Managing an operating room requires strong leadership skills to coordinate interrelated processes, communicate with different groups of people, track financial and clinical benchmarks and more. An OR leader's ability to perform these tasks can be largely influenced by the support of assistants and co-leaders. Dana Crompton, vice president of perioperative services for Long Beach (Calif.) Medical Center and Miller Children's Hospital Long Beach, shares her hospitals' approach to OR management and how straying from traditional structures can yield improved outcomes.
Q: How should a hospital operating room's management be structured?
Dana Crompton: In 2010, Long Beach Memorial Medical Center and Miller Children's Hospital Long Beach — with one of the West [Coast]'s busiest surgery departments on one campus — conducted extensive research using the lean management methodology to determine how best to organize our operating rooms. Prior to the redesign, the hospitals had one clinical director overseeing all of the surgical responsibilities for 41 operating rooms and one business director overseeing all of the non-clinical administrative duties (budgeting, purchasing, etc.) for surgery and the other departments of perioperative surgery (PACU, pre-op, GI lab, sterile processing).
From our research and applications of lean processes, we learned that our operational issues were not related to capabilities, but the challenges of balancing the clinical management function with the operations management function. We [also] learned that to be effective, an OR manager should have no more than five direct reports. Today, the new management structure has been decentralized to achieve that model with two clinical directors (one for adult surgeries and the other for children's, women's and cardiac surgeries) overseeing a balanced number of direct reports.
Our management structure purposely separates direct patient care from business-related accountabilities. There are two types of assistant unit managers — two-thirds are responsible for direct patient care overseeing the front-line staff and the other third supports the managerial responsibilities of the department (i.e., scheduling, time cards, disciplinary actions and education compliance).
One of the most valuable functions to a large surgical environment is the management of fiscal accountabilities (labor, supplies, equipment, etc.). A number of the administrative duties of the previous non-clinical administrative director — like purchasing, distribution, stocking, new product selection, etc. — have now been turned over to the hospitals' materials management department, and the administrative role has converted into a financial analyst exclusively responsible for the fiscal performance of the perioperative division.
We also approach the operating rooms as a segment of the continuum of perioperative services. The pre- and postoperative services are integral to the success of the surgical environment. As mentioned previously, our operating rooms are overseen by a clinical director with service line assistant managers, one of which is dedicated to clinical operations in lieu of a service line. The pre- and post-surgical areas are coordinated by a clinical director. Sterile processing, informatics, purchasing and materials management are overseen by subject matter experts, not necessarily RNs.
Q: What factors influence this structure?
DC: Size of service has a significant influence on structure. In a large operation such as ours, with 41 surgical suites and multiple hospitals (adult, women's and children), equating to 25,000+ cases per year, a small leadership team would be completely overwhelmed and rendered ineffective.
Scope of service also has a significant influence on structure of the leadership team. Long Beach Memorial is a level II trauma center and performs all procedures except for whole organ transplant and burns. Specialization in all of the dynamics requires segmentation with common oversight.
Q: How can the OR leadership structure influence the overall performance of an OR?
DC: A tight, engaged, integrated, talented, flexible and open-minded leadership team will drive an OR to successes not thought possible. The rigid paradigms of past practice can be challenged, allowing changes in behavior. Between synergy and engagement, the achievement of excellence for industry and organization benchmark performance is not only possible — it is expected.
Q: What are the greatest challenges in structuring OR management positions and how do you overcome them?
DC: Overcoming stereotypes and decades-long traditions of how the OR should be structured. For example, more and more hospitals are choosing non-clinical executives to oversee surgical services. While a non-clinical leader may possess strengths in managing the service as a business, having a non-clinical background also necessitates a strong understanding of clinical vocabulary; earning the respect and support of surgeons, anesthesiologists, OR nurses and other clinical and support staff; and a strong supporting team of clinical expert direct reports. A clinician, on the other hand, typically has a strong understanding of surgical flow, the ability to make quicker decisions due to clinical experience and the respect and natural support of medical and department staff. However, the clinician still needs to gain strong skills in business, budget management and strategic vision that go beyond clinical needs of the hospital's overall strategic needs.
Another big challenge is introducing and managing change of responsibilities and accountabilities among all members of the management team. Old habits are sometimes hard to change.
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Q: How should a hospital operating room's management be structured?Dana Crompton: In 2010, Long Beach Memorial Medical Center and Miller Children's Hospital Long Beach — with one of the West [Coast]'s busiest surgery departments on one campus — conducted extensive research using the lean management methodology to determine how best to organize our operating rooms. Prior to the redesign, the hospitals had one clinical director overseeing all of the surgical responsibilities for 41 operating rooms and one business director overseeing all of the non-clinical administrative duties (budgeting, purchasing, etc.) for surgery and the other departments of perioperative surgery (PACU, pre-op, GI lab, sterile processing).
From our research and applications of lean processes, we learned that our operational issues were not related to capabilities, but the challenges of balancing the clinical management function with the operations management function. We [also] learned that to be effective, an OR manager should have no more than five direct reports. Today, the new management structure has been decentralized to achieve that model with two clinical directors (one for adult surgeries and the other for children's, women's and cardiac surgeries) overseeing a balanced number of direct reports.
Our management structure purposely separates direct patient care from business-related accountabilities. There are two types of assistant unit managers — two-thirds are responsible for direct patient care overseeing the front-line staff and the other third supports the managerial responsibilities of the department (i.e., scheduling, time cards, disciplinary actions and education compliance).
One of the most valuable functions to a large surgical environment is the management of fiscal accountabilities (labor, supplies, equipment, etc.). A number of the administrative duties of the previous non-clinical administrative director — like purchasing, distribution, stocking, new product selection, etc. — have now been turned over to the hospitals' materials management department, and the administrative role has converted into a financial analyst exclusively responsible for the fiscal performance of the perioperative division.
We also approach the operating rooms as a segment of the continuum of perioperative services. The pre- and postoperative services are integral to the success of the surgical environment. As mentioned previously, our operating rooms are overseen by a clinical director with service line assistant managers, one of which is dedicated to clinical operations in lieu of a service line. The pre- and post-surgical areas are coordinated by a clinical director. Sterile processing, informatics, purchasing and materials management are overseen by subject matter experts, not necessarily RNs.
Q: What factors influence this structure?
DC: Size of service has a significant influence on structure. In a large operation such as ours, with 41 surgical suites and multiple hospitals (adult, women's and children), equating to 25,000+ cases per year, a small leadership team would be completely overwhelmed and rendered ineffective.
Scope of service also has a significant influence on structure of the leadership team. Long Beach Memorial is a level II trauma center and performs all procedures except for whole organ transplant and burns. Specialization in all of the dynamics requires segmentation with common oversight.
Q: How can the OR leadership structure influence the overall performance of an OR?
DC: A tight, engaged, integrated, talented, flexible and open-minded leadership team will drive an OR to successes not thought possible. The rigid paradigms of past practice can be challenged, allowing changes in behavior. Between synergy and engagement, the achievement of excellence for industry and organization benchmark performance is not only possible — it is expected.
Q: What are the greatest challenges in structuring OR management positions and how do you overcome them?
DC: Overcoming stereotypes and decades-long traditions of how the OR should be structured. For example, more and more hospitals are choosing non-clinical executives to oversee surgical services. While a non-clinical leader may possess strengths in managing the service as a business, having a non-clinical background also necessitates a strong understanding of clinical vocabulary; earning the respect and support of surgeons, anesthesiologists, OR nurses and other clinical and support staff; and a strong supporting team of clinical expert direct reports. A clinician, on the other hand, typically has a strong understanding of surgical flow, the ability to make quicker decisions due to clinical experience and the respect and natural support of medical and department staff. However, the clinician still needs to gain strong skills in business, budget management and strategic vision that go beyond clinical needs of the hospital's overall strategic needs.
Another big challenge is introducing and managing change of responsibilities and accountabilities among all members of the management team. Old habits are sometimes hard to change.
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