3 Operating Room Concerns to Focus on in the New Year

With the introduction of the da Vinci robot, the rise of hybrid operating rooms and increased pressure to reduce surgical complications, the operating room is as dynamic and challenging as ever. The shift in healthcare from fee-for-service to pay-for-performance, potential penalties for low patient satisfaction, and incentives to improve quality also present opportunities for hospitals' OR departments. John Maa, MD, assistant professor in the department of surgery at the University of California, San Francisco, shares three topics he thinks hospital ORs should focus on in the coming year.

1. Financial and patient care goals. "A key for the future is for operating room leaders to balance the financial imperatives of the institution with the needs of the patient population," Dr. Maa says. He suggests hospitals consider including a patient representative on OR leadership committees to ensure patients' voices are at the forefront when leaders make decisions. "The patient's perspective should be paramount," he says. Inviting a patient or patient's advocate to select meetings, for example, can give OR leaders an opportunity to learn about areas of success and areas for improvement as seen by the patient. "Including a patient on OR committees will raise significant legal and confidentiality concerns, but I think understanding the factors that impact satisfaction and experience through the eyes of the patient would be invaluable," Dr. Maa says.

2. Standardization. Dr. Maa suggests ORs standardize procedures and equipment to improve efficiency, reduce costs and improve patient safety. "Eliminate unnecessary variability and personal preferences that make it challenging for the OR to stock all the supplies and equipment that different surgeons may request," he says. "Standardizing preference cards to reduce the number of disposable items and equipment the OR must purchase, maintain and test is an important step for the future."

Dr. Maa highlighted a program at the Beth Israel Deaconess Medical Center in Boston that collected data to educate individual spine surgeons about unnecessary equipment and devices that were wasted intraoperatively. Providing the surgeons with this information resulted in significant cost savings, according to Dr. Maa. At UCSF, a multidisciplinary technology assessment committee evaluates new technology to determine which new devices and tools the OR should acquire, and which ones require further research or discussion with vendors before purchase, according to Dr. Maa.

3. Influence of "top performers." Dr. Maa says one of the greatest challenges for OR leaders is to be fair to key stakeholders in the department, including patients and surgeons. "Traditionally, the emphasis has been on pleasing those surgeons who generate the greatest revenue, thus allowing the business side of the equation to dominate," he says. He recommends ORs make a greater effort to achieve a balance with the acuity of patient needs and allocate resources to optimize patient safety and quality. "What leadership of the OR should not allow to happen is to have the most powerful surgeons (the ones who raise the most revenue) to dominate OR [block scheduling] requests and time if that conflicts with patient safety and timeliness of care," Dr. Maa says. "Those people who generate greater revenue do bring greater acclaim and publicity to a hospital, and they do deserve to be recognized. The task is to make certain that they're not overly dominating the OR block time scheduling resources."

Dr. Maa cites the additional need to measure surgeons' value to the OR beyond financial performance, such as by tracking patient outcomes. "What needs to be developed are metrics that not only value the revenue that a surgeon generates, but also the societal value and patient benefit that [his or her] procedures result in," Dr. Maa says. "Then the OR leadership can use both the surgeon's revenue generation and the patient/societal value and allocate [block] time equitably."

Related Articles on OR Efficiency:

5 Top Strategies to Improve Communication in Hospital Operating Room Handoffs
Structuring OR Management for Success: Q&A With Long Beach Medical Center Perioperative Services VP Dana Crompton

5 Top Challenges in the Hospital OR — And How to Overcome Them

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