With staffing issues still at the forefront of post-pandemic healthcare, meeting the needs of patients and providers calls for some innovative solutions.
On a recent episode of MGMA’s Member Spotlight podcast, Daniel Williams spoke with Dr. Padma Gulur, winner of the 2023 MGMA Harwick Innovation Award. Dr. Gulur is Professor of Anesthesiology and Professor in Population Health Sciences at Duke University School of Medicine.
The Harwick Award is designed to recognize and celebrate the success of an individual who has developed an innovative solution that positively impacts practices, providers and/or patients in their community.
Dr. Gulur was selected for the Harwick Award due to creating the Anesthesia Resource Management System (ARMS), an AI-powered solution to help flex existing staff across a broad range of facility needs. According to the nomination, ARMS “has revolutionized the way (Duke Health) manages anesthesia resources, leading to remarkable operational efficiencies and substantial cost savings.”
“While ARMS can be viewed as a data-driven solution to resource management, it’s really more than that,” Dr. Gulur explains. “It’s our approach. There’s a cultural change to where we’re being more transparent and accountable. By managing our resources optimally, we prevent healthcare costs from rising. And the institutions can then invest the dollars where they’re really needed.”
Patients and Providers Benefit
Dr. Gulur says he appreciates MGMA’s award, and hopes that the successes of Duke Health’s efficiency program can serve as an inspiration to other healthcare systems looking to benefit both their patients and their highly trained providers.
“It’s an incredible honor to be recognized for this, and I think it underscores the innovation in healthcare, especially in optimizing resource allocations and reducing systemic inefficiencies,” Dr. Gulur explains. “That allows us, in turn, to put our focus where it should be, which is on improving patient care and provider wellbeing, which is the other unsaid factor, many times.”
According to Dr. Gulur, American healthcare constantly finds itself in the struggle of simultaneously focusing on patient care and attempting to be a lucrative business at the same time, especially in a climate of ever-increasing costs.
The COVID-19 pandemic threw that all for a loop and highlighted the many holes in the system that needed to be addressed, he adds. In Duke Health’s case, Dr. Gulur and his team had already been working to build additional resilience in the organization’s anesthesia operations, especially as his staff and providers were getting stressed, stretched and burnt out during the height of COVID.
“We really had to come up with a solution that continued to make their ability to provide meaningful work possible. In order to do that, we had to come up with a way that we were utilizing our resources. There were enormous staff shortages. How do we drive our resources to those needs, so we can continue not just critical operations, but continue to provide access to our community, so they can get the healthcare that they needed?”
Efficiency Focuses on Cohesion, Not More Staff
Dr. Gulur says an initial observation was that the traditional method of handling everything from operating rooms to staffing issues was not done in a cohesive manner. Growth and the need for anesthesia services outside of the operating rooms had grown exponentially, as community needs for ambulatory surgery centers and procedure suites within doctors’ offices meant new needs for both services and staff.
“But that also created challenges as we were losing economies of scale. There was a hub-and-spoke model developing, but we moved to what we call staffing to capacity. You need a lot of people who may or may not have work at their local site, but there are other sites that are short staffed. And we’re not having a feast-or-famine situation, because the work itself is variable. It allows us to take a look at the entire picture at one go, and provide appropriate staffing across these platforms.”
Applicability to Other Specialties
Dr. Gulur says the efficiency model his department developed can also have significant impact in different healthcare systems and even independent practices, as it can be scaled up and down depending on localized needs.
“The beauty of this system is that it’s been tried and tested in all those settings and is modular. By following some basic principles and guiding models, this can really be implemented in just about any site and produce value. We ourselves are growing it within the same perioperative platform to incorporate nursing, techs and connections to the inpatient beds.”
Recognizing the Problem is the First Step
Dr. Gulur says that a discovery phase can help decision-makers at individual practices help see if a staffing to capacity model might work for them – by looking at existing staffing issues and any potential gaps. They can also leverage Duke Health’s model and its experiences, with a wide variety of information and resources available to other healthcare providers.
Best of all, Dr. Gulur says many systems may be able to achieve similar efficiency without hiring additional staff. What is required is an upfront investment in management software to better manage all aspects of existing staff, harnessing the power of AI to help. Despite being a large and well-integrated system, Duke Health ended up outsourcing a portion of the predictive algorithm used to help with the staffing model.
“Bringing in someone with expertise in that space obviously helps you develop it faster. Rather than reinvent the wheel, we chose to go with people who had a lot of experience in the space and could help us accelerate the development.”
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