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PRODUCED BY AND FOR MEMBERS OF THE DEPARTMENT OF SURGERY August 2017 | Archived Issues

President's Perspective on Efficiency

By Thomas M. Priselac
President and CEO

In June, I wrote to you about the three imperatives for Cedars-Sinai as we pursue our vision as one of the nation's leading healthcare organizations:

  • Retain our absolute commitment to quality
  • Make our services more geographically and virtually accessible to patients and consumers
  • Fulfill our obligation to make healthcare affordable through operational and clinical efficiency work

While I focused at that time on our FY18 budget planning, today I'd like to share some thoughts on the broader topic of affordability and efficiency, their place in Cedars-Sinai's mission, and the opportunities and challenges they present for everyone who works or practices here. I'll be focusing more on how we approach this challenge together rather than trying to prescribe specific solutions. As we've learned from successfully tackling complex issues in the past, specific solutions are much more effective and meaningful when they come from a process that involves each of you.

If you ask just about anyone what differentiates Cedars-Sinai, almost all will reference our quality. Thanks to your extraordinary commitment, expertise and relentless dedication, we continually set new standards for the nation, and, most importantly, improve the lives of our patients. A focus on quality is definitely palpable at Cedars-Sinai — it's part of our mission, part of our DNA.

Now, our focus is to raise operational and clinical efficiency to the same level as quality. Put simply, our collective challenge is to deliver the highest quality, appropriate care in an efficient, affordable manner.

The imperative to optimize our operational and clinical efficiency is not only a business issue; it is also our institutional obligation to do so.

As a business issue, the very nature of our patient care, education, research and community benefit mission creates a cost structure here at Cedars-Sinai that is higher than community hospitals and other lower-cost settings. If we are to fulfill our mission in an increasingly price-sensitive world, we must do all we can to assure we are as operationally and clinically efficient as possible, in everything we do.

More importantly, if we are advocates for a healthcare system that is truly accessible to all Americans, we have an institutional obligation to optimize our efficiency and affordability.

Increasing our efficiency does not mean infringing on our quality. In fact, over the past several years, our clinical efficiency efforts have improved the quality of care. We have done so by avoiding unnecessary admissions through better care in the outpatient setting, reducing inpatient length-of-stay and reducing unnecessary or ineffective tests and procedures.

Efficiency requires an ongoing focus on keeping things as simple and streamlined as possible (for our patients and for each other), and continually examining our priorities and processes.

This aspect of efficiency will not only benefit our patients but will also benefit each of us. If we identify opportunities to simplify our internal processes, it can increase the job satisfaction of our physicians and staff, enabling them to spend time on what they enjoy most about their work.

Our approach to operational and clinical efficiency should be grounded in the following principles:

Everyone's got a piece of this.
This will not be a top-down push. The challenge is big enough, and the urgency great enough, that it will require the involvement, discipline and innovation of everyone at Cedars-Sinai. Good ideas can come from anywhere in the institution. Operational efficiency improvements are not limited to clinical areas, they can and should occur in all parts of the institution, including academics and support services. As we have done in the past with other issues, we will look together at best practices (operational and clinical), marketplace aspects, and, most importantly, tap the innovative minds of everyone at Cedars-Sinai.

This is not a campaign, it's about who we are.
Our work to continually enhance our efficiency and affordability, like our work to continually enhance our quality of care, is not a one-off, short-term initiative. This won't be solved just by one or a small number of solutions. This is a systemwide issue that demands our collective wisdom and energy. There will likely be thousands of ways to increase efficiency — some large, some small — and it is the collection of all of these efforts that will enable us to achieve our goals together.

Be open to thinking differently.
To make meaningful improvements in efficiency to serve the community, we can't limit our thinking to business-as-usual. We should be willing to question long-held assumptions. Even if it eventually turns out in some cases that these assumptions remain valid, everyone should feel free and secure to raise questions. Healthcare has changed significantly over the years; many processes and perspectives that were best practices in the past may need updating, replacement or even elimination.

An open and supportive approach.
Although it's often easier to point out opportunities for increased efficiency in other departments, each of us should focus first on the area we know best: our own. This is not to say that there aren't major opportunities you may identify in other areas along with your own, given the interconnectedness of healthcare and our institution. And nothing is off limits. But it is crucial that everyone approach this in a constructive, open and supportive manner — no finger-pointing allowed!

The Operational Efficiency Council, led by Mark Gavens, will coordinate our efforts throughout the institution. Over the coming months, you will begin to see a variety of tools, two-way communications and other information-sharing to enable each of you to participate in a coordinated effort. Until then, please share any ideas you may have on increasing efficiency through your respective management structures. Equally important, our clinical efficiency efforts, led by Dr. Scott Weingarten, will continue their successful work and expand their efforts throughout the institution.

Many years ago, Cedars-Sinai set a lofty goal of providing the highest quality care. This was a challenging goal, as it involved many moving parts and every department. Because of the people who work and practice here, we were not only able to become a national quality leader; it is now embedded in our culture. I am confident that together we are up to the challenge of providing care that is not only of the highest quality but delivered in an affordable, efficient manner for the people we serve.

See past President's Perspective columns on the intranet.