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Adam Hornback - Real Ways to Reduce Waste & Increase Recycling
105 Plays2 years ago
Adam Hornback is the Administrator at the North Texas Team Care Surgery Center. He is here to talk to us about a topic we have not covered yet – Real Ways to Reduce Waste & Increase Recycling at your surgery center. As this is a passion of Adam’s, he has tried some exciting and innovative ways to implement processes to reduce, reuse, and recycle, and hopefully, you can take some of these ideas back to your own ASC to try out.
In our news recap, we’ll cover a brand-new tech-filled hospital in New Jersey, new smart bandages with nanosensors, the nine most stressful physician specialties, and of course, end the news segment with a positive story about the first patient ever to be cured of leukemia.
Articles Mentioned:
A New, State-of-the-Art Surgical and Intensive Care Tower
Preventing Surgical Site Infections, Complexities of Operative Care
9 physician specialties named the most stressful jobs in the country
A patient with ‘incurable’ leukemia was cured
Brought to you by HST Pathways.
Recommended
Transcript
Introduction & Podcast Overview
00:00:01
Speaker
Welcome to This Week in Surgery Centers. If you're in the ASC industry, then you're in the right place. Every week, we'll start the episode off by sharing an interesting conversation we had with our featured guests, and then we'll close the episode by recapping the latest news impacting surgery centers. We're excited to share with you what we have, so let's get started and see what the industry's been up to.
Reducing Waste in Surgery Centers
00:00:27
Speaker
Hi everyone, here's what you can expect on today's episode. Adam Hornback is the administrator at the North Texas Team Care Surgery Center and he's here to talk to us about a topic we have not covered yet, real ways to reduce waste and increase recycling at your surgery center.
00:00:46
Speaker
As this is a passion of Adam's, he has tried some really cool and innovative ways to implement processes to reduce, reuse, and recycle. And hopefully you can take some of these ideas back to your own ASC to try out.
Healthcare News Highlights
00:01:00
Speaker
In our news recap, we'll cover a brand new tech failed hospital in New Jersey, new smart bandages with nano sensors, the nine most stressful physician specialties, and of course, and the new segment with a positive story about the first patient ever to be cured of leukemia. Hope everyone enjoys the episode and here's what's going on this week in surgery centers.
Adam Hornback's OR Journey & Role
00:01:28
Speaker
Adam, welcome to the show.
00:01:31
Speaker
Thanks for having me. Appreciate you joining us today, Adam. And I thought we might start out. Can you tell our listeners a little bit about how long you've been in the industry? Yeah, absolutely. I'm married to my wife of 15 years. Trish and I met in the OR. I have three wonderful children, Allison, Deshaun, and Tyler. I've been in the OR for 28 years now.
00:02:01
Speaker
Started off in a small hospital as an orderly. Got the opportunity at this small hospital to work with a surgeon who helped me learn how to scrub. So scrub cases for about 10 years before I went to nursing school.
00:02:22
Speaker
I went down to Parkland, did a critical care residency there. The hours were awful, so I had to move out of there, went to another hospital in the OR. And I worked there for a while, but I did miss the faster pace of the ASC. So I got an opportunity to go back to the ASC in leadership, and I've been there ever since.
00:02:52
Speaker
Um, that was around 2007. Fantastic. So it sounds like healthcare in the OR in particular is a big piece of your, in your blood and in your background. Um, tell us a little bit about North Texas team care where you're at today and what's your specialty mix and what do you guys focus on? Yeah, absolutely. So at NTDC, um, we try to be a leader as far as price transparency.
00:03:17
Speaker
We post all of our prices online and in bundles We're multi-specialty We do everything essentially except for eyes and cardio We're heavy pain and GI But we're seeing a lot of growth in orthopedic total joints and spine Right now we do about 350 cases a month a large percentage of
00:03:43
Speaker
percentage of the cases are cash, which is exciting. Excellent. Excellent.
Benefits of Transparent Pricing
00:03:51
Speaker
And I don't want to dive into it too deep, because we could probably spend a whole episode on pricing and price transparency. But I do love the way you guys have kind of set fixed pricing, extremely transparent, extremely under, you know, easy for a patient to understand. What what benefit have you guys seen from that approach? Oh, my goodness.
00:04:12
Speaker
Huge. The ability to make connections with your large companies is tremendous. There are opportunities to go out there and get some of the big companies. Walmart and Amazon talk about this style of healthcare. Trying to be a leader in that
00:04:34
Speaker
in that lane, that's kind of where we're growing. We're seeing a lot of growth there. And that kind of coincides with the cash bundle pricing. I love it. Yeah, I think that's a unique model. And it's great to see you're getting some benefits from that.
Recycling Efforts in ASCs
00:04:53
Speaker
But I will shift gears here towards why we reached out and what caught our eye initially, which was your article and ASC focus specific to your thoughts
00:05:04
Speaker
and NTTC's thoughts on recycling in particular. And that stuck out to us because we're all about different operational aspects of ASCs and best practices. We haven't seen a lot of thought leadership and examples in case studies as it relates to recycling and waste management. And so I wanted to ask you a couple of questions about that. And is that something that the recycling kind of program and focus, is that something that you brought to NTTC?
00:05:33
Speaker
Yeah, it is. Having essentially grown up in the OR, I noticed, you know, all the waste over the years. The drapes, the sponges, you know, the stuff we would take home to wash our cars. It really became more apparent.
00:05:52
Speaker
as I've gotten older that somebody pays for that. Either it gets passed on to the patient or the hospital or the ASC, they eat that cost. So I grew up very frugal. So I don't like to see waste like that. Got it. So you saw the opportunity and decided to take action on it.
00:06:19
Speaker
And how did you go about that? How did you kind of turn this from an observation into a program or something that you took action on? Yeah, absolutely.
Utilizing Expired Supplies for Good
00:06:31
Speaker
So, you know, we kind of started small. We've done this for, you know, throughout several surgery centers, but
00:06:37
Speaker
You start out small, you're sending the expired supplies and implants on mission trips, medications, that kind of thing. We used to do that a lot. They were very popular until some of the organizations that do these trips stopped taking the expired stuff. So they needed current
00:07:02
Speaker
you know, expiration dates on their stuff, which obviously changes things. We're not a large organization, so we still do specific items. Excuse me. Just not as much as we used to. And then obviously we try to, you know, help with, I know some of the organizations have mission trip organizations that they do, so we try to contribute where we can. Got it. And as you started organizing,
00:07:29
Speaker
These kind of waste management programs, the mission trips are kind of the reuse of some of the supplies. Any pushback around that? Was there a blueprint that you could use? Did you find other ASCs that you're doing this? Or how'd you come up with these ideas that you tried? A lot of the surgery centers, I think, do it. Not to give too much credit to the competition, but SCA has a great program.
00:07:55
Speaker
that they do mission trips, I think they do several a year. And it's really good stuff. And they contribute supplies as well as staff. And they give you the opportunity to go, you know, to, you know, all these different countries, you know, and do good. So no, it's not just, it's in the community. And it's strong in the community. Fantastic.
00:08:20
Speaker
And what about your old bread and butter recycling and waste management from a recycling perspective? Is that something that you guys do?
Overcoming Recycling Challenges
00:08:31
Speaker
Yeah, it is. So that's a little more of a struggle. The city that I live in has a recycling program for residential, but they do not have a business solution.
00:08:46
Speaker
I've talked to them, they've talked about, yeah, we can get you a big recycling bin, but you got to build an enclosure. It's very cost prohibitive. So I kind of did a workaround. I put bins throughout the facility with signage and essentially it's hard plastics, everything's clean, and cardboard.
00:09:14
Speaker
And what I do is I take it home and I put it in my recycling bin. Oh, wow. And we've done this for a year or two now. And I like to think that it makes a difference. But you know, we try to do our part. There are a couple of other ideas that are out there as well. Over the years, veterinarian clinics,
00:09:42
Speaker
usually pretty open to, again, everybody's getting away from the expired and I don't really know why, but they used to take our expired medications as well. They've kind of stopped doing that, you know, for the most part now. But the other thing that we used to give them was our used sterilization wrap.
00:10:04
Speaker
And they would reuse that. So there are different ideas. Obviously, you'd have to have a good relationship with the vet clinic and some trust between you guys. But it's been good. Not all are interested. But when you can find it, I think it's a good deal. Sure.
00:10:25
Speaker
It sounds like the recycling program hasn't exactly been plug and play in terms of coming up with specialized containers and having to take it home. I mean, that's a lot. What about participation rate from your staff and employees within the surgery center? Do they see value in these programs? They do. They give me a lot of grief. It's like the kids. I mean, I have to yell at them all the time. That goes in the recycling bin.
00:10:54
Speaker
Please don't put that in the recycling bin. It's like the children at home. It's no different. It's funny. They give me a lot of grief about it, but they take it pretty seriously and they try to do it as well. It's always full. So it obviously is doing something. Yeah, absolutely. And it's clearly the right thing to do for the environment. It's clearly the right thing to do from a sustainability
00:11:24
Speaker
perspective. So it's fantastic you're kind of taking these initiatives
Financial Impact of Recycling
00:11:29
Speaker
on. Have you found a way to link the effort of what you're doing to the overall performance or bottom line of the surgery center? Because I got to imagine that's a little bit of a tougher stretch. It's tough to
00:11:45
Speaker
get a real number. So I can tell you this. So there's twofold. So there's two ways on that. There's two issues. So number one, just the sheer volume of trash that we create, boxes, you know, hard plastics, there's a pretty good volume. So I would like to think, and we have seen this over time,
00:12:13
Speaker
Due to not throwing that stuff in our garbage, I've been able to decrease my trash pickup by once a week. So I only get trash pickup once a week. So there is a cost savings. It's hard to quantify. It is.
00:12:30
Speaker
Most of it is because it makes me feel good. Sure. But there is absolutely, I think, something to decreasing the trash that goes in landfill. Absolutely. So you're at once a week today. Where were you guys before?
Exploring Solar Energy for Surgery Centers
00:12:45
Speaker
We were twice a week. That's 50% reduction. Yeah. I mean, it is. Yeah. It is. And then the other thing, obviously, I think a lot of people are interested in is solar.
00:12:59
Speaker
We've tried to dive into that. Again, very cost prohibitive even at this point. There's a lot of little tweaks that you've got to really understand about it. One, and the number one is, is it's only good while it's on, meaning you can use it while the sun is out and you're working. The center is open.
00:13:27
Speaker
there is no battery. That's a whole different, you know, purchase and that is almost doubles to triples the cost of the unit. So it is literally, you know, during working hours as long as the sun is out, which is frustrating. So we're not quite there yet. We're still looking because even that would be a savings. I think that what I looked at
00:13:57
Speaker
I've talked to a couple of different vendors. And what we're looking at is you kind of level out at 10 years. That's the break even. Right. Break even at 10 years. And then it's a it's like a 30 year note though. So it's it's an impressive thing. You know you start making enough at 10 years I think that
00:14:21
Speaker
It offsets the cost of it. I've heard that kind of rule of thumb before too. And so that's super interesting. Do you think is taking a trade off like that, how do you think your owners respond to things like that in general, where it's like, hey, there's going to be a benefit here, but it's going to take seven to 10 years to get there?
00:14:46
Speaker
So the problem is I was single physician owned and now I've got partners. So the single physician was very interested in doing renewables and solar. The problem with it is even with our roof being a flat roof, we didn't have enough roof space. So in order to get the coverage, we were going to have to add carports with solar on top of them.
00:15:11
Speaker
So there's additional cost. You don't really see a lot right now. I mean, obviously, to me, energy costs are only going to continue to go up. So I think at some point, it is a good investment. It's just not a clean. It's not yet a no-brainer. Yeah. It's not yet. And that's unfortunate. But that's kind of where we are right now. Yeah. Got it. That's great.
00:15:41
Speaker
You've talked about some of the programs you have around waste and expired product reuse, recycling. You've talked about things that are under evaluation like solar. Any other ideas that you're kicking around at?
00:15:57
Speaker
As far as recycling and kind of renewables, that's really what we're doing right now. Reducing waste is the other thing that we really concentrated on. Those kind of things are keeping your preference cards up to date. If something is questionable on a preference card, we don't open it.
00:16:20
Speaker
The surgeons have been bought into that, which is a great thing because not all are. Some of them just want to open items and that's a cost that a lot of times we don't use. I don't use packs.
00:16:38
Speaker
I don't use the same items often enough that packs make sense in my center. So, you know, often your packs will have, you know, an additional three quarter, you know, a drape or something that you don't use. I don't use them. So we only open what we use. So at the end of the case, there is nothing that has not been used on our tables. I think that's important. And over time, it does make a difference. Sure.
00:17:07
Speaker
We try to use only one brand of an item. We don't have multiple brands of the same item. If we've got a Bovee, we've got one Bovee. And we kind of utilize a most used this kind of attitude and everybody's bought in and it works pretty well for 99% of everything that we do. Got it. Yeah. So it sounds like you're pretty efficient in terms of what you actually use.
00:17:37
Speaker
in the surgeries and the more streamlined and the more standardized you are. It makes sense that you can be more efficient. I want to ask you about, you talked about the preference cards and if there's anything on here that's a question mark, we don't open it. Give me an example of that. Is that something where a nurse would have a question around, hey, is this preference card accurate? Or how does that come into play?
00:18:03
Speaker
For example, Lapcole, where you do a gallbladder surgery. It's laparoscopic. Some guys want an irrigator on there if they pop the gallbladder, if they get a leak. Well, that's only if you pop it. So I don't need to open it unless you burst it. So those kind of things, you know, I may need this.
00:18:28
Speaker
Okay, we'll have it in the room. That's great. We just don't open. Guys, so kind of listing out, I'm envisioning you guys kind of have your preference card kind of organized by kind of almost contingency type items versus. Absolutely. That definitely is items. I love it. Yeah. I love it. Well, Adam, one final question for you here.
Cost Control through GPOs & Vendor Contracts
00:18:49
Speaker
And this is a question we ask all our guests every week, which is, can you give our listeners one thing they can do this week to improve their surgery center?
00:18:58
Speaker
Yeah, I thought about this. I mean, there are obviously several things that we can all improve on. I would, just being on the business side of it, most important thing I think to do is to look at your GPOs and your vendor contracts, make sure that they're updated, make sure that they're
00:19:18
Speaker
on contract, they fall off occasionally. They'll go every so many years and then they'll fall off. Having someone who's knowledgeable in and watching pricing on items, I think is one of the biggest cost savings on day-to-day purchases. If you know that a pack of towels is $32.96 and the next time somebody tries to order them, they're $69. Well, and that's the kind of things that we try to do.
00:19:48
Speaker
you know, there's a thousand items, but on the day-to-day items is where you really spend your money. So, keeping an eye on that kind of stuff. And who tends to take on that role, right? The bigger healthcare organizations, the hospital systems have big supply chain management purchasing organizations. They do, they do. We're not as lucky. Who takes that on? Yeah. And especially independents, you know, we have even less. Yeah. So it's super important that we watch every dime that comes through.
00:20:20
Speaker
Fantastic. Well, thanks so much for joining us here today and really enjoyed the conversation. Yeah, man. Thank you.
Innovations in Smart Hospitals
00:20:32
Speaker
As always, it has been a busy week in healthcare, so let's jump right in. In our first story today, Hackensack Meridian is set to open a $714 million brand new state of the art surgical and intensive care tower. They are calling it a smart hospital with 24 operating rooms
00:20:53
Speaker
72 post anesthesia care unit beds, 50 ICU beds, and 175 medical beds. So what makes it a smart facility? They have really decked it out with all the latest tech. There's bedside tablets for patients so they can control the lights, the shades, the room temperature,
00:21:14
Speaker
They're smart TVs with video chat capabilities, monitors outside each room with all the patient information, in-room workstations, six advanced DaVinci robotic surgical systems, orthopedic robots for joint replacement procedures, and the list goes on and on.
00:21:34
Speaker
We've talked about Hackensack Meridian a couple of times. They seem to really always be on the cutting edge of what's up and coming. But their CEO, Bob Garrett, shared that it's the first hospital that has been built with the learnings of COVID in mind. And it's that piece of it that I thought was really interesting. He didn't go into detail about
00:21:55
Speaker
what that exactly means. But I think just calling out the fact that it was built with COVID protocol in mind is just really interesting to think about. And if you head to the episode notes and find the link to the article, you'll be able to see a video of the facility. And it's obviously hard for AICs to compete with a huge budget like that. But there may be some ideas surgery centers can leverage from what this new hospital is planning to implement.
Introduction of Smart Bandages
00:22:24
Speaker
Our next story comes from Life Sciences Intelligence and it's all about surgical site infections. One to three percent of operative patients experience a surgical site infection, which can not only result in the loss of a life, but
00:22:40
Speaker
Also, an estimated total of $3.3 billion is lost annually dealing with surgical site infections and post-care and everything else that comes with it. So the article does a great job of outlining the types of infections, causes, risk factors, tips for prevention, but what we found most interesting was an update on something called a smart bandage.
00:23:05
Speaker
So early in 2021, researchers at the University of Rhode Island developed the first smart bandage to detect and prevent infection.
00:23:15
Speaker
by embedding nanosensors into the bandage fibers. The smart bandage can be monitored by a patient or a healthcare professional to try to catch infections early on, minimize antibiotic use, save money, and most importantly, save lives. So while this technology is not yet being used to treat post-surgical infections, future iterations may allow for that route.
00:23:40
Speaker
And you know, we love any sort of new tech for the ASC industry. And this one sounds like it has real potential to make an impact.
Stressful Physician Specialties
00:23:50
Speaker
In our third news story, the Labor Department's occupational network released the most stressful jobs in the country based on stress tolerance and how important accepting criticism and dealing calmly and effectively with high stress situations is.
00:24:08
Speaker
The number one most stressful job of every job out there was a urologist. Now the top 20 or so are filled with other healthcare professions, anesthesiologists, acute care nurses, midwives and more. But if we just kind of narrow it down and look at physician specialties, the top nine most stressful specialties were urology, OB-GYN, oral and facial surgeons,
00:24:36
Speaker
neurologists, rehabilitation physicians, family medicine, ophthalmologists, podiatrists, and pathologists. So all of that to say, as you all know, being in the healthcare field is extremely stressful and now there's data to back that up. So make sure you're doing what you need to do to take care of yourself.
Leukemia Treatment Breakthrough
00:24:59
Speaker
And to end our new segment on a positive note, a patient with incurable leukemia was cured. According to positive news, a girl who had been diagnosed with incurable leukemia is now free from the disease.
00:25:14
Speaker
thanks to what scientists say is the most sophisticated cell engineering to date. The patient, 13-year-old Alyssa, was diagnosed in 2021 and she was treated with all the conventional therapies, but the cancer kept returning and there didn't really appear to be any other treatment options left. Just this past May, Alyssa took part in a groundbreaking trial
00:25:39
Speaker
becoming the first leukemia patient to be treated with base edited T cells. And six months later, Alyssa is in remission at home and looking forward to returning to school. And a trial for the new treatment is currently open, they're still running, and it aims to recruit up to 10 patients who have exhausted all other options. So
00:26:00
Speaker
Incredible work, Alyssa. So happy for you and her family. And hopefully her experience can be replicated with many, many others. And that news story officially wraps up this week's podcast. Thank you, as always, for spending a few minutes of your week with us. Make sure to subscribe or leave a review on whichever platform you're listening from. I hope you have a great day and we'll see you again next week.