Practice Management Strategies Among Current Members of the American Association of Hip and Knee Surgeons.

BACKGROUND: A survey was conducted at the 2021 Annual Meeting of the American Association of Hip and Knee Surgeons (AAHKS) to evaluate current practice management strategies among AAHKS members. METHODS: An application was used by AAHKS members to answer both multiple-choice and yes or no questions. Specific questions were asked regarding the impact of COVID-19 pandemic on practice patterns. RESULTS: There was a dramatic acceleration in same day total joint arthroplasty with 85% of AAHKS members performing same day total joint arthroplasty. More AAHKS members remain in private practice (46%) than other practice types, whereas fee for service (34%) and relative value units (26%) are the major form of compensation. At the present time, 93% of practices are experiencing staffing shortages, and these shortages are having an impact on surgical volume. CONCLUSION: This survey elucidates the current practice patterns of AAHKS members. The pandemic has had a significant impact on some aspects of practice activity. Future surveys need to monitor changes in practice patterns over time.

Building a smart FNA cart: When Google meets cytology.

BACKGROUND: The appropriate management of a fine needle aspiration (FNA) supply cart and equipment set up is essential to ensure the smooth and optimal operation of a busy FNA clinic. We applied Lean strategies such as value stream mapping (VSM), the 5S method (Sort, Set in order, Shine, Standardize, Sustain), and Kanban to remove waste and improve patient flow in an FNA clinic. METHODS: The workflow analysis suggested that existent problems such as suboptimal inventory management and unavailability of standard operating procedures (SOPs) caused a 10% to 85% increase in total procedure time. To improve inventory management, we created a 2-bin Kanban system. We used the "Scan to Web" app and a Google Drive form to create a cost-effective electronic inventory management system. We distributed the essential SOPs in the format of video clips using our YouTube channel and leveraged barcode technology to access the links. RESULTS: Upon completion of our process improvement project, we succeeded to eliminate the stock-out events and maintain a process cycle efficiency of 87%. The 5S audit checklist result increased from 6% to 100% implementation, which is consistent with focused improvement. The developed inventory system enabled us to track the supply usage, forecast demands, and improve the accuracy of orders. CONCLUSIONS: Lean methods such as VSM, 5S, and Kanban combined with open source technologies can be implemented to ensure material availability, track inventory, and provide immediate access to SOPs on demand. The developed system also led to increased efficiency and improved flow, as well as responsiveness to changes in demand.

Practice Management Strategies Among Current Members of the American Association of Hip and Knee Surgeons.

BACKGROUND: At the 2017 annual meeting of the American Association of Hip and Knee Surgeons (AAHKS), a survey was conducted to assess current practice management strategies by AAHKS members. METHODS: During the annual AAHKS meeting, a survey was conducted using an audience response system. The moderator queried AAHKS members with respect to a variety of practice management issues. The survey included both multiple choice and yes or no questions. The answers were collected in a central database and provided to the audience in real time. RESULTS: The survey responses provided valuable information with respect to the practice activity of AAHKS members. A total of 47% of AAHKS members are in private practice, and fee for service remains the major form of compensation for 39% of the membership. Participation in bundled-payment programs was 46%. A minority (22%) had performed a total joint arthroplasty in an outpatient surgery center. CONCLUSION: This survey of AAHKS members' practice patterns provided interesting data. Future surveys should determine potential changes in practice activity related to private practice, fee for service compensation, the use of outpatient surgery centers for total joint arthroplasty, and surgeon participation in bundled-payment programs.

Leadership in Ophthalmology: The Role of Physician-MBAs.

PURPOSE: As American health care evolves, an increasing number of doctors are pursuing MBAs. However, relatively little is known about how business training translates into their future careers. This study characterizes ophthalmologists who have completed MBAs and identifies opportunities for physician leadership in the field. DESIGN: Cross-sectional study. METHODS: We identified 120 ophthalmologists who hold MBAs. We searched each individual's online profiles to collect information on demographics, training, and professional activities. RESULTS: Physician-MBAs in ophthalmology are 80% male; 80% are fellowship trained; and 28% are in primarily nonclinical roles and 55% participate in significant nonclinical activity. Hospital administration is most common (31%), followed by pharmaceutical administration (7%) and consulting (5%). Older ophthalmologist-MBAs were more likely to work in nonclinical roles, with 79% of those who completed residency before 2000 engaged in significant nonclinical activity compared to 30% of those who completed residency after 2000. The most common employers of physician-MBAs in ophthalmology are academic medical centers (43%), large group practices (30%), and private practices (13%). CONCLUSIONS: The majority of ophthalmologist-MBAs work in primarily clinical roles, although a sizable proportion hold nonclinical positions. Moving forward, we anticipate an increased role for physician leaders in health care administration, policy, and entrepreneurship. While formal management training is not necessary for these roles, a growing number of physicians have sought out MBAs to support their nonclinical interests.

Competitive Advantage of MBA for Physician Executives: A Systematic Literature Review.

In response to systemic challenges facing the US healthcare system, many medical students, residents and practicing physicians are pursuing a Master in Business Administration (MBA) degree. The value of such proposition remains poorly defined. The aim of this review is to analyze current literature pertaining to the added value of MBA training for physician executives (PEs). We hypothesized that physicians who supplement their clinical expertise with business education gain a significant competitive advantage. A detailed literature search of four electronic databases (PubMed, SCOPUS, Embase and ERIC) was performed. Included were studies published between Jan 2000 and June 2017, focusing specifically on PEs. Among 1580 non-duplicative titles, we identified 23 relevant articles. Attributes which were found to add value to one's competitiveness as PE were recorded. A quality index score was assigned to each article in order to minimize bias. Results were tabulated by attributes and by publication. We found that competitive domains deemed to be most important for PEs in the context of MBA training were leadership (n = 17), career advancement opportunities (n = 12), understanding of financial aspects of medicine (n = 9) and team-building skills (n = 10). Among other prominent factors associated with the desire to engage in an MBA were higher compensation, awareness of public health issues/strategy, increased negotiation skills and enhanced work-life balance. Of interest, the learning of strategies for reducing malpractice litigation was less important than the other drivers. This comprehensive systemic review supports our hypothesis that a business degree confers a competitive advantage for PEs. Physician executives equipped with an MBA degree appear to be better equipped to face the challenge of the dynamically evolving healthcare landscape. This information may be beneficial to medical schools designing or implementing combined dual-degree curricula.

Strategies for building a successful ultrasound guided FNA practice in department of pathology-Experience at a university hospital.

INTRODUCTION: Although pathology services focused on fine needle aspiration (FNA) biopsy of superficial palpable masses with on-site cytological evaluation are available in a wide range of clinical and academic settings, the addition of ultrasound (US) guidance into FNA practice by a cytopathologist group can be challenging. An US-FNA service provided by a cytopathologist in the department of Pathology is a relatively new practice in the field of medicine. This report summarizes our experience and strategies in achieving this objective and our successful preliminary results. MATERIALS AND METHODS: The US-FNA service includes (1) an FNA procedure to be performed by a cytopathologist under US guidance; (2) onsite adequacy evaluation and diagnosis to be done by the same cytopathologist; and immediate patient consultation and sample triaging carried out by the same cytopathologist in an FNA suite within the department of Pathology. The FNA suite including a procedure room equipped with a portable US machine, an exam/procedure table, a mobile cabinet with FNA supplies, a counter with sink, and a reception room with waiting area is set-up. RESULTS: The establishment of the US-FNA service is successful. There is an incremental growth of the service over the first 8 months. Among the 114 cases performed during the first 8 months, the case type distribution is shown to be 50% thyroid nodules, 33% lymph nodes, 5.5% salivary gland masses, 3.5% breast masses, and 8% soft tissue masses. CONCLUSIONS: The authors' initial 8 months experience and strategies in setting up a new US-FNA practice in a new institution are discussed to highlight obstacles encountered and approaches that promoted the successful establishment of a new service. A conservative approach, focusing on building partnerships with existing clinical services, can be successfully implemented in most institutions, if appropriate strategies are applied. The main strategy is to ensure that the best interests of patients remain the primary focus and that everything possible is done to improve the quality and effectiveness of patient care by providing the best possible diagnostic US-FNA service, to enable optimal clinical management.

Bespoke automation of medical workforce rostering using Google's free cloud applications.

BACKGROUND: Providing safe and consistent care requires optimal deployment of medical staff. Ensuring this happens is a significant administrative burden due to complex working patterns. OBJECTIVE: To describe a pilot feasibility study of the automation of medical duty rostering in a busy tertiary Ophthalmology department. METHODS: A cloud based web application was created using Google's free cloud services. Users access the system via a website which hosts live rosters, and use electronic forms to submit requests which are automatically handled by Google App Scripts. RESULTS: Over a 2-year period (8/2014-6/2016), the system processed 563 leave requests and 300 on call swaps automatically. 3,300 emails and 1,000 forms were automatically generated. User satisfaction was 100% (n=24). DISCUSSION: Many time consuming aspects of roster management were automated with significant time savings to all parties, allowing increased clinical time for doctors involved in administration. Planning for safe staffing levels was supported.

Maximizing Time with the Patient: the Creative Concept of a Physician Scribe.

The universal implementation of electronic health records has transformed the practice of medicine. However, there is a general perception that electronic health records impede effective communication with patients. Clinicians feel that they paradoxically spend more time doing nonclinical tasks like documentation and writing orders and less time interacting with their patients. This article evaluates the role of medical scribes in augmenting physician workflows and examines if employing a scribe can enhance physician-patient interactions.

Practice management/role of the medical director.

Although the nature of ambulatory surgery has changed over the years, the ideal role of the medical director mirrors its earliest iterations, focusing on excellent customer service and high quality of care. These efforts are supported by 3 modern methods of quality management borrowed from industry: intentional process improvement, standard care pathways, and monitoring outcomes to determine the efficacy of each. These methods are critical to master in order to lead the facility and providers to the highest quality of care and service.

Estilos reflexivos e atitudes de carreira proteana e sem fronteiras nas organizações contemporâneas brasileiras / Reflexive styles and protean and boundaryless career attitudes in contemporary brazilian organizations

Mudanças sociais e econômicas em organizações contemporâneas passaram a demandar profissionais capazes de refletir sobre as necessidades do mercado, e de gerenciar a própria carreira. Investigou-se as relações entre atitudes relacionadas à carreira proteana (autogerenciamento e direcionamento para valores pessoais), à carreiras sem fronteiras (mobilidade física e psicológica) e estilos reflexivos (autônomo, fraturado, metarreflexivo e comunicativo) de 247 profissionais brasileiros. Os principais resultados indicaram que: 1) as atitudes proteanas referem-se a decisões motivadas por valores pessoais; 2) as atitudes sem fronteiras indicam a crença na capacidade e a intenção de empreender mudanças; 3) a mobilidade psicológica e o autogerenciamento de carreira apresentaram correlação positiva e moderada com estilo reflexivo autônomo; 4) o autogerenciamento de carreira apresentou correlação negativa com o estilo reflexivo fraturado; 5) as médias de autogerenciamento, direcionamento para valores e mobilidade psicológica de profissionais de empresas privadas superaram as dos profissionais de empresas públicas; e 6) não houve diferenças de estilos reflexivos entre profissionais de empresa privada e pública. Concluiu-se que: o modo de refletir tem maior importância para as tomadas de decisão do que o conteúdo sobre o qual se reflete; as atitudes proteanas e sem fronteiras estão presentes entre profissionais brasileiros, e as organizações estão atentas a essas mudanças. A avaliação e a conscientização dos modos de reflexão podem constituir-se em recurso valioso para o desenvolvimento e retenção de talentos em tempos de alta competitividade e fortes anseios por bem-estar psicológico...

Social and economic changes in contemporary organizations require professionals to reflect on the needs of the market and to manage their own careers. We investigated the relationship between protean career attitudes (self-directedness and personal values orientation), boundaryless career attitudes (physical and psychological mobility), and reflexivity styles (autonomous, fractured, meta-reflexive, and communicative) of 247 Brazilian professionals. The main results indicate that: 1) protean attitudes relate to decisions motivated by personal values, 2) boundaryless attitudes indicate belief in the ability and an intention to undertake changes, 3) psychological mobility and self-directedness showed moderate positive correlations with autonomous-reflexivity 4) self-directedness was negatively correlated with fractured-reflexivity 5) professionals from private organizations had higher average self-directedness, values orientation, and psychological mobility than professionals from public organizations, 6) there were no differences in reflexivity styles between professionals from private and public organizations. We concluded that the mode of thinking of professionals is more important for decision making than the content on which they reflect. In addition, protean and boundaryless attitudes are present among Brazilian professionals, and the employing organizations are paying attention to these changes. The assessment and awareness of modes of reflection can constitute a valuable resource for developing and retaining talent in times of high professional competitiveness and heightened concern for psychological well-being...

Operationalizing quality improvement in a pediatric surgical practice.

BACKGROUND/PURPOSE: Quality improvement (QI) is critical to enhancing patient care. It is necessary to prioritize which QI initiatives are relevant to one's institution and practice, as implementation is resource-intensive. We have developed and implemented a streamlined process to identify QI opportunities in our practice. METHODS: We designed a web-based Pediatric and Infant Case Log and Outcomes (PICaLO) instrument using Research Electronic Data Capture (REDCap™) to record all surgical procedures for our practice. At the time of operation, a surgeon completes a case report form. An administrative assistant enters the data in PICaLO within 5-7days. Outcomes such as complications, deaths, and "occurrences" (readmissions, reoperations, transfers to ICU, ER visit, additional clinic visits) are recorded at the time of encounter, during M & M Conferences, and during follow-up clinic visits. Variables were chosen and defined based on national standards from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP), and Patient Based Learning Log. Occurrences are queried for potential QI initiatives. RESULTS: In 2012, 3597 patients were entered, totaling 5177 procedures. There were 220 complications, 278 occurrences, and 16 deaths. Specific QI opportunities were identified and put into place. CONCLUSION: Data on procedures and outcomes can be collected effectively in a pediatric surgery practice to delineate pertinent QI initiatives. PICaLO is recognized by the American Board of Surgery as a mechanism to meet Maintenance of Certification 4 criteria.

La gestión por procesos como estrategia de organización para disminuir el riesgo ergonimico en estudiantes de odontología de la Universidad Nacional de Córdoba

Se realizó un estudio exploratorio transversal, durante las actividades prácticas odontológicas de 40 alumnos de cuarto y quinto año de la Facultad de Odontología de la Universidad Nacional de Córdoba (FOUNC). Objetivo general: proponer desde la gestión por procesos una estrategia de intervención para disminuir el riesgo de trastornos musculo esqueléticos por malas posturas; objetivos específicos: diagnosticar el nivel de riesgo de trastornos osteomusculares; describir las principales causas para adopción de posturas incorrectas y proponer un diagrama de actividades como estrategia de mejora basada en gestión por procesos, en un procedimiento.

Summary: A descriptive, exploratory and transversal study was conducted during dental practice activities of 40 students in fourth and fifth year in the Faculty of Dentistry at the National University of Córdoba (FOUN). General Ojective: to propose process management from an intervention strategy to reduce the risk of musculo skeletal disorders by poor posture, specific objectives: to diagnose the level of risk of musculoskeletal disorders, describe the main causes for adopting bab posture and propose diagram activities as a strategy for improvement based on process management in a procedure.

More black box to explore: how quality improvement collaboratives shape practice change.

BACKGROUND: Quality improvement collaboratives (QICs) are used extensively to promote quality improvement in health care. Evidence of their effectiveness is limited, prompting calls to "open up the black box" to better understand how and why such collaboratives work. METHODS: We selected a cohort of 5 primary care practices that participated in a 6-month intervention study aimed at improving colorectal cancer screening rates. Using an immersion/crystallization technique, we analyzed qualitative data that included audio recordings and field notes of QICs and practice-based team meetings. RESULTS: Three themes emerged from our analysis: (1) practice staff became empowered through and drew on the QICs to advance change efforts in the face of leader/physician resistance; (2) a mix of content and media in the QIC program was important for reaching all participants; (3) resources offered at the QIC did little to spur practice change efforts. CONCLUSION: QICs offer a potentially powerful way of disseminating health care innovations through enhanced strategies for learning and change. Creating collaborative environments in which diverse participants learn, listen, reflect, and share together can enable them to take back to their own organizations key messages and change strategies that benefit them the most.

Trabalho em equipe na perspectiva da gerência de serviços de saúde: instrumentos para a construção da prática interprofissional / Team work under the perspective of health services management: instruments for the construction of inter-professional practice

Estuda-se a contribuição da ação gerencial para a promoção da prática interprofissional. Trata-se de pesquisa qualitativa, realizada em 21 serviços públicos de saúde de uma região de São Paulo, por meio de entrevista semiestruturada com 21 gerentes (diretores) e utiliza-se a técnica de análise temática. Como resultado, para promover o trabalho em equipe, os gerentes lançam mão dos instrumentos: comunicação, construção do compromisso das equipes e dos trabalhadores com o projeto institucional, estímulo à autonomia das equipes, definição de responsabilidades e accountability, promoção de mudança da cultura institucional e supervisão externa. Conclui-se que a comunicação e demais ferramentas quando aplicadas à promoção do trabalho em equipe estão orientadas ao trabalho, isto é, à atenção eficaz e eficiente às necessidades de saúde dos usuários.

Study on the contribution of the managerial action for the promotion of inter-professional practice. It is a qualitative research carried out in 21 public health services facilities in a region of São Paulo, using data from semi-structured interview with 21 managers (directors) and the technique of theme analysis was used. As a result, in order to promote team work, managers use tools such as: communication, construction of commitment on the part of teams and workers in relation to the institutional project, stimulus to team autonomy, definition of responsibilities and accountability, promotion of institutional culture change and external supervision. The conclusion is that the tool of communication and others, whenever applied to the promotion of team work, are work-oriented, that is, oriented to efficient and effective care to the health needs of the users.

Incorporating outpatient venous procedures into a vascular surgery practice.

The use of endovenous procedures to treat superficial venous reflux disease in an exclusively outpatient setting has been growing in popularity during the last decade. Incorporating outpatient venous procedures into an existing vascular surgery practice is a logical step and provides optimal patient care by using the combined expertise and knowledge of devoted vascular surgeons and dedicated supporting staff. This affords the opportunity to treat patients comprehensively and to streamline the evaluation and treatment process for patients with virtually all stages of chronic venous insufficiency. Successful establishment of an outpatient vein care clinic involves making well-informed decisions about workspace, staffing, acquisition of equipment, optimization of reimbursement, and patient recruitment. Separation of the venous practice from the arterial practice both geographically and temporally is critical to success because the clinical and operational needs of these two groups of patients are very different and because the vein practice in many situations may become so robust that it erodes physicians' participation in the arterial side of the vascular practice. In addition to favorable clinical results and increased patient demand, procedures performed on an outpatient basis can be expected to significantly increase revenues. With proper strategy and organization, an outpatient vein practice can round out the existing vascular practice and be a profitable adjunct to an already established vascular surgery practice.