Most hospitals in the US depend on robust high quality surgical volume to maintain their financial viability. And yet, most surgeons do not view themselves as valued customers. Their complaints are consistently similar:
- My productivity and service in the OR is poor; first cases are nearly always late, turnover times are atrocious, and my preference cards are usually wrong.
- I get different staff every day, most of whom are either not very competent, are new hires, or are not familiar with my needs.
- The scheduling process is a problem; I often can’t schedule my elective cases and my add-ons are typically started late at night or I’m forced to work on the weekends.
- Hospital patient preparation is so inconsistent that my office staff has had to assume ownership of this process. Unfortunately, each anesthesiologist appears to have different patient preparation standard.
- I can’t seem to find anyone who is in charge that can address my needs; I am often forced to threaten the administration with moving my cases to another hospital before I get a response.
Changing the culture in your OR to a more surgeon (and patient)-friendly environment, requires relatively fundamental process transformation.
With its complicated structure, surgical services restructuring requires intervention at three levels; i.e., leadership, management and process. Each level requires multi-disciplinary collaboration:
- Leadership: The traditional leadership model, largely relegated to the nursing director and his/her managers, needs updating. In its stead should be a multidisciplinary leadership committee, based upon the principal that physicians, especially surgeons, play a major role in leading OR operations. This Surgical Service Executive Committee (SSEC) should be sponsored by the administration and chaired by a surgeon, with anesthesia, nursing and senior c-level membership. Its mission is to set both strategic and tactical direction of surgical services as well as managing surgeon access and guiding day-to-day operations. Vetted analytics and benchmarking are a required element of its success.
- Management: In best practice ORs, a nursing director and anesthesiologist director work collaboratively in managing daily operations. This team receives its guidance and support from the SSEC. Improving daily quality, efficiency and productivity is their mandate.
- Management: Associated with improved management is the development of a multi-disciplinary Daily Huddle that reviews the schedule up to 5 days in advance. This group, which typically includes representatives from scheduling, patient preparation, pre-op, admitting, discharge planning, sterile processing, materials management, OR, PACU, etc, is responsible for proactively building a schedule that optimizes both OR productivity and efficiency. In practice, the daily huddle greatly reduces delays and cancellations while improving both the patient and surgeon experience.
- Process Improvement: Patient and surgeon satisfaction depends on a seamless, efficient and consistent scheduling and patient preparation process and requires a multi-disciplinary team approach. Improved scheduling must include an SSEC-designed surgeon access / block system that provides for reserved block time as well as daily open time. Best practice scheduling practice improves OR utilization to > 75% while reducing after hour and weekend case load. A hospital-based pre-op preparation system, overseen by the anesthesia department, and based on universally agreed upon algorithms and guidelines is a must. Both the scheduling and patient preparation process require close and ongoing collaboration with the surgeon’s office.
- Process Improvement: Improving first case on-time starts and turnover times are typically the greatest surgeon satisfiers. As with scheduling and preparation a performance improvement team is task with these issues. Best practice operating rooms will have an on-time ‘wheels-in’ time exceeding 90% of their first cases starts fo the day. Turnover time improvement is the most difficult issue to address. It requires the development of a carefully choreographed parallel process that includes all members of the surgical team; i.e., scheduling, pre-op preparation, anesthesia, sterile processing, the OR team, the surgeon, etc.
Successfully addressing these five areas of surgical care, will produce a high quality environment that is both surgeon and patient friendly.
To learn more about engaging your staff, be sure to check out this blog: 6 Tips to Boost Staff Morale
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