Leslie Basham, President and CEO at Surgical Directions

Improving Better Outcomes by Creating Seamless Patient Journeys Across Virtual and In-Person Care with Leslie Basham, President and CEO at Surgical Directions transcript powered by Sonix—easily convert your audio to text with Sonix.

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Saul Marquez:
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Saul Marquez:
Welcome back to the Outcomes Rocket everyone, Saul Marquez here. Today I have the privilege of hosting the outstanding Leslie Basham. She is President and Chief Operating Officer at Surgical Directions. Leslie’s passionate about partnering with health care executives to improve the health and well-being of the communities they serve while profitably growing their organizations as president and CEO of surgical directions. Leslie is responsible for building meaningful relationships with clinicians and administrators, ensuring high-quality working insights, and delivering measurable outcomes. Leslie identified over a billion dollars of revenue opportunities for her clients throughout her consulting career. She focuses on patient access, process improvement, clinician productivity, consumer engagement, and health innovation. She has regularly published and presented in health transformations, and I’m so excited to host her here on the podcast today on the work that she and the team at Surgical Directions is up to. Leslie, welcome.

Leslie Basham:
Thank you, Saul. It’s quite the introduction. So thank you. I’m happy to be here. Thank you for the invitation.

Saul Marquez:
Absolutely. So, Leslie, you guys are certainly playing a big role in helping providers understand the challenges and really building those relationships between the different clinicians to help that overall delivering care and achieving profitability. Before we dive into what you guys do so well, talk to us a little bit about you and what inspires your work in health care.

Leslie Basham:
Yeah, I think that’s important to ask in health care because health care is it is so personal. So I came from a family of health care providers. My father was a pediatrician. And regularly you would see the patients and the families come up to him and be so appreciative of the care that he provided. And, you know, you become like a local hero when you are helping to improve people’s lives and helping them to live a healthier life. So I was always motivated by that. And then on the other side, as a patient, I’ve also experienced health care and how broken, really frustrating our health care system can be. So I see it when it works great. And then I see what really motivates me today is how do we make it work better? Because I cannot know. It takes me months to get an appointment. I don’t know how much anything it’s going to cost. And because I’m seasoned at this, I always ask, well, how much is this going to cost? And it’s nearly impossible to get a straight answer. And so I have become very passionate. It’s really been my life’s mission to take how we take that very close patient-clinician relationship and improve patient outcomes, but make it less complex, less stressful, and to be able to deliver that exceptional patient care, but at a sustainable cost structure and in an easy way for patients. And I don’t think that happens today. And I think we need to you know, I am working very passionately about getting that back, getting back to a seamless care process for patients and for the people who are delivering the care. We’ve made things very complicated now, and I don’t think it’s going to be sustainable to stay the way it is.

Saul Marquez:
Yeah, that’s a really great point. And so the opportunity to do better is there. And I mean, you mentioned a couple of the pain points. You don’t know how much it’s going to cost. It takes forever to get an appointment to talk to us a little bit about what you guys are doing at Surgical Directions to add value to the health care ecosystem.

Leslie Basham:
Yeah, absolutely. So we are focused on addressing a lot of those issues I talked about. So how do we improve patient access? How do we improve the efficiency of patient care so that each person has a meaningful experience and gets the outcomes that they need, but that we’re not creating bottlenecks in the system that that next patient can’t get in and meanwhile reducing the overall cost of care, particularly in the surgical space. So as our company name implies Surgical Directions, we are focused in surgery and anesthesia. And that’s important because you talk about the size of health care, Right. health care is this huge, huge portion of our economy. And so surgical services then equates to about 20 percent of that national health care spending. And typically any individual hospital generates about 70, 70 percent of that health system revenue. And so surgery becomes the heart of the hospital that’s really subsidizing care elsewhere in the facility. And so if that department is not running well and not delivering the outcomes it needs to do, but also remaining productive because it is very high dollar space per minute. How do we make sure that surgery is performing at the best level it can for that institution? And so I’m sure on other episodes of your podcast Right. these health systems, they’re up to or their margins are around less than two percent. So it’s paper-thin margins. There’s very little room for error. And then you throw COVID-19 on top of that and that margin is even more pressured. So surgery really helps to create financial stability for the hospital, which then allows the hospital to keep providing their mission. And so we help with surgery. We help surgical services run better. So we provide you an example. I guess the one thing that we’re doing, our a client I am currently working on is a hospital.

Leslie Basham:
They have a huge trauma center. They see thousands of high acuity patients a month. And it’s a very stressful environment. And then on top of that, they have a lot of staff turnover, poor culture, and various operational efficiency issues. So it’s taking that really high-stress environment and making it and making it worse. They’re still providing excellent patient care, but everything around it becomes stressful. So we work with that system to understand what is the root cause for that turnover, what’s the root cause for the culture issues and efficiency. And we do things we like. We establish cross-functional or multidisciplinary governance councils because really it’s these people who are on the front lines who need to be a part of the solution. So we create this council with a surgeon, chair, and anesthesia co-chair and the nurses are at the table. Administration is at the table, but it’s predominantly surgeons and they’re then the ones who are holding each other accountable. And they’re making the tough decisions on scheduling and operations and behavior expectations. And it’s really got to start with the surgeon because of that operating room, still have a very hierarchical culture. And so that council then can help to drive, drive those changes, helped improve the access and the quality of care.

So what we do with Surgical Directions, we use that council and we give them the analytics they need to make informed decisions. We start daily huddles every afternoon with a different group of people to discuss the cases, the patient cases that are going to be scheduled the next couple of days so that we make certain that that patient has everything that they need to be ready for the day of surgery. There are all these other components that go around surgery because it’s not just what happens in the hospital. It’s all the prep before and the maintenance afterward. And we start to connect those pieces to make a more seamless patient journey and make it run smoother for the clinicians who are all there to help that patient. But there is there are administrative things or operational things around them that put stress on that mission. And so how do we minimize those stressors to let them provide excellent patient care? And that’s part of the work that we helped this client through. And it really we thought turnover improve the culture, really start to improve a lot of things, start with culture. The turnover was probably outcome of the culture and it helped to make the environment it was always a prestigious place to work, but it’s even more prestigious place to deliver care.

Saul Marquez:
Yeah. You know, and there’s an opportunity for all of us to improve how we do things, the process, the governance. And so within surgery, you know, you’re right, it’s a large part of the hospital’s revenue. If that breaks down, it becomes an issue. It’s been an example of that. I mean, without the fault of anybody, you know, any provider, the census has been down and people have been fearful of going in and getting their surgeries. So this has created a lot of pressure on that four percent margin that you mentioned, Leslie. And so as you it sounds like you guys dig into all of the different things that come into play with surgery. So talk to us a little bit about how you believe what you guys offer makes you different than what’s available out there today for a lot of these providers.

Leslie Basham:
Yeah, that’s a good question Saul and you’re right. COVID has made a huge impact that it has reduced the as we’ve seen that reduced around 20 to 30 percent within 2020. Those patients just never were able to get back in. And so it was just a total year loss of cases of patients who were able to receive care. And so what do we do that’s different with your question and I guess build on the example that I just provided in your last question, that type of complex change. It’s not easy Right. it doesn’t come easy. And so we approach these situations with a small but deeply experienced team because it is hard to change the way a surgeon provides surgery. Right. surgery is often that black box within the health care ecosystem because. It is so complex and the stakes are so high, and so we have to make sure that any time we are suggesting a change, it’s a peer to peer model so that we’re matching surgeons to surgeons, anesthesiologists, anesthesiologists, nurses to nurses and people who have who’ve walked the floor, walk the halls and these people shoes. And then they stay with our clients through that transformation on the ground, helping them, you know, address each of the issues as they come up. And since we’ve worked across about four hundred health care clients in the past, we’re able to know what works well and what doesn’t. And we’ve taken other people have taken the bumps in the bruises so that future clients don’t. And that’s, I think, the benefit of health care or where health care can really benefit is let’s not have to have everybody start over again.

Leslie Basham:
You know, the old mantra was health care was local and it still is local, but it can’t operate locally or it can’t just try to solve each problem locally because that’s not going to work as quickly or as with as much impact as learning from other organizations across the country or across the world. And so we take that peer to peer model and we take the learnings from these other institutions. And a lot of times we will automate those learnings through our analytic solutions so that a lot of times people are building schedules, still buy a paper, or excel with what staff should go where. Those decisions have a ton of impact on the care that’s delivered. If you put too many new people in a room, for example, or people who don’t know really know ortho but don’t know neuro, and they’re in a neuro case. And so we create staffing models and block scheduling and preference card improvement and making sure that all the instruments are properly sterilized. We work to all those the many, many different intricacies of the surgical process, and we are able to use analytics to sort of systematize those and that governance council we talked about and partner those together and really drive culture and process change. And so I think that’s what makes us different. Right. we have that experienced team that has done the surgeries, has been in the OR, but now has this huge experience through these other hospitals and our analytic solutions that make our impact much more scalable.

Leslie Basham:
Leslie you mentioned some great examples of how you were able to do that at the beginning of the podcast, improving culture and being able to put together some good systems and processes to lower turnover. What would you say is one of the biggest setbacks you guys have experienced and key learning that came out of that?

Leslie Basham:
COVID-19 the pandemic has been a huge setback Right. it has created and there’s many more. But this obviously is so timely, but it has created such a stressful and fear-provoking environment in the hospitals. Right. And in the care centers as far as our clinicians are trying to treat people who are COVID positive and not get sick themselves. Seeing a lot of people retire early. A lot of clinicians stepping out of the workforce because of that fear and with that, also with the hospital being overrun, canceling elective surgery cases. And so as soon as they canceled or postponed those surgery cases, that the kind of financial engine of the hospital stopped. And so it created a huge amount of financial pressure on these hospitals. And I’m not saying these hospitals are out to get all of the money. Most of them are non-profit and they need those to keep delivering care. And so they have the pressure of getting more and the staff turnover and then the postponement, elective surgeries. And it was really this trifecta of clash in being able to deliver care with COVID-19. And then that in turn has an impact on us. We can’t do things the way we used it. Right. where you can’t necessarily be arm in arm with your clients when you can’t travel or there are huge restrictions on people going into the hospital, understandably. And so it really gave us a moment to say, what do we need to do now? This is different. We can’t do what we were doing the same way. And we were able to retain one hundred percent of our clients that we had started through covid. So that was a very good thing. But we had to think about it differently for the new ones because you’re not meeting face to face and not having that handshake. And so we had to think about first, what do our clients need.

Leslie Basham:
The ambulatory, it’s not just hospitals and health systems, but ambulatory surgery or physician groups or med device companies with startups, anybody who’s in the surgery space, what how are they going to have to do things differently? And so what do we do to help them do things differently? So we really became more innovative in our solutions. We had to have survival and then we had to look at how we ran as a company and say, what do we need to do differently now to deliver these different types of solutions? And so I’m sure you felt this. Most small businesses and even large companies felt this huge amount of pressure of how do we weather the storm? And so we were thinking about that for our clients and for ourselves. And the silver lining of it all is I think people really took the good organizations, took that time to say, OK, how do we innovate? How do we do things differently now? Because it will change the way care is delivered right there. There’s a lot of things that will change in terms of patient prep and the testing that happens and additional virtual technologies even within surgery, virtual being used a bit more. And so I’ve loved that we were able to respond and I love seeing how other organizations were able to respond and come together. I think there was more collaboration across new parties than there was in the past when we’re all so busy doing that we always had done. And so the silver lining or one of the silver lining was that innovation. But it was clearly a setback Right. that we had to start doing something differently.

Saul Marquez:
Yeah. And, you know, a lot of the leaps that we’ve made during the last year are really around the perioperative areas, the primary care that you know, testing all that stuff. And I’m curious from your perspective, Leslie, how has COVID changed surgery, or hasn’t it?

Leslie Basham:
Yeah, no, that’s a good question. I think it most certainly has. And so you’re right in that there has been a lot of change in the surgery space, canceling or postponing those elective surgeries back in March and April of 2020. That shined a lot of light on surgery as what surgery did for the hospital. But it also put some pressure on how do you get all those people back. And what if they don’t come back and how do they come back? And so I think there is been a significant amount of change, especially in the preop. There is always pre-surgery testing, pre-anesthesia testing. It’s called different things and different places. But that looks very different now than it used to. And it’s become increasingly more important. And I don’t think that will change. I don’t think it’ll change that that becomes important or even more important than it was before, because if patients aren’t prepped, they won’t go into surgery. And the opportunity cost of a same-day cancellation is huge for the patient.

Leslie Basham:
The stress of that. All the prep that goes into it, you show up and you can’t have the surgery. But there’s also a huge opportunity cost for the surgeon and the hospital and the care team. And so I think we’re going to start seeing a lot more virtual and digital patient engagement tools to help make sure that that patient is prepped properly before surgery. And it also helps to connect that care team with the patient earlier, which I think it’s going to be helpful from that patient anxiety, patient payment and patient care perspective. And then also at the end. So surgery will have different. There’s a ton of new safety protocols, the way the rooms are pressurized, the flow of patients. But then post postoperatively when there is that care after surgery, I think that same patient engagement, patient solution communication will flow through at the end because really you’ve got to watch patients 60, 90, 180 days after surgery, depending on what sort of surgery it was to make sure there’s not readmission, manage their length of stay. And so I think there’s going to be changes there. And it’s been so interesting to see all of the new start-ups in the space thinking about how do you reduce the cognitive load or the stress of those clinicians in the hospital or in the car while they’re delivering care.

Leslie Basham:
There’s a lot of cool new innovation that has come up recently that we’re working with to help them better understand the surgery space. And it’s fun to see that and fun to see this new innovation that, as I mentioned, coming out of COVID. And like I said, even though it’s a black off, it is not immune to this to this changing. And I like you use the word leap there. They’re able to leap ahead of where and maybe primary care was already utilizing a lot of these patient engagement solutions that that really surgery should have been using and some of the analytics that we’re happening in the retail industry. How do we or the manufacturing industry, how do we think about that now, here and in health care? So it’s been I’m excited. I’m really excited. The vaccine coming out is a wonderful thing. And many health care workers have already gotten that. And I think we’re going to see a renewed interest or an openness. Openness is a better word for change. People were maybe resistance resistant to change. But we’ve because we’ve all experienced so much disruption over the last nine months or so, nine to 10 months, it’s that will be a good thing. People are going to be interested in doing things a little bit differently now because the status quo is has been so volatile.

Saul Marquez:
That’s great. And one of the things you mentioned is, you know, the biggest opportunity potentially for change and help with that change is, is that preop postop? What are you doing to make sure that these patients have a good experience leading up to their surgery? They have everything they need and that they don’t cancel when they get there and then on the back end, ensuring that there are no readmissions or reduced readmissions. And what kind of plan is there? What are your neighbors doing about this? These are the types of things that Leslie and her team have a bird’s eye view on and could potentially help gain insights for you and your facility. So fantastic insights there. Leslie, this has been great. You know, you talked about a couple of things that you were excited about, but, you know, with innovation. But which of those is the most exciting for you?

Leslie Basham:
Yeah, I think the most exciting part is going to be what happens within the OR. So pre and post up like it’s a kind of benefit from some of these other types of care and type of industries. But what happens in an operating room looks very different and the place that the operating room is located looks very different. So it may not be in a hospital anymore. There’s a huge growth in ambulatory surgery instead of in hospitals. And so. And then does it stop at the growth in ambulatory surgery or does it go to the doctor’s office? And how do we start making safe surgery more accessible? Well, that means I think it has to be in more locations. It’s not just always in an acute care center. And we’re seeing that with the shift, what they’re calling outmigration of cases from the acute care center to ambulatory surgery or to office space. And how do you make sure that that stays safe and there’s the benefit? So there are patient preferences to actually do your case outside of a hospital, especially if it’s elective, because why go where there’s a lot of people who are really sick and have surgery conducted when you could go someplace that is more elective? And it’s not necessarily because anyone is sick, it might be ortho related, for example.

Leslie Basham:
And so I’m very excited about really that transformation of care delivery to make it much more care everywhere type things and not just always in a hospital. And that means you need all that preop and post up where that makes the pre and post that much more important. And it’s because those exist and that you are able to create infrastructure and support. You’re able to do things in a non-hospital setting. And there are programs like the Perry OP Surgical Home or there’s a lot of talk about patient surgical concierge and how can the surgical concierge then create that seamless experience and create that connection, irrespective of where your surgery is conducted? And I think that’s going to be very a trend really to watch. And that will as cases move outside of a hospital, it will also evoke a lot of innovation in how things are done. And those model payers like that type of model surgeons potentially like that type of model better. And so it starts to create momentum in that shift and then hospitals will have to respond to. So I’m excited to see where that goes and the innovation that is allowing that that outmigration to accelerate.

Saul Marquez:
Yeah, it’s a really interesting idea. And it makes you think about hospitals, you know, and the role that they play in our communities and what the future potentially can look like. We have to be thinking about that. And Leslie, this is a very interesting and exciting thing to think about. So really appreciate you jumping on with us today. Why don’t you leave us with the closing thought and then the best place for the listeners could get in touch with you and your team to learn more and engage?

Leslie Basham:
Absolutely. Saul, it is very interesting. And so I guess what I would encourage my closing thought is, as most of the listeners, I’m sure, are related to health care to start picking up the phone or email and start connecting with people who may not be in your exact space, right. But I think what happened with that silver lining I talked about with covid of connecting the health care ecosystem and thinking about things differently, I think now is the time to start to rebuild, reimagine what health care can look like. And I think the more we collaborate and communicate together, the quicker we will get to a better and more sustainable health care model. And so I always encourage the younger people I talk to you to go into health care. We need the best, the brightest minds to go into health care. It’s incredibly rewarding, and we need people to solve these problems. And so the people that are in it, I think we need to keep motivating each other because we know that our system, our health care system is not working as well as it should. We’re not we don’t have a sustainable model. And so how can we come together and build this more sustainable model and there’s going to be winners or losers is a little bit too binary. But how do we come together and make it so that the greater health care ecosystem is improved and that people are able to be a part of that instead of left behind?

Saul Marquez:
Great message. And folks, you can learn more about Leslie and her team at SurgicalDirections.com. Leslie, what’s the best place for folks to get in touch with you? Is it the website or is there are there other ways?

Leslie Basham:
Yeah, the website is a great place. We also have an email address. You could go to Surgicaldirections.com or I’m also on LinkedIn as Leslie Bashan with Surgical Direction, so I look forward to it. People have questions or want to talk more. I’m very passionate about the subject and Saul I appreciate the opportunity. So I do encourage folks to reach out if they have questions or want to talk more.

Saul Marquez:
Outstanding. They have it. Folks, take Leslie up on that. I think this year is probably the best year to do that. Think about where the system is going and what you can do to partner to prepare yourself for that change. So, Leslie, big thanks to you and certainly looking forward to staying in touch.

Leslie Basham:
Me too. Thank you, Saul.

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