The following nine responses address leadership in the operating room, particularly concerning initiatives to improve OR efficiency.
Q: Who should initiate programs to improve OR efficiency — nurses, anesthesiologists, surgeons, administration, a combination?
Mark Antoszyk, Chief CRNA, Carolinas Medical Center NorthEast (Concord, N.C.): Leadership should lead and encourage and give the ability to increase efficiencies to the people who can make it happen. That starts with volunteers in the admission or registrations area. Then all members of the pre-op area, OR personnel, anesthesiologists and surgeons. This is not hard, it only takes a few moments each day to go out and talk with the staff.
Houtan Chaboki, MD, Plastic Surgeon, George Washington Medical Faculty Associates (Washington, D.C.): Everyone. It takes a team to provide safe surgical care.
Steven M. Gottlieb, MD, CEO, TeamHealth Anesthesia: The person with bottom line, administrative responsibility for outcomes is often the best person to initiate action. They have the most to gain (and lose) if results are poor. However, any of these groups can and should initiate a discussion about an OR efficiency improvement strategy if they think changes are in order. And though anesthesiologists are in a unique position to facilitate OR efficiency improvements, the effort will require buy-in from and collaboration among all groups in order to be effective. The anesthesiologists, since they interact in all phases of the OR continuum, should be responsible for recommending and implementing process improvement changes, tracking the program's progress and reporting results to administration.
Sue Kozlowski, Senior Healthcare Consultant, TechSolve: The best improvement teams use the expertise of everyone involved in the process. That includes all levels of staffing — from surgeons to receptionists. In addition, having a patient on the team (or a patient advocate) is a wonderful way to understand their experience. You might be surprised to learn how interested patients can be in the details of providing their surgery! Lastly, having someone from the process improvement or quality departments adds a set of fresh eyes and can really help identify wasteful or out-moded ways of doing things. Administrators usually serve best to set goals, identify the scope of the project and develop an expected timeframe — in other words, acting as process champions or sponsors. An experienced facilitator from outside the department can serve as an objective guide with no loyalties other than to the patient. If surgeons can't attend due to their schedules, you can be creative by inviting a resident to participate; asking a surgeon to act as an ad-hoc member and to give feedback periodically; or utilize some time at physician meetings to review and get feedback on metrics and improvement initiatives.
Joseph Livengood, MD, Acute Care Surgeon, Medical Center of the Rockies (Loveland, Colo.), Biomedical Engineer, President, Livengood Engineering: The nurse manager of the OR is the primary person to initiate and manage the program supported strongly by the clinical educator and service line managers. While physicians, administrators and the nurses are all critical to this process, they are key participants, not leaders in this process. A team needs distinct leaders that are visible and positioned to set the day-to-day expectations and tone.
John Maa, MD, FACS, Assistant Professor, UCSF Department of Surgery: Changes to improve efficiency will require the input of all the stakeholders — surgeons, anesthesiologists, nurses, OR schedulers, central supply and sterilization processing units, administrators, schedulers, residency leaders, medical school leadership, pre-op and PACU staff. Everyone has a role to play.
Adam McLarney, Director; Maggie Longshore, RN, MS, CNOR, CAPA, NE-BC, Senior Consultant, Blue Jay Consulting: Ideally, the OR will create a leadership team consisting of nursing, medicine and administration. This team should meet weekly and is primarily established to set the vision, goals and operational strategy for the department. Other primary responsibilities would include: reviewing quality issues and patient satisfaction, reviewing operational metrics and targets, implementing action plans to improve operations, establishing practice and behavioral expectations and holding staff accountable for customer service principles and improvements.
Catherine Munoz, BSN, RN, CNOR, LNCC, Director of Perioperative Services, St. Vincent Medical Center (Los Angeles): Programs to improve OR efficiency should be initiated by the perioperative leadership team in collaboration with all stakeholders, including the perioperative staff and physicians. It takes a team to sit down and talk about what the issues are, who are the players and what their roles are and the benefits and consequences of making change happen.
Joe Smith, Vice President, Perioperative Care Division, Picis: The initiator or owner of the improvement program should be dependent on the individual issue being addressed, e.g. surgeon behavior, anesthesia processes, preoperative processes or supply/implant ordering issues. However, typically nursing and surgeon management initiate these programs.
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Q: Who should initiate programs to improve OR efficiency — nurses, anesthesiologists, surgeons, administration, a combination?
Mark Antoszyk, Chief CRNA, Carolinas Medical Center NorthEast (Concord, N.C.): Leadership should lead and encourage and give the ability to increase efficiencies to the people who can make it happen. That starts with volunteers in the admission or registrations area. Then all members of the pre-op area, OR personnel, anesthesiologists and surgeons. This is not hard, it only takes a few moments each day to go out and talk with the staff.
Houtan Chaboki, MD, Plastic Surgeon, George Washington Medical Faculty Associates (Washington, D.C.): Everyone. It takes a team to provide safe surgical care.
Steven M. Gottlieb, MD, CEO, TeamHealth Anesthesia: The person with bottom line, administrative responsibility for outcomes is often the best person to initiate action. They have the most to gain (and lose) if results are poor. However, any of these groups can and should initiate a discussion about an OR efficiency improvement strategy if they think changes are in order. And though anesthesiologists are in a unique position to facilitate OR efficiency improvements, the effort will require buy-in from and collaboration among all groups in order to be effective. The anesthesiologists, since they interact in all phases of the OR continuum, should be responsible for recommending and implementing process improvement changes, tracking the program's progress and reporting results to administration.
Sue Kozlowski, Senior Healthcare Consultant, TechSolve: The best improvement teams use the expertise of everyone involved in the process. That includes all levels of staffing — from surgeons to receptionists. In addition, having a patient on the team (or a patient advocate) is a wonderful way to understand their experience. You might be surprised to learn how interested patients can be in the details of providing their surgery! Lastly, having someone from the process improvement or quality departments adds a set of fresh eyes and can really help identify wasteful or out-moded ways of doing things. Administrators usually serve best to set goals, identify the scope of the project and develop an expected timeframe — in other words, acting as process champions or sponsors. An experienced facilitator from outside the department can serve as an objective guide with no loyalties other than to the patient. If surgeons can't attend due to their schedules, you can be creative by inviting a resident to participate; asking a surgeon to act as an ad-hoc member and to give feedback periodically; or utilize some time at physician meetings to review and get feedback on metrics and improvement initiatives.
Joseph Livengood, MD, Acute Care Surgeon, Medical Center of the Rockies (Loveland, Colo.), Biomedical Engineer, President, Livengood Engineering: The nurse manager of the OR is the primary person to initiate and manage the program supported strongly by the clinical educator and service line managers. While physicians, administrators and the nurses are all critical to this process, they are key participants, not leaders in this process. A team needs distinct leaders that are visible and positioned to set the day-to-day expectations and tone.
John Maa, MD, FACS, Assistant Professor, UCSF Department of Surgery: Changes to improve efficiency will require the input of all the stakeholders — surgeons, anesthesiologists, nurses, OR schedulers, central supply and sterilization processing units, administrators, schedulers, residency leaders, medical school leadership, pre-op and PACU staff. Everyone has a role to play.
Adam McLarney, Director; Maggie Longshore, RN, MS, CNOR, CAPA, NE-BC, Senior Consultant, Blue Jay Consulting: Ideally, the OR will create a leadership team consisting of nursing, medicine and administration. This team should meet weekly and is primarily established to set the vision, goals and operational strategy for the department. Other primary responsibilities would include: reviewing quality issues and patient satisfaction, reviewing operational metrics and targets, implementing action plans to improve operations, establishing practice and behavioral expectations and holding staff accountable for customer service principles and improvements.
Catherine Munoz, BSN, RN, CNOR, LNCC, Director of Perioperative Services, St. Vincent Medical Center (Los Angeles): Programs to improve OR efficiency should be initiated by the perioperative leadership team in collaboration with all stakeholders, including the perioperative staff and physicians. It takes a team to sit down and talk about what the issues are, who are the players and what their roles are and the benefits and consequences of making change happen.
Joe Smith, Vice President, Perioperative Care Division, Picis: The initiator or owner of the improvement program should be dependent on the individual issue being addressed, e.g. surgeon behavior, anesthesia processes, preoperative processes or supply/implant ordering issues. However, typically nursing and surgeon management initiate these programs.
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