The success of any performance improvement team endeavor is dependent on the participating team members and sponsorship. Teams work best with a clear understanding of “why are we doing this”, mutual respect and a common goal to towards making the improvement.
Why are we doing this?
Many think the goal of the surgeon preference card is to know what should be opened or held for a surgical procedure. When in fact, the preference card is the circulating system of the operating room. These cards function to transport information from the surgeon to central sterile processing, materials management, biomedical engineering, clinical staff, IT, purchasing and finance. They provide valuable data from the size of glove needed, how to position the patient and the data gathered from predicative analytics. The preference card data may be used as a catalyst to deliver cost variations between surgeons, quantity of disposable products needed, waste discrepancies between products purchased and used, budget forecasting for supplies, equipment and instrumentation capital needs, and many more.
Who sponsors a preference card cleanup and drafts charter?
Awareness of the magnitude of information the cards may provide is the first step to assembling a performance improvement team tasked with managing the preference card cleanup project. Generally, executive hospital leadership are the first to acknowledge the need to improve the functionality of preference cards and sponsor a change initiative. This sponsorship may be an individual or steering committee that kicks off the idea with a project charter.
The charter is the foundation to delineate:
- Project purpose
- Goals
- Membership – Roles
- Plan
- Risks
- Responsibilities
- Expectations
Who should lead the project?
To be effective, the team charter should include individuals representing all areas of the practice that will be affected by team recommendations. The team should have a clearly identified chair who is committed to building a process of continuous improvement. The chair should be knowledgeable about both card input and output as well as have skills to effect ongoing processes to enable improvement. A partnership between an accomplished coach and PIT chairperson is advocated for skill development to identify best practice, engage team members and implement process modifications. The role of the chairperson is to ensure that the performance improvement team functions effectively and fulfills objectives.
What goes into team formation?
Team formation is an essential part of the plan to improve preference cards. Consideration must be made to include candidates that:
- Have the availability to meet regularly
- Are skilled in workflow mapping, assessments, auditing, best practice and benchmarking
- Have the authority to implement a change
- Are skilled in problem solving issues
- Have technical expertise in the electronic health record
- And primarily – are stakeholders that have some “skin in the game”
What stakeholders should be on the PIT?
Keep in mind that the stakeholder team will be provided with surface concerns of which they must dig to uncover the root causes. They will select interventions for pilot and implementation that will affect a wide range of entities. The team should be decentralized to provide a comprehensive approach for oversight of preference card review, maintenance and data extraction. The optimal size of a team is between eight and twelve individuals, more importantly is the diversity of the group. Participants should have different roles and perspectives on both the input and output of preference cards. This group should include input from the end user including:
- Project Sponsorship
- Clinical Operating Room Leadership – OR Director/manager
- Clinical Service Line Leaders
- Clinical Staff – OR RN/Surgical Technologist
- Case Cart Picking staff
- EMR IT Super user
- Surgeons
- Materials Manager
- Materials Procurement Staff – OR Buyer
- Central Sterile Processing Manager
- Billing Department staff
- Item File/Charge Master Resource
- Finance Director
Additional Considerations:
Teams will benefit from having memorandums of commitment that clearly describe the intent and nature of the project, participation expectations, and include signatures from each participants. Newly formed teams are challenging, however, they have the benefit of a fresh point of view, a clear understanding of why change is needed, and decreased resistance to change. As cells of the body require oxygen, nutrients, waste removal and a network of vessels, the preference card optimization process must take into consideration all components to optimize efficiency, satisfaction and financial performance of the organization.
