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Innovators’ Academy: Perioperative Services Teams Pitch Hospital Improvements

Over seven weeks, Duke’s Innovation & Entrepreneurship Initiative (I&E) teamed up with Duke Health Perioperative Services to offer the second Innovators’ Academy, a course customized for early career faculty and staff interested in advancing new ideas, interventions, and technologies. Nineteen clinicians and staff participated, supported by four Duke undergraduate workers.

Whereas the first Innovators’ Academy—a partnership of I&E and the Department of Medicine—largely supported faculty in developing and pitching technologies, this one guided participants to examine current Duke Health systems and processes and develop innovative solutions to known problems and obstacles in the surgical perioperative setting.

Format & Approach

Innovators Academy Perioperative Services

Due to busy work schedules, participants met at 5pm ET twice weekly on Zoom. After learning principles of design thinking for innovative problem solving, they worked in teams to develop and propose solutions to problems identified by the Perioperative Services management team. Each group worked with an expert coach and mentor as well as a student assistant to research, gather, organize, and analyze data to build the business case for its solution.

The cross-functional teams included surgeons, registered nurses, sterile processing specialists, and schedulers; this diversity of experiences and backgrounds helped teams better tackle complex problems related to the patient experience, developing solutions informed by different perspectives.

The program culminated in the teams pitching their solutions to a leadership panel including Tara Walczak-Daege, Assistant Chief Nursing Officer, Perioperative Services at Duke Raleigh Hospital; Paula Cates, Clinical Operations Director at Duke Regional Hospital; Kate Ulrich, Assistant Vice President of Nursing, Perioperative Services, Duke Health; and Clif Flintom, Associate Vice President, Perioperative Services, Duke Health.

Team Projects

Enhancing Patient Flow: To prevent issues that cause slowdowns at every stage of the perioperative workflow—lack of supplies, lack of staff, delays in patient discharge—the team proposed a Feedback Alert System Timer (FAST) that would leverage existing status boards to centralize communication about specific holdups, thereby increasing patient satisfaction, decreasing costs, and improving work culture.

Inventory Management and Resource Availability: After analyzing pain points in the distribution of necessary materials—including ensuring accuracy of case posting information, review of preference cards, and documentation—the team identified avoidable waste, the most wasted products by volume and cost, and the services that incurred the majority of this waste. They proposed further analysis and a pilot system that would incentivize staff to reduce avoidable waste using awareness, transparency, accountability, and rewards.

Cost Transparency: While the same procedure varies in cost as physicians charge different amounts for procedures, this team found no negative correlation between average cost per procedure and outcomes. The team proposed a pilot, supported by IT and Performance Services, to improve cost transparency with updates for surgeons on how their costs compare, updated review of performance cards to eliminate unneeded items, and departmental education.

Holes in Sterilization Wrap: The team analyzed the problem of sharp edges, improper storage, and excessive handling causing holes in the sterilization wrap used to protect decontaminated instruments and trays as they’re prepped, packed, stored, and transported—an issue impacting patient safety, storage efficiency, team dynamics, delays in the OR, and costs. The team proposed funding for a pilot of Belintra carts, used in other hospitals throughout the country.

A presentation slide illustrates improper storage of sterile wrapped trays

Leadership Panel Response

The leadership panel asked questions about how the proposed solutions would work alongside efforts already underway—and gave all four groups tentative approval to move forward with researching or implementing their solutions.

“I think these are some projects we can really take forward and utilize on a day-to-day basis,” said Ulrich.

Walczak-Daege noted the theme of transparency that ran throughout the solutions, saying, “The more things you can make transparent, the more engagement you get in trying to figure out ways to improve.”

Cates added, “A lot of it is leveraging data we can get our hands on. Just how do we take that data and translate it to our staff in a way that makes sense? A lot of things can be accomplished with information.”

Innovator Takeaways

Many participants said they would recommend the program to other Duke Health colleagues, saying they especially appreciated the opportunity to work in interdisciplinary teams.

“Having the opportunity to learn from a variety of experts with vast experience in innovation was very helpful to set the framework for the experience,” said Becky McKenzie, Assistant Vice President, Perioperative Services. “The leaders were very resourceful and supportive. I was so proud of our team as we collaborated on the project, and it was exciting to present our proposal to the DUHS Periop Leaders and gain their endorsement.”

Of the four undergraduate students who supported the program, three of them are in the I&E Undergraduate Certificate program, and they represent a range of majors: neuroscience / economics, international comparative studies, biology, and biomedical engineering.

“The Periop Innovators’ Academy gave me a lot of insight into the clinical setting, which as an undergraduate biomedical engineering student is truly an invaluable experience,” said Claire Szuter ’22. “My team was especially wonderful, by respecting my ideas and what I brought to the table despite the age and experience difference, which made our solution a true team effort.”

“This Innovators’ Academy was a great example of how each team member contributes a unique perspective and experience towards problem solving and innovation,” said Sharlini Sankaran, Director of Translational Programs at I&E. “We look forward to continuing to support the teams as they develop and implement these solutions that will ultimately improve the patient experience at Duke Hospitals.”

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