Research published in the Canadian Journal of Surgery suggests an eight-step change process may help improve operating room efficiency, particularly on-time surgical starts.
8-Step Process for Leading Change
John P. Kotter, chief innovation officer of Kotter International and professor at the Harvard Business School, is a renowned expert on leadership and transformation. Mr. Kotter developed an “8-Step Process for Leading Change” designed to help organizations successfully implement and maintain change. While the process isn’t designed specifically for healthcare, the researchers in the study sought to apply it to OR start times and assess its impact on on-time starts.
1. Establish a sense of urgency. Healthcare organizations can establish urgency by behaving with urgency every day and finding opportunity during times of crisis. However, organizations must be careful in differentiating between complacency, false urgency and true urgency.
2. Create the guiding coalition. Bringing together the right mixture of leaders is crucial to achieving and maintaining organizational change. The guiding leadership must have the right set of expertise, power, credibility and leadership skills.
3. Develop a change vision. Effective visions must be imaginable, desirable, feasible, focused, flexible and communicable.
4. Communicate the vision for buy-in. Healthcare organizations are complex structures, so effective communication, both verbal and physical, is imperative for successful transformation. Under-communication and communication inconsistencies must be avoided at all costs.
5. Empower broad-based action. In order to engage and empower employees — and consequently yield broad-based action — healthcare organizations must overcome common barriers, including “troublesome” supervisors.
6. Generate short-term wins. Healthcare leaders must be able to lead their organizations to short-term wins that will ultimately lead to long-term change.
7. Never let up. Healthcare organizations must fight every urge to regress on change efforts and maintain momentum toward long-term goals.
8. Incorporate changes into the culture. By this point, healthcare organizations must be able to prove the changes are better alternatives to old behaviors and processes. These changes must take root across the organization in order to sustain long-term success.
OR application
Mr. Kotter’s eight-step process has been reported to help organizations affect permanent change. Accordingly, a group of researchers sought to determine whether this process would help improve start-times at The Hospital for Sick Children in Toronto, Ontario.
Change efforts included establishing a sense of urgency, which was accomplished by conducting formal presentations on the need for change to key stakeholders: nurses, anesthetists and surgeons. Bi-weekly meetings were also conducted to communicate the vision and goals for improved operating room start times. A guiding coalition was comprised of perioperative services chiefs and the operating room executive committee. Another seven-member multidisciplinary task force, co-led by a surgeon and a nurse, was created to more closely oversee multidisciplinary change efforts.
The multidisciplinary team determined several factors contributed to operating room start time delays, including anesthesiologists availability (24 percent), surgeon availability (21 percent), patient readiness (23 percent) and need for midazolam (13.6 percent). The team implemented small changes to help remove these barriers, including a 7:35 a.m. huddle in the operating room and additional staffing in admissions areas to ensure patients were prepared in the preoperative area by 7:15 a.m. and in the operating room by 8:00 a.m. on the day of surgery.
Over a nine-month period, the hospital saw a dramatic increase in operating room on-time starts, from 6 percent of patients in the operating room by 8 a.m. to 60 percent. Broken out by departments, ophthalmology patients saw the best average on-start times, with 71.7 percent of patients present in the operating room by 8:00 a.m. and 94 percent present by 8:15 a.m. Although other departments saw a lower proportion of patients with on-start times at 8:00 a.m., most had at least an 83.5 percent to 90 percent start-time of 8:15 a.m.
In addition, despite some resistance from surgeons and anesthesiologists, the 7:35 a.m. huddle improved nurses’ perceptions of patient safety within the operating room. The morning huddle also increased on-time starts by 16 percent in the month following its implementation, though this effect seemed to have leveled out over the course of the study. Although it did not reach its target goal of 90 percent of cases starting on time at 8:00 a.m., researchers concluded the eight-step change process helped improve operating room efficiency.
8-Step Process for Leading Change
John P. Kotter, chief innovation officer of Kotter International and professor at the Harvard Business School, is a renowned expert on leadership and transformation. Mr. Kotter developed an “8-Step Process for Leading Change” designed to help organizations successfully implement and maintain change. While the process isn’t designed specifically for healthcare, the researchers in the study sought to apply it to OR start times and assess its impact on on-time starts.
1. Establish a sense of urgency. Healthcare organizations can establish urgency by behaving with urgency every day and finding opportunity during times of crisis. However, organizations must be careful in differentiating between complacency, false urgency and true urgency.
2. Create the guiding coalition. Bringing together the right mixture of leaders is crucial to achieving and maintaining organizational change. The guiding leadership must have the right set of expertise, power, credibility and leadership skills.
3. Develop a change vision. Effective visions must be imaginable, desirable, feasible, focused, flexible and communicable.
4. Communicate the vision for buy-in. Healthcare organizations are complex structures, so effective communication, both verbal and physical, is imperative for successful transformation. Under-communication and communication inconsistencies must be avoided at all costs.
5. Empower broad-based action. In order to engage and empower employees — and consequently yield broad-based action — healthcare organizations must overcome common barriers, including “troublesome” supervisors.
6. Generate short-term wins. Healthcare leaders must be able to lead their organizations to short-term wins that will ultimately lead to long-term change.
7. Never let up. Healthcare organizations must fight every urge to regress on change efforts and maintain momentum toward long-term goals.
8. Incorporate changes into the culture. By this point, healthcare organizations must be able to prove the changes are better alternatives to old behaviors and processes. These changes must take root across the organization in order to sustain long-term success.
OR application
Mr. Kotter’s eight-step process has been reported to help organizations affect permanent change. Accordingly, a group of researchers sought to determine whether this process would help improve start-times at The Hospital for Sick Children in Toronto, Ontario.
Change efforts included establishing a sense of urgency, which was accomplished by conducting formal presentations on the need for change to key stakeholders: nurses, anesthetists and surgeons. Bi-weekly meetings were also conducted to communicate the vision and goals for improved operating room start times. A guiding coalition was comprised of perioperative services chiefs and the operating room executive committee. Another seven-member multidisciplinary task force, co-led by a surgeon and a nurse, was created to more closely oversee multidisciplinary change efforts.
The multidisciplinary team determined several factors contributed to operating room start time delays, including anesthesiologists availability (24 percent), surgeon availability (21 percent), patient readiness (23 percent) and need for midazolam (13.6 percent). The team implemented small changes to help remove these barriers, including a 7:35 a.m. huddle in the operating room and additional staffing in admissions areas to ensure patients were prepared in the preoperative area by 7:15 a.m. and in the operating room by 8:00 a.m. on the day of surgery.
Over a nine-month period, the hospital saw a dramatic increase in operating room on-time starts, from 6 percent of patients in the operating room by 8 a.m. to 60 percent. Broken out by departments, ophthalmology patients saw the best average on-start times, with 71.7 percent of patients present in the operating room by 8:00 a.m. and 94 percent present by 8:15 a.m. Although other departments saw a lower proportion of patients with on-start times at 8:00 a.m., most had at least an 83.5 percent to 90 percent start-time of 8:15 a.m.
In addition, despite some resistance from surgeons and anesthesiologists, the 7:35 a.m. huddle improved nurses’ perceptions of patient safety within the operating room. The morning huddle also increased on-time starts by 16 percent in the month following its implementation, though this effect seemed to have leveled out over the course of the study. Although it did not reach its target goal of 90 percent of cases starting on time at 8:00 a.m., researchers concluded the eight-step change process helped improve operating room efficiency.