving them right now," Peck advised. "No matter how much you like your EHR or how comfortable you are with it, it's not designed to take your perioperative program to where it needs to go. Don't expect your EHR to do what it wasn't designed to do.

"Every provider organization has been disappointed by digital technology that didn't deliver what it promised, but there are new digital technologies out there that can tie the entire perioperative process together, eliminate inefficiencies and free your staff from much of the time-consuming manual work," she continued.

Most providers are in situations where they can't easily add additional resources to solve problems; that means making the most of existing staff and resources with technology that allows staff to perform at the top of their licenses, she added.

"If you need a new strategic edge in your market, you can't just use the same tools as everyone else," she concluded. "We've been first in our market with this automation technology, which is giving us a distinct advantage. You can wait to bring in these capabilities, but that will result in a massive opportunity cost."

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.