Optimizing patient outcomes by improving communication and teamwork was the goal for the TeamSTEPPS Master Training course that all AMSURG Clinical Quality team members completed in July. Held at AMSURG's Nashville headquarters, the Master Training course featured an in-depth train-the-trainer approach.

The two-day session, led by a team from the University of Washington, brought techniques, tools and innovative solutions to assist the AMSURG Clinical Quality team in successfully implementing and sustaining TeamSTEPPS principles of communication, leadership, situation monitoring and mutual support.

"This training is about empowering our Senior Clinical Directors with better knowledge to carry to our centers and equipping them with the know-how to help center staff improve the quality of care they're delivering," said Debbie Cibulka, vice president, clinical risk management. After the intensive training, all AMSURG Clinical Quality team members are now certified master trainers and will be training staff at various AMSURG surgery centers throughout the next year.

"You can strive all day long to try to do the best you can, but unless you have protocols in place that have been practiced to the point of habit, you're still going to be prone to errors," said Sarah Martin, vice president, clinical services.

Medical team training programs have been shown to reduce annual surgical mortality rates and adverse events. "The quality of patient care is equal to the quality of communication and planning," Martin said. "This training will be an invaluable asset to AMSURG Clinical Quality moving forward. We are committed to excellence and to providing accessible and proven tools for building a culture of safety in each of our centers."

AMSURG surgery centers are leading the way in creating a culture of safety. In honor of National Safety Month in June, AMSURG centers in various specialties answered the question: "How do you create a culture of safety in your center?"

The Center Leaders highlighted opportunities for strategic communication about patients, processes and procedures, including during staff meetings and timeouts. They provided ideas for enlisting staff members to be engaged in patient safety and for sustaining that engagement day in and day out.

Center Leaders are encouraging staff to view themselves as patient advocates and to speak up if they are concerned about a patient safety issue. Ideas were submitted via AMSURG's secure communications portal, Center Connect. The portal provides AMSURG Center Leaders and their staff with best practice performance improvement modules, financial reports and operational benchmarking reports, quality assurance performance improvement (QAPI) reports and opportunities to learn what other AMSURG centers are doing in their efforts to become centers of choice for physicians and patients.

Some of the best practices that were offered include:

• Discussing patient safety in each staff meeting
• Patients always being escorted to their family members or to their car
• Fully engaged participation in timeouts
• Encouraging nurses to speak up about concerns
• Having staff participate in creation of patient safety posters
• Including verbal reminders during patient hand-offs

This initiative to gather best practices from centers is one example of AMSURG's collaborative culture, illustrating the value the company places on the ideas and strategies its centers are putting to the test and the need to share those proven strategies between all centers.

When it comes to ambulatory surgery centers (ASCs), the right corporate partnership can make the difference between surviving and thriving. Ophthalmologist Kerry Solomon, M.D., of the Physicians’ Eye Surgery Center in Charleston, S.C., believes that AMSURG has been his center's key to success.

“I think what makes AMSURG a good partner is they understand the eye business. I think they also understand the importance of having a true partnership with physicians. Not everybody does that,” he said. “Prior to my being here I was at a corporate entity, a university-based hospital, and it really was not the case. It’s hard to have a corporate entity understand your business, yet let you do what you want to do.”

Dr. Solomon shared some of his initial concerns when considering a corporate partnership with AMSURG, but explains that his uncertainties were quickly put to rest. “When we owned 100 percent of the center, we were ok to make investments in new technology or new things, regardless of the expense, if we felt it was in the best interest of our patients. Yet we were concerned that bringing a corporate partner in may alter that,” he explained. “But everyone I called said that’s absolutely not the case with AMSURG. In fact, your day-to-day running will be no different than it ever was, and your decision making should be pretty similar to the way it always was, yet AMSURG provides great resources if you need them. And that really has been exactly the case.”

Regarding the future of his practice, Solomon feels certain that AMSURG will be a key component helping them advance to new levels. “There’s no question AMSURG is going to bring us to new places in the future. We can already see it as we’re looking to position ourselves for accountability care organizations and the Affordable Care Act and things along those lines. I do think they’ll be able to help us in negotiations.”

“The partnership is going better than I thought it could possibly be going, and I really went into the partnership with a lot of comfort and a lot of reassurance and a great deal of confidence that this would be successful,” Solomon explained. “They’re good people. They understand the business. They’re good to work with.”

Solomon is a well-recognized leader in ophthalmology, specializing in LASIK vision correction and cataract surgery. He was awarded TOP Doctor by US News & World Report in 2013 and currently serves on the editorial board of Premier Surgeon magazine.

Click here to watch the complete interview with Dr. Kerry Solomon. Be sure to subscribe to our YouTube channel and be notified when AMSURG physician partners discuss surgery center insights and their experiences with an AMSURG partnership.

Patient registration can be a cumbersome process. Eye surgery center patients generally have complex health histories, long lists of medications and, of course, less than stellar vision. Collecting patient histories and paperwork is no small challenge.

Early this past year, several AMSURG ophthalmology centers transitioned to online patient registration. Online patient registration offers several advantages:

• Patients can fill out patient histories at any convenient time, from the comfort of their home where their medicines and records are nearby. As necessary, their adult children or other caregivers can readily assist them
• The process includes digital signing of release forms, simplifying the check-in process
• Each center customizes the information collected to meet its needs. Once collected, the information can be printed out in an easy-to-read, consistent fashion
• A dashboard tracks which patients have submitted their information. Those considered to be high risk, based on criteria provided by each center, are highlighted so that staff can follow up
• For the second eye or any subsequent surgery, patients can log in and update their history, rather than having to provide the same information again

Center Leader Georgia Voss, The Eye Surgery Center in Silver Spring, M.D., has become a strong advocate for the program: "Using online patient registration has been a real help to our center. About 85 percent of our patients go online to fill in their information, which is a huge time saver. It improves the patient experience at the center because the check-in process is so much simpler for the patient."

Voss's center made the commitment to get every patient registered online. For patients who don't register themselves, a nurse calls the patient, collects the information and enters the data for them. The center even offers access to a computer for patients who don't have access elsewhere. "It has been hard work, but we believe it helps us give the best possible patient care," Voss said.

Incorporating online registration is one of the ways AMSURG centers can earn Cataract Innovator™ status. AMSURG launched the Cataract Innovator program in 2013 as a way to recognize centers for going above and beyond standard best practices in order to improve patient experience. Eye surgery centers with the distinction of being a Cataract Innovator always strive to provide the best patient experience possible and are dedicated to using the most up-to-date technology and research to provide outstanding treatment. Cataract Innovators are part of AMSURG's large network of outpatient eye surgery centers, where more than 100,000 procedures are performed each year.

After several years of moving around the Burton Hills office complex in Nashville's Green Hills community, it became clear that AMSURG needed a building of its own to continue to grow. That need produced a custom designed space right around the corner. The new location provides capacity for increased customer service, marketing and leadership functions to support the company's physician and surgery center partners.

There were big plans for the new headquarters from its inception. The moment AMSURG began working on the space the goal was to be as ecologically responsible as possible. This desire led to AMSURG’s new location being recognized as the largest gold-certified LEED (Leadership in Energy and Environmental Design) building in the state of Tennessee.

“We knew right from the beginning that we wanted to go about the design responsibly. Pursuing LEED certification was just the logical extension of that desire,” asserted Ashely Coleman, associate vice president of construction.

LEED certification is an extensive system of points and regulations that ensure a building is paying attention to things like environmental sustainability and energy efficiency. As simple as this sounds, there are always obstacles, both expected and surprising, that complicate the process.

One such complication came to light when the foundation of the building was being excavated. There was an unexpected natural spring. Construction turned this surprise into an advantage by utilizing the spring for the building's HVAC cooling tower.

LEED certification also emphasizes local sourcing. For that reason all materials in the Burton Hills location come from within a 500-mile radius, most from much closer. However, it is with the decorations and conference room naming that AMSURG really brought in some hometown flair. Photographs and paintings throughout the building depict areas all across Tennessee and each conference room is clustered into groups of Nashville favorites such as Cheekwood, Loveless Cafe, Ryman Auditorium and Vandyland.

By creating an exceptionally ecologically responsible building, AMSURG not only built an optimal workspace for its employees to continue to serve its surgery center partners, but also an optimal structure for the city of Nashville and Tennessee. In the end, everyone wins.

Having the ability to compare quality measures for procedures such as a colonoscopy to a national average is an invaluable tool that can provide ambulatory surgery centers (ASCs), endoscopy centers and physicians with quantitative proof that they are the best option when it comes to patient care.

“GI is kind of unique because they have, for a long time, worked on establishing standard quality measures for GI,” said Kathy Wilson, vice president of clinical quality services, “So they are well ingrained in having common quality metrics that everybody is familiar with.”

Through AMSURG’s collaboration with GIQuIC, centers and physicians can report and compare quality measures on gastrointestinal (GI) procedures, creating a standard of excellent care provided to patients.

GIQuIC formed in 2005 as an affiliation between the American College of Gastroenterology (ACG) and the American Society of Gastrointestinal Endoscopy (ASGE) to establish a quality registry for GI. Registries are data repositories which can be analyzed to detect patterns and trends that can improve the process and outcomes for patient care.

AMSURG started collaborating with GIQuIC in 2011, and established a special relationship for AMSURG physicians by creating a standard process for centers to be added to the GIQuIC registry.

“We were kind of the first line of technology support for our centers that would go on GIQuIC," Wilson said. “We have more than 60 centers [on GIQuIC], and our records are almost 25 percent of the whole record base in GIQuIC.”

The GIQuIC registry has rapidly grown in the past few years from only 100,000 procedures in 2012 to a 1.5 million procedures today. The data in GIQuIC provides a benchmark for physicians and ASCs and sharing this data with the doctors can drive improvement in quality. Research from the American Journal of Gastroenterology suggests that distribution of report cards and establishment of standards of practice can significantly improve quality measures such as adenoma detection rates.

Adenoma detection rate (ADR) is a standard measure that is considered one of the most important for GIs. The higher a physician’s adenoma detection rate, the more likely he or she will detect and remove a precancerous polyp during a colonoscopy. A high detection rate also usually means that a physician produces higher quality colonoscopy with fewer cases of colon cancer among his or her patients. It has been reported that each one percent increase in adenoma detection rate is associated with a three percent decrease in the risk of cancer (Adenoma Detection Rate and Risk of Colorectal Cancer and Death).

“Consumers don’t know what they need to know regarding quality,” said Rich Palumbo, vice president of field marketing. “We have a rare opportunity to frame the conversation. Consumers don’t know what ADR is or what it means, but we have the ability to educate and compare ours to national averages.”

With the data available on GIQuIC AMSURG is also able to show managed care payers very concrete data to prove quality and to use that to better compete in a pay for quality environment and to drive business to AMSURG centers and physicians.

“Without [data from GIQuIC], it will be difficult to compete for preferred status in tiered or narrow networks,” said Mark Wainner, vice president of financial operations and revenue management. “We have to educate [payers] on the value of our data because we know which indicators are most important. We can utilize the data to better compete in an environment where better outcomes differentiate ourselves from the competition.”

AMSURG encourages their centers to give the physicians their own report cards, as well as post their overall GIQuIC results in the center.  AMSURG is also including some GIQuIC information in benchmarking reports that go out to all ASCs.

“They’ll know how they compare to other centers, but most of the improvement really comes from the physicians knowing what their results are and maybe establishing standards for their own practice or for their center,” Wilson said.

The Atlantic hurricane season begins each year on June 1 and goes through the end of November. The peak of the season is just now gaining steam and will last until October. Because their reach can extend many miles inland, hurricanes can wreak havoc on the facilities of many ambulatory surgery centers (ASCs). Hurricane season can be a tough time for anyone in the path of a storm, which is why AMSURG provides tools and services to help its surgery centers stay prepared for weather-related facility emergencies and to minimize the repercussions from being hit by extreme weather. The first line of defense when it comes to extreme weather conditions is preparation. AMSURG ASCs have policies in place to make sure each facility is prepared for extreme weather conditions such as hurricanes, flooding and tornadoes. The centers are required to drill or practice these emergency protocols quarterly. “Of course when a hurricane or whatever does hit, no one is sitting there reading the manual,” said Mike Whitby, director of facilities. “But they remember what to do from the drills. They’re prepared to handle it.” Preparedness policies and training not only help AMSURG centers stay survey ready but also help minimize the severity of damage possible in extreme weather events like hurricanes. Much like most medicine, the key to a quick recovery from a traumatic injury is maintaining good health prior to the injury. This is why the help AMSURG offers with day-to-day facility maintenance tasks is so crucial. Consistently keeping the center in top operating condition helps to prevent more serious issues from occurring in the future. While these policies can help facility staff know what to do in these situations, damage to the center can be inevitable. When extreme weather does make a direct hit, AMSURG steps up. If a center experiences damaging weather conditions, frozen pipes, equipment failures, HVAC outages or other building issues, AMSURG’s facilities team is one call away to provide a prompt, expert response to minimize the disruption of ASC services. “Helping our centers near the coast remain or return to full productivity and function after a hurricane is a top priority for AMSURG,” said Daniel Buehler, vice president of facilities management and construction (FM&C). “The goal is to keep our centers operational with no downtime.” AMSURG proved this policy of proactivity and security in August 2012 when it preemptively deployed a response unit to New Orleans to help its centers in the path of hurricane Isaac. With experts and resources immediately available after the storm had passed, the affected centers were back in business quickly in order to accommodate new and rescheduled procedures. “We keep an eye on the forecast situation, and after they occur, I’ll call centers in that area to make sure everything is ok,” Whitby said. “Situations involving hurricanes and such extreme weather conditions can be difficult for centers to manage. Sometimes just calling to make sure everything is all right gives us a chance to offer some direction in a chaotic time.”