Present Situation of Enhanced Recovery after Surgery in Shiyan Taihe Hospital and Plan of Establishing Strategic Alliance with General Surgery Department

Yang YAO, Shuwen WANG, Chunming MA, Chao YU, Pengtao ZHOU, Qing ZHAO, Shuhang ZHANG, Jingping MU

1. Department of Rehabilitation and Advancement, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China; 2. Department of Otolaryngology, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China; 3. Department of Rehabilitation Centre, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China

Abstract The accelerated rehabilitation specialist surgery and general established strategic alliance plan of Taihe hospital is introduced in the paper. The background of strategic alliances established, and the political, environmental and technological factors are introduced, and stakeholder analysis and management plan, risk analysis and management plan are made. Furthermore, a junior coalition problem that may occur in the process and the resulting deep thinking is analyzed, to provide the reference and enlightenment for the management of hospital and establishment of strategic alliance.

Key words Enhanced recovery after surgery, Medical services, Strategic alliances, Plan

1 Introduction

Enhanced recovery after surgery (ERAS), also known as rapid recovery surgery, postoperative rapid recovery, and rapid recovery process,etc., has been widely accepted throughout the world[1]. In China, ERAS is just starting out and has been faced with many difficulties and challenges in its application for more than 10 years. However, with the increasing maturity and development, in the era of big data and the wave of precision medicine, such an innovative model of ERAS is bound to have a far-reaching impact on China’s medical industry[2].This paper analyzes the role and feasibility of establishing ERAS strategic alliance from the perspective of current development of medical services in rehabilitation surgery in Taihe Hospital.

2 Background

Accelerating the development and status of enhanced recovery after surgery is a new mode of surgery and clinical path, through the perioperative (including preoperative, intraoperative and postoperative) implementation of a series of optimization measures, such as preoperative education, application of multimodal analgesia for pain management, temperature control and fluid management, ambulation and eating as soon as possible after surgery[3], minimizing surgery patients stress[4], promoting rehabilitation of patients as early as possible, to recover and reduce pain, and achieve the goals of improving curative effect, reducing complications, shortening hospital stay, reducing costs[5], or even reducing readmission risk and mortality, and improving quality of life. ERAS has been applied and popularized in general surgery, cardiothoracic surgery, urology surgery, hepatobiliary and pancreatic surgery, spinal surgery, orthopedics, and gynecology[6-7]. Domestic and foreign literature reports are numerous and evidence-based evidence has been accumulated. Many international organizations have also formulated corresponding ERAS guidelines for relevant fields[8]. ERAS will pay more attention to the application of cancer surgery, the evidence-based basis of preoperative risk factors affecting ERAS effect, perioperative blood management, multidisciplinary collaboration, large and multicentric clinical trials,etc.[1]. The accelerated rehabilitation surgery was quickly established by ERAS in Taihe Hospital after the introduction by Professor Wang Junhua in 2017, and has achieved gratifying results in the past three years. Now, the plan of establishing a strategic alliance between the Department of Accelerated Rehabilitation and general surgery in Taihe Hospital of Shiyan City is introduced, so as to better develop the medical service of accelerated rehabilitation surgery in Taihe Hospital and benefit patients.

3 Goals and objectives

Currently, medical specialist alliances are being carried out. The diagnosis and treatment mode of multidisciplinary joint consultation will provide a new mode of cooperation for improving the medical and health service system and breaking through the development dilemma[8]. About Taihe hospital medical services to accelerate the recovery of surgery and general surgery in the direction of a strategic alliance with the asset value is to realize the hospital and high quality medical resources real joint benefit to patients, fundamentally solve patients from illness to functional recovery, and return to family and social problems, thus providing the high quality and convenient medical service for the local people. This alliance is the equity alliance, which will lead to more stable long-term operation of "father-in-law cooperation" mode. Before discussing the establishment of a strategic alliance between the two departments, we need to discuss and review the environmental, technical and political factors in the operation of the two departments.

4 Environmental, technical and political factors

Taihe Hospital is the largest comprehensive grade III first-class hospital in the area, integrating medical treatment, teaching and scientific research. It is located in the city center, with 3 540 open beds. Currently, the total number of employees in the hospital is more than 5 000. The Department of Accelerated Rehabilitation Surgery of Taihe Hospital is a public treatment platform composed entirely by rehabilitation therapists. Now it has more than 100 rehabilitation treatment staff with various professional titles of high, middle and primary. According to the existing rehabilitation treatment technology, the Rehabilitation Treatment Department has set up six treatment departments, covering PT (Physical therapy), OT (occupational therapy, psycho-speech therapy), acupuncture therapy, massage therapy, spa, physical factor therapy, prosthesis and orthopedic device therapy, with a total treatment area of more than 4 000 m2. In accordance with the tenet of "medical health, rehabilitation", rehabilitation department takes ICF idea as the guidance according to the clinical, rehabilitation integration management mode, "pressing disease to implement clinical-recovery path, the specification, highly effective rehabilitation evaluation and treatment process, rehabilitation treatment process digitization management" as the instruction method, and rehabilitation, teaching and scientific research as a whole. In the neck and shoulder, waist, hemiplegia, cerebral palsy, paraplegia, amputees, joint disorders, rheumatoid disease, cardiopulmonary disease, aging, sub-health, sphincter dysfunction, speech disorder, swallowing disorder and cognitive impairment, mental disorder, and many other professional integrates-clinical recovery, we always adhere to the principle of patient-oriented, comprehensive rehabilitation, total quality control, comprehensive management, modern and traditional rehabilitation combined with digital features and clinical early, super early emergency, rehabilitation treatment closely, to enhance the function of patients maximumly and improve their quality of life, and create good conditions and opportunities for patients to rejoin and participate in the society. The general surgery department of Taihe Hospital of Shiyan City has 4 wards, 300 appointed beds, more than 5 000 times of operation annually, sufficient source of disease and wide range of diseases.

In 2019, in order to standardize the construction of specialized alliance, Taihe Hospital issued thePerformanceAppraisalWorkPlanofMedicalSpecializedAlliance. The establishment of the strategic alliance between the two departments is to fulfill the main responsibility of the hospital. On the one hand, by giving full play to the leading role of the senior management of the hospital and supporting policies such as finance and medical insurance, different departments can get what they need from each other. On the other hand, because grade III hospitals pay attention to clinical effect, their clinical efficacy is no longer the goal pursued by a certain department, but the fulcrum that drives the improvement of the overall medical service capacity of the hospital with the support of the hospital.

5 Key assumptions

Taihe Hospital has some advantages in terms of overall strength, management ability, medical technical level, discipline construction and personnel training of the accelerated rehabilitation surgery department. After the establishment of the strategic alliance, the general surgery department has specific goals in terms of overall strength, discipline construction and rehabilitation technology level with the help of the professional advantages of rehabilitation specialty, including the number of talents, the number of characteristic technical projects, high-end technologies and rehabilitation equipment. A clear task list and responsibilities of both parties during the strategic alliance formed on the basis of target determination are the key prerequisites for the establishment of a feasible strategic alliance.

6 Stakeholder analysis and management plan

The stakeholder analysis is shown in Table 1.

According to the stakeholder analysis, we can adopt the corresponding management plan to solve these problems. The Junior College Alliance Promotion Management Committee shall be established as the management organization jointly decided by both parties during the cooperation, and shall be responsible for the preparation, construction and relevant operation of the junior college project. ERAS concept training is constantly enhanced. In ERAS concept, surgeons, nurses, clinical pharmacists, anesthesiologists, physiotherapists, psychologists, nutritionists and other treatment related personnel form a close organic whole, which is no longer the narrow mode of "fighting alone" and "fighting by themselves" in a single department[9-11]. In relatively narrow medical model, the traditional single department medical staff that could give patients according to actual situation will be more suitable for the treatment and care, but because of unclear operations and treatment of the patients before being taken over, the treatment and nursing can not get, but only the conventional process. ERAS multi-department cooperation enables personnel from each department to participate in the process, so that each relevant personnel can understand the progress and dynamics of the whole disease treatment process, and also ensure that in any case of patients, corresponding personnel in the team can timely and effectively deal with patients. We will jointly formulate detailed rules for the implementation of ERAS.

7 Risk analysis and management plan

The risk analysis and management plan are shown in Table 2.

8 Critical success factors

It is the key factor for success by mobilizing the enthusiasm of the expert team and making good use of the technical factors of Taihe Hospital. Technical cooperation among specialties is the foothold of strategic alliance construction of departments[13]. At present, medical treatment in China still has the major problem of "difficult and expensive medical treatment". "Expensive" medical treatment is reflected in three aspects, namely, patients’ subjective feeling of "worth", family payment of "high" and whether the social payment can bear it[14].The improvement of bed turnover rate and diagnosis and treatment efficiency brought by rapid rehabilitation advocated by ERAS can, to a certain extent, help patients to get medical treatment quickly, reduce the economic burden of families[15], reduce the medical insurance expenditure[16], reduce the social payment burden, and promote the solution of the problem of "difficult and expensive medical treatment".

9 Promotion plan: publicity

In order to accelerate the establishment of a strategic specialist alliance between the Department of Surgery and the Department of General Surgery of Taihe Hospital, more efforts should be made to publicize convenient items such as registration appointment, inspection appointment and mutual examination results, as well as important information such as the introduction of home visits by various specialists among the central hospitals in Yunyang District in a timely manner, so as to increase the awareness rate of the people. ERAS emphasizes preoperative education. Preoperative education strengthens the doctor-patient communication, and makes advances in the treatment of changeable patients condition; perioperative considerations suggest how to prepare for and coordinate, exact discharge time and so on, which not only eases the tension, and receives good treatment compliance and treatment effect, but also objectively increases the patient contact, and realizes more harmonious doctor-patient relationship[17].

10 Additional content

After the establishment of the strategic specialist alliance, the comprehensive service capacity of Taihe Hospital is comprehensively improved, which will not only achieve sustained growth of main medical indicators, but also obtain good social benefits.

10.1 Full coverage of talent trainingMedical technicians can be further trained. For the management personnel, rotation training can be carried out, to learn and transmit advanced technology and management concepts.

10.2 Improvement of referral mechanismEstablishing and improving the two-way referral system of the two hospitals, and clarifying the scope, procedures and safeguard measures of two-way referral are the basis for smooth two-way referral. In addition, based on information platforms such as mobile WeChat and telemedicine collaboration network, the establishment of multi-party consultation mechanism before referral can be explored. In other words, general surgeons can decide whether to make an urgent, optional or downward referral according to the patient’s condition priority. At the same time, patients are referred to the rehabilitation department during rehabilitation period, or rehabilitation therapists directly carry out bedside rehabilitation,etc.Rehabilitation therapists also participate in the formulation of later treatment plans through regular rounds and other means, and the intermittent service is transformed into continuous and responsible service. Meanwhile, it can reduce the external transfer rate of patients in the hospital, and save medical costs, urban medical insurance fund and other benefits.