5 Common Mistakes Affecting Hospital ORs

The operating rooms represent the heart of a hospital's surgical services and can dictate financial viability, as it makes up approximately 60-70 percent of any one hospital's margin. Because of this, hospital leaders must pay careful attention and exercise due diligence in maintaining an efficient OR with great clinical outcomes as well as patient, physician and staff satisfaction. Here, Djamel Bayliche, vice president of operations at Accelero Health Partners, a healthcare services company, shares five common mistakes hospitals make that negatively affect their ORs.

1. Failure to truly engage OR physicians. One mistake hospitals often make is failing to engage physicians in owning the OR. Hospitals should not foster a culture where OR physicians are excluded from the decision-making processes that affect their practice. Rather, hospitals should engage those physicians as partners and work with them to implement holistic and positive change, Mr. Bayliche says.

"Many times, solely the hospital management is running the OR, and at best, the management often sees the OR physicians, whether they are surgeons or anesthesiologists, as clients and not partners," he says. "The problem with that is you end up not having physicians on-board with every decision, so proposed changes never get very far."

The key to engaging physicians using the OR is to empower them with a sense of ownership. By involving them in the decision-making processes that affect OR operations, physicians are much more likely to actively take part in making significant improvements. "Looking at metrics, such as turnover time, block management and other process improvement metrics, is very important, but hospitals often don't realize there is an important human factor in making change," Mr. Bayliche says.

2. Failure to maintain open communication.
Communication is essential for many reasons, yet some hospitals struggle to prioritize or maintain open communication with OR physicians. Fostering an environment of open communication is critical to developing a culture of trust among hospital management and physicians, and any questions or concerns from physicians should be dealt with swiftly and tactfully. Mr. Bayliche often sees communication breakdowns and lack of transparency in many hospitals and health systems, which can lead to mistrust and lack of confidence in leadership.

"In some cases, there may be a physician or nurse that is still upset about something that happened five or 10 years ago with the hospital management, and for some reason that situation was never resolved," he says. "It's important for hospital management to level with physicians, acknowledge their mistakes if they made any and reassure physicians that they are willing to work with them as partner."

Beyond communication between the ORs and hospital management, hospitals must also make sure ORs are maintaining a high level of communication with other departments, such as nursing units, surgeons' offices, anesthesia departments and so on. "Hospitals need to understand that, with surgery, there is a full continuum of care. It starts from the moment a decision is made to do perform surgery all the way until that patient is discharged," Mr. Bayliche says. "Many hospital surgical services are fragmented and run as silos."

3. Failure to exercise positive reinforcement. Expectations and accountability are key components to a hospital OR's efficiency. However, Mr. Bayliche says oftentimes hospitals practice too much negative reinforcement and not enough positive reinforcement. While some hospitals may find it effective to implement consequences for bad behavior, it is must more constructive to start out with positive reinforcement after a new policy or procedure in the OR is set in place. After some time has passed and the new OR policies and procedures are more well-known, the hospital can go forward with punitive action.

"We recommend hospitals to highlight the positive things physicians and staff members do well. That way, others can see what kinds of behaviors are being accepted and they know they have to get to that level," Mr. Bayliche says. "After you spend time focusing on the positive, hospitals can implement consequences for those who don't perform according to policy."

For example, if a hospital is working to reduce case delays in the OR and implements changes to rectify that deficiency, the hospital should identify which physicians and staff members have changed their behaviors to eliminate case delays and share those behavioral changes as best practices to the rest of the staff. "After you build a policy with surgeons and other stakeholders and make clear what is a good process, you implement consequences for physicians and staff who are consistently late or don't follow the new policy in some other way," Mr. Bayliche says.

4. Failure to accurately predict case length. Hospitals often fail to carefully predict how long an OR case could take, which directly affects scheduling and the flow of cases on the day of surgery. Mr. Bayliche says hospitals often defer to surgeons to determine how long a certain procedure will take, but those physicians' predictions aren't always on spot.

"It's not a perfect science, but if a particular surgeon does a high number of a certain procedure, such as knee replacements, recent historical data by surgeon should be used to determine on average how much time these cases require," Mr. Bayliche says. "A hospital OR starts the day with a neat and compact schedule, but it usually ends up looking like Swiss cheese."

In order to help hospitals visualize how their schedules end up with holes, Mr. Bayliche uses a tool to compare a hospital scheduled OR cases for a typical day to how those cases actually happen. This exercise almost always leads to surprised and shocked hospital administrations and physicians, he says. To combat scheduling inaccuracies, hospitals will also need to engage OR physicians, scheduling staff and other key departments to smooth case transitions throughout the day.

"Some hospitals only have enough equipment to do four or five knee replacements, yet they do not work with the surgeons and other players to smooth the schedule to be coordinated with equipment they need," Mr. Bayliche says.

5. Failure to perform tasks in parallel. OR turnover is a parameter that is often followed and measured closely across many healthcare organizations. Maintaining high OR turnover is important, but many hospitals make the mistake of performing tasks sequentially, rather than in parallel. Mr. Bayliche says hospitals should re-organize and re-delegate tasks across staff members to help achieve optimal OR turnover times.

"Most hospitals ORs perform tasks sequentially, where they don't start the next task until they have finished the previous task. What they don’t realize is that some tasks can be performed concurrently," Mr. Bayliche says. "In that same vein, hospitals sometimes don't leverage all available resources to expedite turnover times."

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