3-part series shares lessons learned based on new ASC’s experience so far

Since opening its doors in early 2018, Oregon Surgical Institute (OSI) has had a banner year delivering high-quality, outpatient outcomes to total joint replacement (TJR) patients. Designed as a center of excellence specifically for complex procedures, the center focuses on TJR, spine, orthopedics, and pain management. Two of OSI’s partner surgeons, Dr. Jim Ballard and Dr. Chris Nanson, sat down recently to talk about the center’s first year in operation.

Their thoughts will be the focus of three question-and-answer articles: this article features lessons learned in year one, with subsequent articles on patient selection/experience, and the economic drivers of success.

Question: What’s the most important thing you’ve learned so far at OSI? 

Answer: “Success with an effort like this takes tremendous commitment from the surgeons,” Dr. Ballard says. “It takes a lot of sweat capital. You need a group of surgeons who are extraordinarily talented, but also extraordinarily open to the teamwork that’s needed to find common ground on procedures and setup. We have some of the best TJR surgeons in Oregon, and we were able come to an agreement. Every protocol at this place is the same for every surgeon, which is very unique.”

Dr. Chris Nanson agrees, amplifying the importance of OSI’s single care pathway throughout the facility – one that physicians support, staff are educated on, and everyone delivers consistently.

“It’s amazing that as a brand-new facility with surgeons from across the city, we have been able to come together and produce excellent results with no misfires,” Dr. Nanson says. “That’s a testament to sitting down beforehand and standardizing the process. Now, no one has to figure out how Dr. X does things differently from how Dr. Y. It took a lot of work to get to this level of standardization. Everyone volunteered extra time upfront to pitch in and contribute, and the effort has created one heck of a program.”

Question: How do you feel about the “sweat” you’ve personally put in so far? Is it paying off?

Answer: “Absolutely, and every one of the 13 surgeon-owners agrees,” says Dr. Ballard, “because it’s an environment we created, staff that we hand-picked, and the staff has this unique energy about them; everybody’s on the same page. That creates an energy that’s impossible to find in a hospital setting. Everybody that works (at OSI) knows they’re part of the team, they’re part of something bigger, so they’re willing to work hard and do whatever it takes. It’s such a positive environment, it’s infectious.”

Dr. Ballard says hospitals can’t create that kind of vibe. “Hospitals are great, but they’re so large and they’re so clunky when it comes to decision making. When we want something, it takes a couple of days and we get it; when we tell people what it’s going to be like in our ASC, that’s what it’s like. Hospitals are so layered with bureaucracy that the ability to do these things is lost.  At OSI, we’ve operationalized nimbleness and energy, and it rolls over to the patients.”

Question: What are the biggest impediments that keep patients in the hospital versus moving outpatient for TJR?

Answer: “On impediment for surgeons is getting over the inertia of tradition,” says Dr. Ballard. “Everybody just accepts that total joints are a hospital-based procedure, because that’s what they’ve been told and experienced their whole careers.” He says one way surgeons can get over that inertia is to visit somebody who’s doing outpatient TJR well. “I visited some ASC surgeons in Ohio that were very, very good at it, and that helped me get over the fears that I had,” he says. “It helps you recognize it’s totally doable; and it absolutely should be done.”

Dr. Nanson identifies patient fear as an impediment as well. “One of the biggest hurdles is you tell a patient they’re going to a surgery center, they’ll have a hip replaced, and go home same day, and they look at you like you’re crazy. It’s such a new thing,” he says. He cites steps OSI has taken to help candidates for outpatient surgery get comfortable with it. “We try to present this option in a manner that highlights the benefits of the ambulatory setting and of the ability to recover at home in a comfortable environment, rather than in a hospital.”

Question: What adjustments have you made to hospital processes/protocols to transition to outpatient TJR?

Answer: “Educating patients is even more important because from the very beginning you need patients to know two things: this is an outpatient surgery and they’re going to be fine,” Dr. Ballard says. “Our education program at OSI is very comprehensive, including physical therapy, anesthesia, and a tour of the center. Education sets expectations and encourages familiarity with the process and with the location.”

Another difference in protocols at the ASC is the level of control enjoyed by the surgeons. “As an ASC surgeon-owner, you’re in charge,” he says. “We’ve hand-picked our anesthesiologists, and our entire staff. A good example: we can’t use IB Tylenol in the hospital, but here we can use different pain protocols without waiting six months for a board downtown to meet and then ask for more information before they decide.”

“We’ve got smart people on our board, we argue about things,” Dr. Ballard continues, “but we all understand the whole is more important than the parts, meaning the ASC is more important than what I want individually. We have come together around core best practices. That’s important to our success.”

For more information about Regent’s partnerships in total joint replacement, click here.