This is part of an ongoing series of audio profiles of front-line improvers.
Kevin Stange, MD
Alaska Native Medical Center
My name is Kevin Stange. I’m a surgeon at the Alaska Native Medical Center in Anchorage, Alaska. I used to be the Medical Director there and I decided I was getting a little far away from clinical care, and now I am a staff surgeon there. There are some people who have the rare ability to set terrific stretch goals for health care systems, and then there are people that need to go back and implement them at the front lines. I would view myself as somebody who needs to implement them at the front lines.
Anchorage is about 350,000 people, but we are actually a tertiary referral hospital for the state of Alaska for the native population, which is someplace around 200,000 to 250,000 depending on how you count it. We receive referrals from all over the state for general surgical procedures.
They certainly have more than their share of medical problems. We have a lot of trauma. I mean living in Alaska, and certainly living out in a rural setting, is a dangerous undertaking and there are a lot of issues with transportation. So they get delays in care already, related to distance, time, and weather. We have interpreters throughout the building. We have a high percentage of native employees, a lot of which speak their native language. We have quarters that patients stay in, because they’re mostly from out of town; it’s in the hospital. They usually have escorts that help with getting around the big city. We have a traditional healer on our staff.
There’s a lot of waiting going on in Indian Health Service hospitals, and one of the things that they used to say in our mantra to get people motivated was that this was the best place to receive care, the best place to work, and what a lot of people added on after that was yeah, it was also the best place to wait. It was run like I imagine most federal hospitals, where there was a big centralized clinic that all the specialists and even the primary care providers used to share. The patients would all show up to clinic at 1 o’clock, 2 o’clock, or 3 o’clock, the doctors would go out and call a name in the waiting room, bring them into the rooms. You did your pre-op workup, talked to the patient, the patient then left and went to the pharmacy, and waited on a line that was, for their prep, longer than I think people could see. They went to EKG and waited there, they went to a lab and waited there, and they went to day surgery and waited there. When we looked at the cycle time it was someplace around 6 hours to get your pre-op evaluation done.
We looked at all the cycle times and found out that it was fairly obvious people didn’t need to wait in all these places. We had staff in our clinic that could easily do EKGs, draw blood; the physicians could dispense even simple preps. And we could move the pre-op teaching from the day surgery department to the clinic, give people appointment times that reflected when we would see them. And so, if you knock out waiting 20, 30, 40 minutes at six locations it’s pretty easy to affect the amount of time people spend in the hospital, waiting. You feel like you’re not being forced to push people through the system, you have time to interact with them, and learn about them. The reason that people work up there is so that you can interact with people from a different culture and enjoy that part of it. It’s hard to do that when you feel that you’re 15 patients behind, so that part has been great.
We are fortunate that we’re in a system that is funded partially federally, and partially by collections, and the more money that we save by being efficient translates into providing more health care services. We’re not in competition with each other; I’m not in competition with my partners. It’s very easy for me and my partners to agree on guidelines, or whatever you want to call them, about how we agree to take care of patients, and come to a consensus on that. It’s one of the things that we all enjoy about working there; it feels more like a learning environment that you share with your peers. Also our hospital, as long as I have been there, has been organized around multidisciplinary teams. So, it’s interesting you go to places and they say we need all these disciplines on a team. Okay, so what else is new, why would you not think that?