Perioperative Power List 2024: Lou Bottoms – Patient Care Director for Perioperative and Procedural Areas, Emory University Hospital, Atlanta, GA
Lou Bottoms serves as Patient Care Director for Perioperative Procedural Areas at Emory University Hospital, Atlanta, GA. With comprehensive experience in operations, fiscal management, development/planning, and process improvement, Bottoms is a highly accomplished perioperative leader with a career spanning over 30 years.
Q: How do you streamline training processes and skill sets across multiple sites?
LB: While some areas lend themselves to cross-training—because Emory University has the nation’s third highest patient cure index—we are a highly specialized facility doing complex procedures in the operating room, our interventional radiology, and our heart and vascular Center that requires specialization. So, while we can do some cross-training, our approach is multidisciplinary. Our attending [physicians], residents, and fellows all work together to support each other. We are a teaching institution with all services, so we lend ourselves to our specialty teams on weekdays and on-call. For instance, our cardiac team has two call teams, our neuro team has a call team, and our general surgery has a call team. We do that to support the care that is required for these patients.
Q: How do you manage financial constraints and optimize revenue cycles?
LB: We try to be good stewards of our labor costs and supply chain processes, particularly regarding implants. Two years ago, we converted to EPIC. It’s been quite interesting and challenging concerning reimbursement and capturing all the parts of the charge piece required within our Epic product now. We’re working very closely with our IT team as we identify areas of opportunity with the multi-departmental approach. The OR, heart and vascular, and interventional radiology have been very supportive in trying to make sure that the EPIC product supports their workflow and the standard work that the nurses in all these areas are trying to accomplish in their documentation to help monitor supply usage, implant usage, and charge capture. We’re trying to hit the sweet spot of connectivity, accuracy, and everything working as it did with our previous EMR. It’s an ongoing process.
Q: Cardiac cases are the fastest-growing specialty at ASCs. What other specialties are you finding financially beneficial in moving from a hospital setting to an ASC?
LB: We work very closely with our ambulatory surgery center (part of our Emory Clinics) to ensure that the appropriate patients are scheduled in the ASC. They need to be appropriate for their anesthesia ASA classification. We look at what procedures require an outpatient visit vs. an inpatient visit. We have a closed staff here, and we work very hard to leave the OR time open for inpatients and appropriately placed outpatients in the clinic setting.
Q: What solutions or policy interventions might address staffing shortages systemwide? Are we at a crossroads?
LB: COVID pushed us to think about things like well-being and salaries. We could not rely on history. Past hiring practices just don’t work. You have to be very futuristic and think hard regarding what the workforce looks for now and what they require. What’s important to them? What can we do to help meet some of those needs while still staying afloat and having ratios that will take care of our patients in the best manner? We’ve been fortunate here that as soon as we could open the ORs back up during COVID, we could keep all of them open. We have maintained that ability.
We’ve had to consider more creative scheduling because of the patients we care for and the need to get them on the schedule. We brainstormed and threw anything out on the table. Nothing was sacred. We looked at different approaches to the 8, 10, and 12-hour exclusivity shifts. We asked ourselves what we could do to help the individual have professional fulfillment and get them home to be with their family. That means predictable scheduling and staffing so they can go home when their shifts end.
Q: What are your thoughts on developing C-Suite roles within the next few years?
LB: We’ve already got those rules here at Emory. It’s indicative of a changing environment and technology. Part of our role as visionary leaders is to look at where we will be in 10 months, two years down the road. I have stressed to my leaders that when you do build-outs, don’t think about replicating what you have now; think about where you’re going to be three years, five years, seven years down the road. It is a huge investment. We’re building out 14 rooms; seven are ORs, four are cath labs, and three are EP (electrophysiology). These aren’t things that will be replaced or changed out in 5 or 7 years. We have to think big enough and broad enough where you consider what these rooms will need technology-wise. That’s why our rooms are 900, 1000 sq. ft., big enough to accommodate the technology as it comes and goes.
Q: What role can system leadership play in creating or modeling a positive work culture?
LB: Leader modeling is top-down, from our executive teams to our leadership across the system to our on-site leadership. We have to be authentic and walk the talk. Staff can see sincerity and hypocrisy. We have to lead from the head and heart, as we were taught in nursing school. Round openly, ask people how their day is going, and be sincere. Ask about their family and call them by their first name. It’s difficult when you have 400 FTE that report up to you, but just get out there and be visible.
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