Hi, my name is Paul Verossi, and I'm thrilled to be talking to you today from Grandview Medical Center here in Birmingham, Alabama. I'm going to start with a truism that probably a lot of you have heard. Start with why. This phrase was made popular a few years ago by a guy named Simon Sinek. He now famously remarked, people don't buy what you do, they buy why you do it. Let me say that again. People don't buy what you do, they buy why you do it. What Sinek was saying goes far beyond business, marketing, and commerce. It's true for all of us, yes, even for us in healthcare. As we approach every detail of our day to day, our why is the thing that connects us to other people. It's the reason we get out of bed every morning. It's the thing that makes us do what we feel called to do. So why do we do the things that we do every day? It's my pleasure to be joined now by Dr. Jose Osorio and Chris Cooper. Jose, tell me, why should we care about the quality improvement processes you all introduced here at Grandview? So Paul, it's all about the patient, right? I think ultimately, not just the quality improvement process or efficiency or what some would describe as throughput of your EP lab. I think the best way is to look at our customer. The most important person here is the patient. That's the stakeholder that we owe to the patients to have this continuous quality improvement mindset. And the way we have worked and the way we have built our lab and the culture we have today is not a focus on efficiency, as it really has been a focus on standardization of processes and quality improvement and data collection, outcomes data collection built into that. And the end result was efficiency. So I think as one decides to look into why, you should ask yourself, I mean, we got into medicine and for patient care. And a process of standardization, a process of data collection, protocols, this will give you the end result of an efficiency process. Improving the efficiency of the lab will be something that it's all win, all stakeholders. I think as we have worked so diligently to achieve the efficiency we have today, I think the more important aspect is our staff. They're more satisfied with what we're doing and how we're doing. The physicians that work with us also have seen great improvements in their ability to not just get home earlier, but also to deliver better patient care. And by having extreme standardization, we are delivering better care for our patients. So why is the patient? However, as you work on it, everybody wins. Amazing. I mean, getting the opportunity to watch it in progress and in process is humbling for me as an outside observer coming to see this. Truly amazing. Let me turn to you, Chris, from the staff perspective, how has this been for you and for your team introducing these processes? So with the staff, what we wanted to create is an environment that they're all a part of, that they all have some say-so in how things go, the flow of the day, and the care of the patient. They come in ready to work. They're on time. They know to get there on time, to go to the rooms and get set up, assignments are pre-made on the board. I mean, we try to standardize all these processes because we want to be able to make their day predictable so that they can get their cases ready. They'll know what case they're getting. They know who's coming to the room, what's next, what they need to be ready for, or when it's time for lunch, or who they need to relieve for lunch. So we've standardized all these processes. The table being built, all of our physicians use similar tables. So I mean, we can use one table for all the physicians that we have with us because they're all standardized as well. So that makes for a day that is predictable. The staff knows they're going to come in, they're going to work, but they're going to get done at a decent time and they're going to go home. So that helps us with staff retention. It decreases the staff fatigue. We do staff to where that our patients, I mean, our staff, they're able to relieve one another. We have it to where nobody's just caught up in these long drawn out cases and it causes them to have this fatigue and they get upset and they get frustrated. So we try to make the whole day predictable for the staff and so that we don't schedule past a certain time, a four o'clock cutoff. We won't start a case after that unless it's just an absolute emergence. Our staff is not on call, so they don't have to worry with that. So when they're done for the day, they go home and they can do whatever they want to do with their family or whomever. So we try to make everything predictable for the staff for that purpose as to, so we want to retain our staff. Our staff is very valuable to us. It's hard to replace those people. You just can't go out and find somebody that can do what these guys do. So we are aware of that and we want to cater to that. We want to try to take care of that and keep that person. Amazing. So I think ultimately, you know, the word that is in full alignment with the standardization is having a predictable day. But more than that is a predictable outcome, right? And if the outcome we're discussing is efficiency, it's by standardizing and getting the staff, the physicians, the anesthesia team, prep and recovery, registration, by having these processes standardized, the outcome is better for your day. At the same way, along the same lines, by standardizing the actual procedure, the outcome for the patient should be better. So standardization will yield a more predictable day, a more predictable efficiency and throughput of the lab. It's easier to plan the staffing needs. It's easier to understand how many procedures you can do in a day without overwhelming the lab. It's easier to plan for investments. It's also easier in the end to understand what the ultimate outcome of that patient will be. So we want things to be as predictable as possible. Control our environment in as many variables as we can. Well, it sure comes across as being an incredibly well-oiled machine with a very fine choreography of the motions that the whole team goes through. It's just striking to watch. How does it then all influence the efficiencies for the bottom line of the hospital? You mean the bottom line in terms of the finances for the hospital? Exactly. One of the great results of this standardization that we've seen very quickly with the hospital is because we created a predictable environment, right? The hospital understands very easily and much easier than other areas in the hospital what the return on investment will be. So as we started here just five years ago in this institution with one EP lab, it was easier for the hospital to understand that with such an investment, this is the return on investment we're going to have. So six years later, we have four electrophysiology laboratories. So I think the fact that we created an environment that is so predictable down to how much we control over time by creating an efficient day, how many cases we can do in a given EP lab, how we interact with the anesthesiology department, we have a very good way of discussing with the hospital and planning and convincing the hospital that such an investment is important. So that's how we have also been able to continue to invest in equipment, mapping systems, recording systems, ultrasound machines. Everything ties into this, into the fact that the ways to understand return on investment in a laboratory that has an established flow and that for anyone to join and start working in our laboratory, that has made the life for the hospital easier as well. So at the end of the day, it's better for the patient, it's better for the staff, it's better for the hospital. And the physicians as well. I think we all want to go home and have dinner with our families. So that's a part of how we've seen this. If you don't have perfect alignment of all the stakeholders, you're not going to accomplish what we have. And the alignment of all the stakeholders needs to be hospital administrators, the staff at prep and recovery, registration, physicians, the techs, the nurses in the lab, and the patients. We prepare very well our patients for these procedures. The patients come with a very good expectation for what the day is going to be like. We have brochures that explain, you're going to get this time, you're going to have a transesophageal echo, this is where the cafeteria is, this is how your day is going to go. So the setting expectations and the standardizing the process makes for a more predictable outcome. Amazing. Jose, to be a little bit more specific, tell me about how these processes have affected your ability to get patients into the lab for procedures. It has having a predictable day and knowing exactly how many ablations, devicing plants I can do in a day. And having reached that steady state. What it has caused is typically from evaluation in the office to having a procedure done. We are at about two to three weeks. So shortening that time from evaluation to a procedure, it improves patient care and improves the satisfaction of the patient and family members and also improves the satisfaction of the referring physicians. So if you close the whole cycle, we have been able to deliver much more efficient care for our patients. So that interestingly has led us to have to then focus on the clinic processes as well. Because now, you know, our bottleneck is no longer the lab and how many procedures can be done in a day. The bottleneck has become, has shifted to the clinic. It's how many new patients we can evaluate to then appropriately bring to the EP lab. So it's changed significantly the focus on where need we try to improve processes at this point. But we see great examples of patient, significant patient satisfaction stories about being able to be seen in the office and sometimes have a procedure three, four, five days later if clinically there's a need. So Chris, I know in many labs, folks who work in nurses, techs, get used to the idea of, oh, today's going to be a late day. We'll be there till 10, 11, midnight sometimes. And they like that over time. Tell me about how this has been for your staff getting used to the idea of knowing that they're leaving at reasonable hours. So a lot of my staff came from hospitals to where they worked till 10 o'clock at night, starting at 7 o'clock that morning. And I think some of them felt like it wasn't true at first what they heard about us before they came here when we were trying to recruit them. And I told them, I said, I can give you a day where I can predict what time you're going to go home. And I can predict what time you're going to start work today. And then you're going to be able to make those t-ball games. You're going to be able to go and see your kids recital. You're going to be able to do those things. And that's all a part because what the efficiency model we put together, I mean, it's a complete buy-in from the physicians, administration, everyone, pre-op. Everybody knows that their part, they take in that. And the physicians as well. They know that if they're in the lab and they don't go somewhere in between cases, they get right back into the room and get started. That helps my staff to be motivated to stay working harder because they see that everyone around them is working equally as hard to complete the day and get the cases done. They like to go have dinner together sometimes. They like to go have a drink. They like to do extracurricular activities together. And they're able to do that. And they became a kind of a family together. I mean, they're here more than they're at home. And they work so well together. And it's just because of the decrease in stress, the predictable day, these guys, they tend to, you know, they share more together and they do more together. And then they become, you know, as a functioning, one functioning unit. I mean, and it's a beautiful thing to watch, really, when you see them all together up there. And a lot of the guests who came here in the past have made comments about, well, how do you get your staff to get along so well? And it's just part of the culture here. It's just part of what we've done to decrease stress and make a more predictable day for these guys. I think one thing interesting, we're frequently asked, how do you incentivize the staff? It has never been a financial incentive. OK, it has been incentive for them has been different, has really been that we feel they feel like they're in a collegial environment. Their voices are heard. They are considered an important stakeholder and they have a predictable day. So it wasn't a financial incentive that made us build the staff the way we have today. It was paying close attention to how they are doing and responding to that and building a lab. And I think I'll say this several times as we continue this conversation, building a lab that all stakeholders had their voices heard. Well, these changes really would represent a massive departure from the standard culture of what happens in most places. And I can see in a time where there's so much physician and staff burnout, this has got to be a part of the solution to those issues. And think about many of our staff members have young kids, you know, they have two, three, four, five year old kids. I have children. And I think allowing people to live their personal life to the fullest is part of what we should do to improve their quality of life and overall morale and interest in continuing to work with us. So we have not had turnover in our staff. We've been very fortunate with that. We've lost a few that went to industry. But we have not had a single staff member that left our lab to go to a competing lab. But this hasn't happened ever. Jose, Chris, thank you both for helping us to understand why we all need to care, because clearly we do. Thank you.

quality improvement processes

patient care

standardization

efficiency

financial benefits