Improving surgical services performance through changing work culture

AORN Journal,  March, 2008  by Tom Schubnell,  Laura Meuer,  Ryan Bengtson

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* central processing staff members, and

* bed placement personnel.

Group members also participated in subteams including

* surgical scheduling and communication;

* preoperative services and patient flow,

* equipment and supply management; and

* finance and accounting.

The groups focused on implementation and assessment of the impact of potential improvements and used a "balanced scorecard" designed to score multiple goal improvements.

Overall, the aims of this project were to

* continue to provide high-quality surgical care while delivering services as efficiently as possible;

* accommodate existing and future service demands;

* enhance financial performance; and

* provide a positive, satisfying experience for patients, staff members, and clinicians.

Beginning in June 2005 the team worked for seven months to do the following:

* redesign and standardize processes for scheduling, including verification of insurance coverage and eligibility and completing pre-anesthesia assessment and family/ patient education before surgery;

* provide physicians' offices with online access to the surgery schedule and block times open for adding surgeries;

* create routine bed meetings between preoperative, PACU, and OR charge nurses and inpatient bed placement personnel to track and adjust patient flow;

* update a subset of the preferred surgical supply and equipment pick lists (ie, 185 of 1000) used most frequently by individual physicians (ie, during 80% of the hospital's surgical procedures);

* improve equipment allocation and create an ongoing maintenance process through automated inventory and usage tracking of existing equipment;

* provide the nursing staff members with processes and tools to identify the correct charges for each patient; and

* implement an OR dashboard tool for continuous performance measurement and efficiency monitoring.

The automated OR dashboard report uses data from Children's Memorial Hospital's existing systems to track performance. Examples of dashboard metrics include

* OR utilization rate,

* percentage of procedures with on-time starts,

* number and percentage of cancelled procedures,

* length of stay in the preoperative and recovery areas, and

* percentage of procedures accurately scheduled.

Front-line managers receive the dashboard report each week and provide an explanation of their areas' performance to the hospital's executives (Tables 1, 2, and 3).

To engage physicians in the initiative, the leaders used existing forums, such as the OR Council. This council guides all OR processes and includes surgeons, anesthesiologists, nurses, executives, and other administrators who oversee perioperative processes. The medical director of perioperative services also serves as a physician champion and liaison to the physicians. The dashboard report is shared monthly at OR Council meetings where results are discussed and possible opportunities for improvements are identified.

RESULTS

As a result of the project, Children's Memorial Hospital has