Cedars-Sinai Medical Center

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A BI-WEEKLY PUBLICATION FROM THE CEDARS-SINAI CHIEF OF STAFF June 8, 2012 Issue | Archived Issues

Meetings and events


Grand rounds

Click here to view upcoming Grand Rounds.


Upcoming CME conferences

Click below to view a complete list of all scheduled Continuing Medical Education conferences.

CME Newsletter - June 2012 (PDF)


In memoriam

The following medical staff members recently passed away:

  • Irving H. Berkovitz, MD (1924-2012)
  • Stephen H. Greenberg, MD (1944-2012)
  • Sivam Ramanathan, MD (1943-2012)
  • David L. Rimoin, MD, PhD (1936-2012)

» Read more

Share Your News

Won any awards or had an article accepted for publication? Share your news about professional achievements and other items of interest.

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President's Perspective: the efficiency-quality paradox

Thomas M. Priselac
President and CEO

At first, it seems counterintuitive: How can you increase efficiency while also enhancing quality? Isn't one or the other inevitably going to slip?

On top of that, can this possibly work at a place like Cedars-Sinai - a very large, complex, pluralistic organization? The answer is yes, and what is notable at Cedars-Sinai is the way we've resolved the efficiency-quality paradox: by recognizing that efficiency is an intrinsic part of our continuous effort to improve quality, and that it takes the engagement and collaboration of everyone throughout the institution to achieve our goal of doing the right thing for our patients - in the right setting, at the right time, with the right resources.

Our efforts encompass both clinical and operational initiatives to improve quality and efficiency, and I'm pleased to report that we already have some early wins in both areas, thanks to the innovative ideas that have been coming from so many of you throughout the health system. Make no mistake, we still have a long way to go, as the financial realities of declining reimbursements remain harsh, and we must do a lot more to increase efficiency and reduce costs. But your progress to date is truly impressive, and I'd like to share a few examples.

Re-examining our clinical processes

In clinical areas, the Cedars-Sinai Medicine initiative continues to make a positive impact on patient care through the efforts of more than 300 healthcare professionals who serve on our clinical best-practice teams. We now have about 20 multidisciplinary teams, with physicians, nurses, case managers, social workers, pharmacists and others working together to research and develop best practices for a long list of specific diseases and conditions.

With guidance from the clinicians involved, we've implemented improvements in clinical processes for a number of high-volume, typically short-stay surgical procedures such as hip and knee replacements and non-malignant gynecologic surgeries, as well as for common conditions that bring people to the hospital - including atrial fibrillation, pneumonia and diabetes. Length of stay, which has a major impact on costs, has declined overall by about 10 percent as a result of a wide range of changes in clinical practice that also improve outcomes for patients, including faster diagnostic testing and evaluations, rapid response to infections, comprehensive treatment planning from pre-admission to post-discharge, and education to guide patients through recovery and prevent complications.

The way the Cedars-Sinai Medicine effort has reduced length of stay for non-malignant gynecologic surgeries provides examples of the types of changes that make a difference. The team's research on best practices for post-operative care showed that many patients do better with earlier removal of the Foley catheter and an earlier transition from IV to oral pain medication. They found that these steps lower the risk of infection, reduce side effects and enable patients to resume activity more quickly.

The team worked with physicians on changing post-operative orders for these patients, and with nurses to engage them in helping patients reach certain milestones each day they are in the hospital. The next step is education to align patient expectations with post-operative treatment plans so that everyone is working toward the same goal - a smooth recovery that allows patients to return home within the expected time frame for their procedure, or even sooner.

Increasing operational efficiency

Equally important are the efforts by our staff to increase efficiency of operational performance based on nationwide research on best practices in hospital operations. While all hospitals are closely examining how they use staffing resources - because labor represents a hospital's largest single operating cost - we also are looking in many other directions to reduce expenses.

For example, one major area of focus is re-engineering our supply-chain operations. Supplies represent the second largest cost to hospitals. We can reduce costs by as much as $18 million a year in supplies alone through strategies that enable us to get better prices without sacrificing high quality. This involves increasing our participation in purchasing coalitions and cooperatives with other major medical centers to gain more leverage on pricing, and working with our physicians to reduce variation in the types of medical devices we order - for orthopedic and cardiac procedures, for example.

Even seemingly trivial things can add up, given the size of Cedars-Sinai. For example, the Purchasing Department recently found that we currently offer as many as 729 different types of pens for use across Cedars-Sinai. If that number was reduced, enabling us to increase the volume of each type of pen purchased, we could significantly reduce their unit cost. Seems like a small thing, but it all adds up.

Technology plays a major role in our drive to become more efficient. As part of CS-Link™, we've implemented a new bar coding system that has streamlined pharmacy operations while also reducing the risk of errors. And we're just beginning to realize the potential of CS-Link as a tool for increasing safety while lowering costs.

One of the ironies we face as we adapt to healthcare reform is that doing the right thing for our patients in a more efficient way sometimes results in less revenue in the short term. This is because some of the payment models currently used by Medicare and private insurance companies are still “old-school” and do not yet fully reward effectiveness and efficiency. But this will change as our nation's healthcare system adopts new payment models more closely tied to performance. We're better prepared for the changes ahead, thanks to our comprehensive initiatives and your innovation, flexibility and teamwork.

Your ideas are always welcome as we continue to identify and implement strategies to increase efficiency and value throughout our organization. I'm confident that the steps we are taking will enable us to do even more for our patients, at less cost, and to serve as a role model for hospitals nationwide during this extraordinary period of change.