Jackson Surgery Center Sarah Starr, Kendall Watson, Nicole Wiesneth,

Xinyu Zhu (Sam)

Auburn University

Jackson Surgery CenterThe first surgery was performed in 2008. 1000 cases performed a month in:

General SurgeryGastroenterology, Urology OrthopedicsPlastic Surgery Ear, Nose, Throat

Often called the “Wal-Mart” for surgeries50% of the Surgery Center is owned by Jackson

hospital, the other 50% is owned by physicians

Endoscopy procedure room

General Procedure Operation Room

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.

Culture of the Surgery CenterA 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.”

Conflict resolution strategy• Communication is the primary method used to

resolve conflict

• The nurse manager states that almost all conflicts are result of miscommunication

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)

Assuring patient-centered care

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 is marking 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.

Measures to ensure continuous quality

improvements

Quality StandardsIt is important to review and report quality

standards each monthSome example of reviewable events include:

patient fallsantibiotic timinghand washing compliancepatient cancellationsreturn to surgery rateshospital admission post-op infection rate

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

Challenges facing the unit

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

2. Low patient volumeJackson 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

3. Scheduling Dealing with staff “call-ins” is challenging for the

environmentEvery person’s job is unique and when individuals

call in, it throws off the dynamic of the groupAt 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

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

• 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

Staff at The Surgery Center

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

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.”

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

Staffing processApplications are submitted online through the

Jackson hospital websiteThe 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

Questions??