In this current, rapidly changing healthcare era, hospital operating rooms are facing the daunting task of moving to value-based, patient-friendly services.
Although there have been significant improvements in surgical technology, the process of patient care, from scheduling to discharge, has largely remained unchanged. However, this new payment methodology, based upon measured quality and cost (value) indicators, will necessitate significantly improved operating room quality, efficiency as well as customer satisfaction.
Unlike its competitors, the ASC and office-based surgery, the modern hospital OR faces a number of unique and formidable obstacles in optimizing its services:
Organizational complexity: In today’s OR, there are four distinct groups, each with different, often clashing, agendas; i.e., surgeon, anesthesia, nursing and administration. The traditional largely bygone approach to managing these disparate factions, was the larger-than-life autocratic nursing director. In today’s best run ORs, the Nursing Director has been replaced with an Executive Operations Committee, sponsored by the administration, with surgeon, anesthesia, nursing and senior administrator membership. With surgeons making up a relatively large proportion of membership, the committee provides oversight to daily operations, surgeon access, strategic direction, etc.
Lack of accurate and appropriate data, dashboards and benchmarks: Although the EHR is now an integral part of all hospital OR operations, these systems are not providing the high-level analytics required in this new outcome and value-driven era. Building this vetted and benchmark-based reporting system should be part of the skill set of a Surgical Services Business Manager. Regular reporting of operational, quality and cost data identifies issues, both high-level and granular, and is an essential requirement in driving operational improvement.
Siloed organizational structure: Surgical services in a typical hospital is made up of a large number of units, each with highly specialized personnel; i.e., scheduling, pre-admission testing, pre-op, PACU, admitting, sterile processing, etc. In reaching best practice, these traditionally siloed and territorial groups, must improve their collaboration and communication. The best approach, using lean and six sigma methodologies, are the creation of multi-disciplinary performance improvement teams; each with a mission statement and charter. An important key to success is clearly defining the goal of the group using agreed upon benchmarks. Often, limiting proposed changes, initially to a pilot, improves the chance of overall success. Whether it’s improving on-time starts or reducing cancellations, performance improvement teams can overcome institutional obstacles.
Poor coordination/cooperation between the hospital and surgeon’s office: It is not uncommon for hospitals beginning a surgical services transformation project to forget to include their most important customer, the surgeon and his office. The surgeon’s office staff can provide valuable insight and feedback for OR improvement efforts. This is especially true in the areas of scheduling and patient preparation. Office staff participation in performance improvement teams focusing on scheduling and the patient process can greatly improve the chances of meaningful and productive improvements. It’s also a good idea to have regular hospital-hosted town halls with office staff. Topics often discussed include block time changes, patient preparation algorithms, scheduling office changes, etc.
A lack of understanding of the behavioral science of successful organizational transformation: It is a well-substantiated fact that most transformation efforts fail. In surgical services, ignoring the obstacles discussed above, can significantly reduce the chances of successful process improvement. There are some additional points. First, all change is resisted! Even when it’s obvious that change will be beneficial to the patient and the organization, managing transformation require patience and perseverance. Most change efforts will require months of aggressive leadership, frontline accountability, pilot tests, and careful nurturing. Finally, experience has taught us a few individuals will never fully embrace change efforts. For these individuals, departure from the organization is probably best.
Change is hard, especially in today’s hospital operating rooms, however, understanding the obstacles can improve the chance of success.
