Last Updated January 12, 2025
In this episode of the AHA Associates Bringing Value podcast, Kathleen Wessel is joined by guests from Hackensack Meridian Health and Surgical Directions: Dr. Lucy Pereira-Argenziano, MD, and Chief Quality Officer of Northern Region at Hackensack Meridian Health; Jeff Peters, founder and chair-emeritus of Surgical Directions; Supriya Patel, Director of Consulting Services for Surgical Directions; and Dr. Jason Klopotowski, MD, Lead Physician Managing Director for Surgical Directions. Together, this team facilitated Hackensack Meridian Health’s complex move to a new facility with upgraded facilities and additional rooms. Their discussion explores the strategies and collaboration necessary to ensure patient safety and operational efficiency during the move, including simulation education, communication strategies, and more.
Transcript
Kathleen Wessel
Moving a hospital location is no small task. Executing the move smoothly and efficiently can mean sustainable improvements in overall patient care and the workforce experience. Welcome to AHA’s Associates Bringing Value, a podcast from the American Hospital Association. In this series of podcasts, we speak with AHA associate program business partners, check in on their efforts, and learn how they support AHA hospitals and health system members.
I’m Kathleen Wessel, Vice President of Business Management and Operations with the AHA. And today I am joined by guests from Hackensack Meridian Health and Surgical Directions. I’m happy to welcome Dr. Lucy Pereira-Argenziano, MD, Chief Quality Officer for Northern Region at Hackensack Meridian Health. Jeff Peters, founder and chair-emeritus of Surgical Directions. Supriya Patel, Director of Consulting Services for Surgical Directions, and Dr. Jason Klopotowski, Lead Physician Managing Director for Surgical Directions. Together this team facilitated Hackensack Meridian Health’s complex move to a new venue with upgraded facilities and additional rooms. Our discussion will explore the strategies and collaboration necessary to ensure patient safety and operational efficiency during the move, including simulation, education, communication strategies, and more.
Team, welcome to the podcast.
Jeff. Can you kick off the discussion today by telling us about Surgical Directions and how you partnered with Hackensack Meridian Health?
Jeff Peters
Sure. Thank you. So Surgical Directions helps to improve the clinical, operational, and financial performance of ORs and hospitals and health systems. And we had the privilege of working with Lucy and Hackensack Meridian Health when they came upon a strategy to move all of their ORs, critical care beds, and surgical recovery beds to a new tower. Hackensack had looked at its existing ORs and realized that they were dated, that their volume had expanded, and the rooms weren’t big enough to meet the needs of their surgeons and patients. So came to the realization that they needed to upgrade their perioperative space. And as they looked at upgrading it and the need to build a new surgical tower, they also knew that they had strong market share in their market, but that this gave the organization the opportunity to have what Porter calls a sustainable competitive advantage.
How do we use this move not only to upgrade our facilities, but to ensure that we have world-class facilities? And I can tell you by looking at hundreds of hospitals in America, the new surgical tower is clearly the most innovative, state-of-the-art perioperative platform in this country today with intraoperative MRI and other technology that really helps to differentiate the services that are offered. And when they looked at doing this, I think Lucy reached out to us because they understood the complexity of the task. They understood that if it wasn’t done perfectly, there was a potential risk to patients. And because the organization is so focused on having impeccable quality and reducing any chance of errors, they really reached out to Surgical Direction to partner with them to make sure that the move went flawlessly.
Kathleen Wessel
Lucy, from your perspective, why was there a need for this move for your organization and what were some of the potential risks or challenges that you were aware of?
Lucy Pereira-Argenziano
Yeah, thanks so much. And I think Jeff actually so nicely hit upon several of them. Just to give a little bit more background. So Hackensack University Medical Center is truly committed to raising the bar on clinical excellence and the care that we’re providing to our surgical patients in addition to our medical and ICU patients as well. What we came to the recognition was that we needed a facility to meet all of those things and also the growing needs of the communities that’re serving in our local area and the greater New York metropolitan area as well. The Helena Theurer Pavilion provides us with a nine-story state-of-the-art facility, included within has 50 ICUs, 24 new ORs. And within the ORs, as Jeff mentioned before, an MRI directly within the operating room for ease of access. Within the ICU platform, a CT scanner to again ensure the safety of the patients—those most critical patients to be safely transferred to a study and back to their rooms.
In addition to that, there’s 175 additional medical surgical beds as well. So again, with the creation of this tower, being able to enhance the needs of the community that we’re serving. I will just raise one additional caveat. One additional feature that was added with the new tower. The new tower was being built as the Covid pandemic was ongoing. I think as many hospitals out there, as many clinicians, we were consistently learning as we were going through the pandemic of what the needs truthfully are for each of our hospitals. But also, in order to maintain the safety of the patients and the clinicians and team members, we quickly recognized the need to be able to enhance the amount of negative pressure rooms that are currently available to our patients. So something that was a feature that was added to the new pavilion tower is the notion of a full pandemic mode.
So in essence, what now happens in that new tower is that with the flip of a switch, the entire building can become a negative pressure facility. So that can really enhance again, with the next pandemic or if there is another event that’s needed, ensuring we can safely care for the patients and keep our team members safe as well. I think those were really, really critical.
You happen to mention also risk points that we thought of. I look at Jeff and Supriya and Jason, I think through how many times we had conversations about sleepless nights or those real worry spots along the way with such a significant move and the significant footprint that we were going into. Just to kind of put it simply, I looked at it really from two buckets, or we did at HMH. We looked at it in the bucket that our main focus was always to keep every single one of our patients safe and ensure that every clinician that came in contact with any of those patients had everything that they needed at their fingertips to provide high-quality and safe care. So that was really at the crux of what we wanted to ensure with every single touch point.
I’d say the secondary feature to that was ensuring efficiency in our processes and procedures as well, knowing that we were now moving into a new space, a much larger footprint, a different environment. We wanted to ensure that we could remain efficient in the care that we’re providing, and truthfully, how do we elevate that efficiency as we move into the new space as well. So I think of our risk points, I think of our worry areas as being within those two buckets of work.
Kathleen Wessel
That’s great. I’m sure some of those changes made huge comfort to the teams going forward. With a project at this size, there has to be multiple strategies used. Can you share some of the key strategies, both before and during the move with our listeners? Supriya.
Supriya Patel
Hackensack as an organization was really focused on creating a culture of collaboration. And they did this by creating a robust governance structure that was made up of surgeon leaders, OR leadership, Hackensack C-suite leadership, and also anesthesiology leadership. And under this governance structure was also task forces and work streams that were set up to help ensure that the transition was safe and also efficient. These task forces consisted of a lot of the staff in the OR—OR leadership—and a lot of the physicians are really champions in the OR to help lead this work. And this was crucial to the move in the sense that it really helped to create more innovative ideas and also helped trial things as we went through the transition. And we really learned from the key stakeholders there to make this work successful. Jason, I’ll let you add a little bit more color to that.
Jason Klopotowski
Sure. I think you explained it very well. One thing that comes to mind this project is the granularity inclusivity that we included with the new processes. The governing structure of leadership and administration underneath that level were several different workstreams, as Supriya alluded to. In those workstreams were anything looking from blood utilization, pathology…if you can think about it, we dealt with it. And the purpose of those workstreams was to identify issues, come up with solutions, and then to elevate those to the senior leadership level to operationalize the decisions that were made. So we really tried to be inclusive of everyone, from environmental services to the surgeons, to make sure that we were not missing any key steps or potential potholes within the old tower, the new tower, and most importantly, the intersection in between, right? So there were some functions of the hospital that needed to stay in the old building. Those functions needed to translate into the new building. So being very granular, looking exactly step-by-step how those processes work, even down to the number of footsteps taken for pathology to get a frozen specimen, and analyze that, were very important. So we were very granular, I would say in the word as far as one of our strategies to make sure we maintain patient safety. And Supriya, I’ll knock it back to you for the simulation education.
Supriya Patel
And Lucy and Jason are going to touch a little bit more on this when they go through kind of clinical safety. But in a gist of it, the task forces really had to be focused on the timeline that we had, along with making sure that all the processes we had in place that we had to improve got done. And also education got done. And I think that was the biggest type of strategy that we used was partnering communication with the timeline that we had in place. And the task forces and the staff physicians did such a great job with ensuring that communication was there throughout this transition. And that, in this short timeline, we had all the right tools in place, we had the right structure in place to make sure that everyone was on the same page throughout that, and that was very important.
Jason Klopotowski
Yeah, I’ll add to that a little bit, Supriya. We really had to embrace information technology during this project. The whole world is short-staffed right now. We are going into a new tower that was a brand new landscape, brand new look, brand new gadgets, you name it. We had a challenge making sure that we could adequately ensure that every person that would be working in that new tower knew where the things were that were essential to patient safety— knew where code carts were, knew where fire management systems were, you name it, as far as patient safety, we had to ensure that. We came up with semi-innovative process to use information technology, to use QR codes, to use virtual simulation, to have super Saturdays where we would bring people in to help identify all the key and necessary things for a safe patient move.
Kathleen Wessel
How did you ensure clinical safety, bounce it back to the Surgical Directions team?
Jason Klopotowski
Yeah, I think it goes back to a lot of the last slide, right? So we wanted to be simulation heavy. We partnered with a national safety organization called ORDX, who are pretty much the leaders in perioperative safety. They helped guide us through simulations, preparedness for simulations. We checked all the national organizations for comprehensive checklists to make sure for every different group of individuals, from physicians to nurses to techs—we made individual passports to say that if you filled this role, these are the things you needed to have checked off before a safe move to the new tower. I would also say, I will stop talking here in a second, but we leaned on a lot of high-reliability organization habits. One of those, and I’ll just bring one to mind…during the actual transfer of patients from the old building to the new, and it was hundreds of patients, the ICU team along with Surgical Directions developed a very almost military-style voice prompt script to ensure that there were checks, double checks, and triple checks of patient safety. The patient would be evaluated by the team in the old building. That information would go to a central command center. They would use copy, ten-four, a script to make sure that that patient was ready for transport. We had a dedicated team that did the transporting, and then another sign-off at bedside in the new building. So that was one of the key safety features of the actual move. And I’ll let others on the call expand upon that.
Lucy Pereira-Argenziano
So Jason, thanks so much for raising all this. I think that you’re spot on with the techniques and strategies that we used to ensure that we were clinically safe. You mentioned the simulations, which I think were absolutely critical for our teams to make sure that prior to walking into the building, we were all comfortable. We had processes, we had mitigated any risks that could potentially come up. And as you mentioned, the OR was a large area for that. This was also really critical for the floors and for the ICUs as well. Thinking through the comprehensiveness of the tower. And just to give an example, as Jason alluded to before, thinking through processes and procedures, and also using simulation to strengthen the teams. Looking at our code response or our emergency responses was really an area where this became so critical because again, we’re taking rapid response teams or code teams…they’re still within the other older towers. And now we’re also adding on a new footprint, new areas, new patient populations. So really working through those processes of how they’re contacted, they’re path of travel, where all the equipment is, what their communication is like, and then simulating it with the local teams as well, prior to walking into the building, or prior to putting any patient into that building, I think was incredibly critical. And to be honest with you, I think that that truly led to really has prevented truthfully any safety events from occurring. So that was definitely critical. I have to…
Jason Klopotowski
Nope, Lucy, go ahead.
Lucy Pereira-Argenziano
And I just have to echo also what Jason mentioned about the day-of-move command center. I can’t tell you how I impressive it was actually to sit back and watch it, to observe it. And again, this command center used simulation with all the local teams to walk through what the day-of-move would be like to work out any kinks, any little things that we could think through might’ve happened that day. I have to tell you, they made significant revisions and would test again, and they would trial again. Because again, the last thing we wanted was to put any patient or team member at risk for anything that we could actually think through and mitigate ahead of time. So watching those teams work in such a coordinated, interdisciplinary way was truly remarkable, and I think is truly a credit to them, but also the reason why we’re able to do this so safely.
Jason Klopotowski
Yeah.
Supriya Patel
And just…
Jason Klopotowski
Supriya, go ahead.
Supriya Patel
Just to add to what Lucy was saying, one thing we also did in the OR was do safety checklists of what was in the OR prior to day-of-move. The staff, and OR leadership, and our team went in couple days beforehand, or actually two weeks to a couple days beforehand. We did multiple checks of all the supplies that were in the room if everything was stopped and organized correctly from a patient safety standpoint, from also a staff safety standpoint. And that was really crucial to making sure that when we went live that everything was there when staff needed it.
Jeff Peters
I think the other aspect of this, sort of stepping back, is there was a lot of preparation that everybody was aware of and a lot of their surgeons were aware of because they not only have employed surgeons, but they also have surgeons with private practices that have a lot of options where they can take their surgical patients. And as the surgeons not only observed the amount of preparation that went into it, but also were very aware that this went flawlessly, and critically ill patients were transferred from one building to another without any incidents. In talking to some of the surgeons afterwards, it really heightened their confidence in the organization and reinforced the fact that, “If I have a sick patient or I have a challenging patient, Hackensack is where I want that patient to have surgery and get care because I know there’s no other facility in the market that cares as much about the patient and has perfected their systems to the point where I know that patient is going to get good care.” So they’ve done a fabulous job of putting in safety mechanisms and providing a high-level of care, but the result of that is also to build their image in the market, which then helps us to get at the original strategy of taking a strong market share and growing it to an even higher level.
Jason Klopotowski
Well, I’ll add onto that just a little bit. I think one overlooked part of this was a lot of places call it block management. We like to call it surgeon access management. You were going from a footprint of 18-19 ORs to now 24 with a completely new layout. The block redesign process was, in my mind, a crucial part of patient safety. We’re going to a bigger space. We want to balance surgical volume with patient safety. Right now, as I mentioned earlier, the whole world is short on OR personnel. So how do we have these conversations with not only the C-suite, but with individual surgeons and groups so that we could fill that new space efficiently, but mostly, safely. So we worked very hard with administration to make sure we were balancing surgeon access with the personnel we had. So instead of going to a full sprint, we started by walking and then eventually jogging. And the idea is eventually we’ll get those 24 OR sites and on the non-OR anesthesia sites up and running to full capacity, but do it in a safe manner. And I think that’s one aspect that many people don’t think about when they think of moving to a new facility.
Supriya Patel
And to that point, Jason, I think what made that piece very successful was administration and surgeon support. The surgeons were very, very collaborative throughout this entire process. They actually really took initiative to say, “What are ways that we can make this more innovative? How can I make sure that the OR is efficient and has room for other people that want to grow?” And I think it was a very collaborative approach, and administration really helped push that and create that culture for the surgeons, I think, too, to have room to be empowered to do that.
Jason Klopotowski
Right. Well, the entire organization embraced a best practice block redesign. And in doing so, made room for not only add-ons in emergencies, and thereby, decreasing length of stay and improving bed capacity, but also identifying areas for growth for other surgical services and robotics, right? I mean, the amount of robotic procedures going on in Hackensack is huge, and they wanted to grow that program more. So we helped in that capacity as well.
Kathleen Wessel
So curious, what has been the response from the surgeons?
Lucy Pereira-Argenziano
It has been an incredibly positive response from the surgeons. It was a safe transition both during the move, and it has been a safe transition thereafter as well. In the surgeon’s mind, this has really reinforced that Hackensack University Medical Center is the center of choice for surgical care.
Kathleen Wessel
Well, you’ve reviewed a tremendous amount of benefits so far, but Lucy, could I ask you from you, your team, your organization’s perspectives, were there other positive benefits or outcomes from the move?
Lucy Pereira-Argenziano
Yeah, so I’d have to say there are so many. So just to highlight a couple that have not yet been mentioned. I think if we really take this from the patient’s perspective, patient experience within the Helena Theurer Pavilion has significantly improved. As we’re talking to patients and speaking with families as well, the private rooms really facilitate the visitation with their family members for a prolonged period of time. The ability for clinicians to have very complex conversations at the bedside and the technology to then still engage the family members if they can’t be there during those times. So there’s a lot about the setting and structure of the building itself that has really led to increasing the experience for the patients. I have to say, the staff as well has really taken to the space. They love it. They’re truly embracing it, and they speak about it as significant improvements in their workflow, as we just had mentioned. There’s increased efficiencies. They feel safer in the care that they’re delivering. They have what they need at their fingertips to truly take care of patients in the moment. And they’ve also described efficiencies that have come through in the OR, as Jason and Supriya just mentioned as well. And the dedication and the commitment that they have to continuing to enhance and drive that forward. So it didn’t stop on move day. It didn’t stop on the day that we got into the new tower. Those foundational elements are there and they’re continuing to build upon them to continue to enhance the delivery of care that we have here, as well.
Kathleen Wessel
That sounds like a wonderful collaboration between the two organizations. Thank you for sharing this with us. Lucy, Jeff, Supriya, Jason, thank you so much for joining the podcast and sharing your takeaways with other AHA members. For our listeners, if you’d like to learn more about the AHA associate program or anything you learned on this podcast today, please visit us at sponsor.aha.org. This has been an Associates Bringing Value podcast, brought to you by the American Hospital Association. Thanks for listening.
Learn more about this success story in our case study, Innovative Strategies for a Successful Hospital Move: Focus on Safety, Growth & Efficiencies.
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