Patient engagement and patient education tools have a much bigger impact on preoperative care in those hospitals that have re-engineered their surgical processes to breakdown traditional silos and created an effective multidisciplinary approach to surgery.

For many, this might not be an insightful observation and merely belabors the obvious. If it were so obvious, more hospitals would be re-engineering their surgical processes. And the embrace of the preoperative surgical home and ideas such as enhanced recovery after surgery would be less tentative.

Hospitals that have successfully streamlined surgery to improve safety, satisfaction (for both the patient and clinician), and outcomes first focussed on change management, and only then looked at their clinical protocols or technology and tools. Changing the culture by breaking down silos between anesthesiologists, surgeons, nurses and administrators makes the biggest impact on raising the bar on quality, and reducing the variability of outcomes.

Clinicians that have effectively implemented an enhanced recovery protocol for surgery are emphatic that their success had less to do with the clinical pathways, and more to do with re-engineering the surgical process and building a multidisciplinary team.

At one large health system, they implemented only two steps — early ambulation and early alimentation — of the more complex ERAS protocol, but spent the effort getting buy-in from and aligning all the surgical stakeholders on a vision and strategy (including metrics), creating an effective process for communication and planning, and a process to monitor and fine tune the implementation. The results were stellar and implemented at more than a dozen hospitals with more than 100 surgeons. Most importantly, the success was sustained over time.

Often times a pilot initiative in the preoperative surgical home or enhanced recovery is successful with compelling results, but that success does not get translated across the hospital or the health system. Getting early buy-in from the executives and administrators from the hospital is critical to a pilot’s success to be implemented more broadly.

Twistle is a great process and quality improvement platform that uses the familiar model of interactive messaging to provide an empowering and reassuring experience to patients when they are confronted with health care symptoms and challenges. But the platform makes a bigger impact on health systems where the surgical team is fluent with ideas such lean, six-sigma or other systematic methods of process engineering.