Building a Platform for More Effective Care
North Shore-Long Island Jewish Health System
Situation: The Bigger the System, the Harder to Manage
North Shore-Long Island Jewish (“North Shore-LIJ”) Health System is the largest integrated healthcare system in New York state (and the 14th largest in the United States), with 13 hospitals, 18 surgical sites and 186 operating rooms. It performs about 180,000 surgical procedures every year. Some of these procedures are routine, and some are complex, but all demand excellence of execution in the three phases of perioperative service: preoperative (what happens from the time the procedure is scheduled to when a patient is brought into the operating room), intraoperative (what happens during surgery) and postoperative (how the patient is cared for until discharged from the recovery room). The goal of all perioperative services is to provide the best possible care for patients before, during and after their surgery.
North Shore-LIJ has grown to its current scale largely through mergers and acquisitions with other healthcare systems, hospitals and independent physician practices. As a result, it has had to accommodate and integrate many disparate protocols and procedures into its perioperative services. Doing so effectively in such a large environment — optimizing its assets and ensuring consistent quality of care — can be a daunting management challenge. To help it develop an executable vision for how a world-class perioperative practice should be organized and governed and to execute on that vision, North Shore-LIJ engaged FTI Consulting.
FTI Consulting’s Role: Developing a Systemwide Approach
FTI Consulting began reviewing North Shore-LIJ’s perioperative services across all its surgical facilities, looking at operating room utilization, patient throughput, the way operating rooms were supplied for each type of procedure, variances in protocols, and the processes for how each facility within the North Shore-LIJ system tracked and reported such critical data.
“The input of the exemplary leadership of FTI Consulting helped all system perioperative facilities come together as a united group to implement best practices and identify many opportunities for improvement. This has resulted in significant cost savings and improved processes and practices systemwide.”
Kelly Cifu-Tursellino, System Vice President, Perioperative Services, North Shore-Long Island Jewish Health System
FTI Consulting found that many hospitals in the North Shore- LIJ system were employing varied reporting formats and using different key performance indicators (KPI), which made it challenging for North Shore-LIJ’s leadership to acquire a holistic view of operations. Indeed, FTI Consulting discovered that due to these reporting variances and the difficulty of consolidating them, North Shore-LIJ’s operating rooms were underutilized to a greater degree than the leadership had believed. This presented a variety of challenges that, left unaddressed, could lead to both patient and physician dissatisfaction.
To optimize the use of its operating rooms and to enhance patient safety, it was essential for North Shore-LIJ to adopt a systemwide approach to perioperative services while recognizing and respecting local needs and differences.
FTI Consulting helped North Shore-LIJ’s leadership implement a unified strategic vision for perioperative care and establish system-wide policies, procedures, processes and guidelines, as well as develop and put in place an enterprise-wide KPI dashboard that recognized and displayed multiple operating room information systems. Working collaboratively with North Shore-LIJ’s leadership and gaining buy-in from North Shore-LIJ’s key physicians and opinion leaders, FTI Consulting suggested strategies intended to introduce a greater degree of standardization in both surgical protocols and operating room material supply, thereby lowering the cost of surgical services — including supply costs — without affecting quality of care or patient outcomes
Outcome: More Effective Perioperative Care
Reducing the range of instrumentation used by surgeons in joint replacement procedures allowed North Shore-LIJ to realize a 15 percent cost reduction within that surgical category, which amounted — when combined with greater operating room utilization that improved patient throughput — to $12 million in annualized savings while ensuring patient satisfaction with quality of care and timeliness of service.
Through its dashboard and the integration of disparate information systems, FTI Consulting provided supporting data that helped North Shore-LIJ better manage operating room booking and capacity by, for example, being able to move less complex cases from the main operating rooms to ambulatory facilities or from one hospital to another with greater capacity. Among other benefits, this has enabled North Shore- LIJ to build a robust platform for more effective, world-class perioperative care.