With the arrival of valued-based payments and the continuing out-migration of surgical volume to ASCs and the office-based environment, hospital ORs are embracing the necessity for substantial improvements in quality, efficiency and customer satisfaction. These organizations are turning to anesthesia department and its leadership to help lead this transformation.
As stated in previous blogs, there are three components of a successful operating room transformation effort; i.e., leadership, management and process improvement. A proactive and engaged anesthesia department will have a major role in all three levels:
Leadership: Improving the value of surgical services starts with leadership. Replacing the traditional nursing director leadership model with a collaborative group of surgeons, anesthesia, nursing and senior administration, is now becoming standard in best practice ORs. This group, functioning as an empowered “board of directors” of surgical services, provides oversight, directions and sponsorship to frontline management and process improvement efforts. Often, these committees are co-chaired by both a surgeon and anesthesiologist medical director. The committee’s most challenging mandate is balancing the need of surgeons for OR access versus the hospital’s need for improved productivity/utilization. The anesthesia committee members, including the anesthesia medical director, typically play a key role in mediating these two opposing, often clashing, agendas.
Management: Given authority and guidance by the leadership committee, the frontline management team in best practice operating rooms consists of an anesthesia and nursing director ‘team’ presiding over frontline operations. Managing daily operations in a typical hospital operating room can be a daunting challenge. Add-ons, delays, cancellations, staffing issues, surgeon complaints, are just some of the daily issues confronting OR managers. An engaged and collaborative group of anesthesia “board runners”, working closely with nursing leadership can have a profound effect on improving OR productivity and customer satisfaction.
Participation in proactive schedule management should be another principal role of anesthesia department leadership. The multi-disciplinary “daily huddle”, reviewing the OR schedule up to 5 days in advance, with anesthesia department in attendance, is an important tool in moderating variation in daily OR demand, cutting delays and cancellations, while reducing after hour and weekend add-ons.
Process Improvement: With the value demands of today’s surgical environment, in addition to new patient-centric process improvement efforts (i.e., bundling, surgical home, ERAS, etc), anesthesia leadership and participation is crucial.
A key element of anesthesia’s role in this new era is aggressive and consistent management of patient preparation. Well-prepared patients will reduce cancellations and delays besides improving outcome, with reduced post-op complications and LOS. Building a state-of-the-art algorithms and guidelines system, agreed upon and adhered to by the entire anesthesia department, is an essential part of an improved patient preparation system. This requires close anesthesia oversight and support of the hospital patient preparation unit. A well-designed and supported PAT process focuses on promoting a consistent, hospital-based patient care system. An added bonus of this approach is improved cooperation and trust between the surgeon’s office staff and the hospital.
In summary, the anesthesia department can play an instrumental role in improving the value of hospital-based surgical services. At all levels, throughout the patient’s surgical experience the anesthesia department must take on engaged leadership and management responsibility.
