15 Tips & Tricks for Successful Process Transformation in the Operating Room

After 20+ years of bringing about successful transformation efforts in hospital operation rooms, there are a number of hard-learned tips that can improve your chances of success and permanence: 

• Senior administration must be committed to the need for change. They must work with the physician and nurses on the executive committee.  A united front is essential for successful transformation.

• Surgeons must play a major role in leading the transformation; this is should occur in an executive administration-sponsored committee. Balancing the need for surgeon’s access vs the hospitals need for OR productivity /efficiency requires surgeon leadership as part of a collaborative team of surgeons, nursing, anesthesia and administration.

• Executive committee meetings should be scheduled in the morning before the beginning of the OR schedule; with a one hour time limit, starting on time and ending on time.

• A ‘typical’ hospital OR transformation requires intervention at three levels; i.e., leadership, management and process. Leadership is provided by an administration-sponsored executive committee. Proactive management of daily operations requires a collaborative team approach that includes nursing and anesthesia. Patient throughput in the OR can be broken down into performance improvement team that address specific areas within surgical services; i.e., Scheduling/Patient Preparation, Efficiency, etc..

• Patience! Change takes time.  All change is resisted.

• Successful change efforts require clearly defined goals and benchmarks with ongoing data collection and analytics driving both guidance and transformation. Metrics improve accountability during the change process.

• Remember: ‘The goal of your efforts is to have ‘the surgeon feel like a valued customer, with great patient care the product!’

• Create physician leadership positions of co-Medical Directors: A surgeon medical director that leads the Executive Committee and an Anesthesia Medical Director whose prime role is a manager of front line day-to-day operations.

• In organizational transformation efforts, it is not uncommon to find individuals in front-line and management positions who resist change or have limitations that are not suited for new roles and duties. Communicate your concerns, with intervention and coaching.  From our experience, it should be obvious, relatively early, which individuals will require HR intervention and replacement.

• Consistent attendance at performance improvement team meetings is a must for successful transformation. Schedule PIT times and chose members that achieve consistent participation. 

• When confronted with physician complaints / pushback, refer these issues to the SSEC. Whenever possible, limit individual intervention with surgeon complaints. As an example, a successful ‘end around’ to senior administration by a complaining surgeon (bypassing the executive committee) is the death nil of a collaborative leadership effort.  Committee involvement in addressing surgeon issue is much is much more effective and fair.

• Public presentation of quick wins and changes is very effective in driving change. For example, posting daily number of on-time starts, room turnover times, etc. can energize appropriate activity.

• It is well documented that most change efforts fail. Use of an outside experienced change agent (consulting group) can significantly improve the likelihood of successful and permanent transformation.  Change inevitably causes organizational pain and consumes political capitol, best assumed by an external consulting team.

• Physicians and hospitals have always had a rocky, relatively distant relationship; each has very distinct goals that are often at odds. Working to collaboratively recognize and overcome these differences should be at the core of organization operating room transformation.

• Improving the quality of patient care will always improve the bottom line! Documenting quality improvement is now an absolute must for survival in the healthcare market.