Here are eight ways operating room staff and physicians can take advantage of data on their OR's efficiency to make meaningful, positive changes.
Q: How can OR staff and physicians use measurements of efficiency to make improvements?
Mark Antoszyk, Chief CRNA, Carolinas Medical Center NorthEast (Concord, N.C.): [After discussing problems and successes,] trend the comments, then assign the staff to finding ways to improve things that are not working and also how to sustain what is working.
Houtan Chaboki, MD, Plastic Surgeon, George Washington Medical Faculty Associates (Washington, D.C.): Make each team member responsible and accountable. Provide rewards for most efficient teams. Try to have the same team members work together consistently, i.e., the same anesthesiologist with the same surgeon and nursing staff.
Steven M. Gottlieb, MD, CEO, TeamHealth Anesthesia: Data-driven decisions often yield the highest return, and once the hospital has a clear vision of how its OR teams are performing against its benchmarked goals, it can begin considering process and procedural changes to improve performance. For example, if there is a chronic problem with surgical cases starting on time as a result of inadequate pre-admission testing, the hospital might assign oversight of pre-admission testing to the anesthesia team and charge them with reducing delays and cancellations to acceptable parameters. Methods might include completing the process at least 72 hours in advance for each patient, continually updating clearance criteria to current evidence-based standards and/or educating the primary care staff on appropriate pre-surgical/anesthesia clearance.
Sue Kozlowski, Senior Healthcare Consultant, TechSolve: Process metrics can vary for two types of reasons. Random variations are the little differences that occur daily due to differences in patients, people involved in the process and small issues. Our process metrics (such as on-time case starts) will probably show some variation — that's normal. For this type of pattern, you don't have to do anything if you are meeting your overall target. If you're not meeting targets on a consistent basis, you may need a process improvement effort on that issue. Special cause variations are due to a big, unexpected problem. If a surgeon calls in sick or a sterilizer breaks down, that's a special cause with a big impact on the process. For this type of issue, you would want to get to the root cause of the problem rather than addressing just the symptoms. In the case of the surgeon, you can't prevent it (we all get sick sometimes!) but you could develop a back-up plan. For a sterilizer, you could investigate maintenance issues.
Joseph Livengood, MD, Acute Care Surgeon, Medical Center of the Rockies (Loveland, Colo.), Biomedical Engineer, President, Livengood Engineering: Approach the process as a root-cause analysis and be careful not to drill down too quickly on a single parameter. The OR is a complex environment that starts in the preoperative clinic and involves a large number of people and processes. Adding OR techs to help clean rooms faster for turnover may completely overlook an issue with sterile processing, not having enough equipment or surgeons not arriving in time to mark their patients.
Adam McLarney, Director; Maggie Longshore, RN, MS, CNOR, CAPA, NE-BC, Senior Consultant, Blue Jay Consulting: Reviewing the scorecard metrics regularly allows departments to understand where areas for improvement exist, both in the short and long term. Many departments will use the scorecard data to help initiate dialogue regarding the changes needed to make improvements. The scorecard is then used to measure and validate the effects that process changes have had in key operational areas. Trending allows the department to perform root-cause analysis on compliance metrics and determine if implemented changes are sustained.
Catherine Munoz, BSN, RN, CNOR, LNCC, Director of Perioperative Services, St. Vincent Medical Center (Los Angeles): Sharing results of the key measurements with staff, physicians and administrators is as important as the measurement itself. The key stakeholders must continue to see their efforts produce results and to be able to respond and explain variations and setbacks. Commending and praising staff and physicians goes a long way to foster and sustain continued results.
Joe Smith, Vice President, Perioperative Care Division, Picis: Proper measurement of efficiency will only result in positive change if the measurement includes cause and effect information — why a case was delayed, why a patient was delayed getting to pre-op, why patients were not properly educated or prepared for surgery. If the measurement of efficiency identifies the reasons behind inefficiency, then the corrective actions are easy to identify and easier to implement.
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Q: How can OR staff and physicians use measurements of efficiency to make improvements?
Mark Antoszyk, Chief CRNA, Carolinas Medical Center NorthEast (Concord, N.C.): [After discussing problems and successes,] trend the comments, then assign the staff to finding ways to improve things that are not working and also how to sustain what is working.
Houtan Chaboki, MD, Plastic Surgeon, George Washington Medical Faculty Associates (Washington, D.C.): Make each team member responsible and accountable. Provide rewards for most efficient teams. Try to have the same team members work together consistently, i.e., the same anesthesiologist with the same surgeon and nursing staff.
Steven M. Gottlieb, MD, CEO, TeamHealth Anesthesia: Data-driven decisions often yield the highest return, and once the hospital has a clear vision of how its OR teams are performing against its benchmarked goals, it can begin considering process and procedural changes to improve performance. For example, if there is a chronic problem with surgical cases starting on time as a result of inadequate pre-admission testing, the hospital might assign oversight of pre-admission testing to the anesthesia team and charge them with reducing delays and cancellations to acceptable parameters. Methods might include completing the process at least 72 hours in advance for each patient, continually updating clearance criteria to current evidence-based standards and/or educating the primary care staff on appropriate pre-surgical/anesthesia clearance.
Sue Kozlowski, Senior Healthcare Consultant, TechSolve: Process metrics can vary for two types of reasons. Random variations are the little differences that occur daily due to differences in patients, people involved in the process and small issues. Our process metrics (such as on-time case starts) will probably show some variation — that's normal. For this type of pattern, you don't have to do anything if you are meeting your overall target. If you're not meeting targets on a consistent basis, you may need a process improvement effort on that issue. Special cause variations are due to a big, unexpected problem. If a surgeon calls in sick or a sterilizer breaks down, that's a special cause with a big impact on the process. For this type of issue, you would want to get to the root cause of the problem rather than addressing just the symptoms. In the case of the surgeon, you can't prevent it (we all get sick sometimes!) but you could develop a back-up plan. For a sterilizer, you could investigate maintenance issues.
Joseph Livengood, MD, Acute Care Surgeon, Medical Center of the Rockies (Loveland, Colo.), Biomedical Engineer, President, Livengood Engineering: Approach the process as a root-cause analysis and be careful not to drill down too quickly on a single parameter. The OR is a complex environment that starts in the preoperative clinic and involves a large number of people and processes. Adding OR techs to help clean rooms faster for turnover may completely overlook an issue with sterile processing, not having enough equipment or surgeons not arriving in time to mark their patients.
Adam McLarney, Director; Maggie Longshore, RN, MS, CNOR, CAPA, NE-BC, Senior Consultant, Blue Jay Consulting: Reviewing the scorecard metrics regularly allows departments to understand where areas for improvement exist, both in the short and long term. Many departments will use the scorecard data to help initiate dialogue regarding the changes needed to make improvements. The scorecard is then used to measure and validate the effects that process changes have had in key operational areas. Trending allows the department to perform root-cause analysis on compliance metrics and determine if implemented changes are sustained.
Catherine Munoz, BSN, RN, CNOR, LNCC, Director of Perioperative Services, St. Vincent Medical Center (Los Angeles): Sharing results of the key measurements with staff, physicians and administrators is as important as the measurement itself. The key stakeholders must continue to see their efforts produce results and to be able to respond and explain variations and setbacks. Commending and praising staff and physicians goes a long way to foster and sustain continued results.
Joe Smith, Vice President, Perioperative Care Division, Picis: Proper measurement of efficiency will only result in positive change if the measurement includes cause and effect information — why a case was delayed, why a patient was delayed getting to pre-op, why patients were not properly educated or prepared for surgery. If the measurement of efficiency identifies the reasons behind inefficiency, then the corrective actions are easy to identify and easier to implement.
Related Articles on OR Efficiency:
How Should ORs Measure Efficiency? 8 Responses10 Experts Share the One Behavior They Believe Cripples an OR
The One Change ORs Should Make to Improve Efficiency: 9 Responses