5 Steps to Successful Change Management in a Hospital OR

While change management poses challenges in any hospital department, implementing change within a hospital's OR suite may be the most difficult as the operating room has an impact on every part of an institution. In order to implement change and do it well, hospital leaders need to gain buy-in from multiple stakeholders, enabling them to coordinate and make the appropriate adjustments across several areas in addition to surgery, such as anesthesiology and nursing.

Leo Penzi, MD, executive vice chair of the department of anesthesia at North Shore University Hospital in Manhasset, N.Y., a member of the board of directors of North American Partners in Anesthesia and assistant professor in the department of anesthesiology at Hofstra North Shore-Long Island Jewish School of Medicine, shares five steps to successfully manage change in a hospital OR.

1. Designate an effective perioperative leader. Transitioning into an unknown territory is never an easy task. Strong, consistent leadership is the key to a sustainable transition to help overcome the fear of change and the inevitable pushback from directly- and indirectly-involved constituencies, according to Dr. Penzi. He says, "The perioperative leader should be an excellent communicator with a deep knowledge of OR management in order to successfully make the necessary changes required in carrying out the hospital's overall goals. As anesthesiologists are present in the OR every single day, it is important that the anesthesia chair takes on this role to promote consistency across the board through this time of change."

2. Create an OR leadership structure and strategize. The perioperative director should involve the OR leadership in the identification and prioritization of key operational strategies that drive the change process. "There are historically individual silos that exist [in an OR]: anesthesia, the surgery department, nursing and administration," Dr. Penzi says. "The key is to create a structure amongst these groups that promotes transparent communication and supports a collaborative work environment. With the active participation of these areas, each department that touches the OR is involved in the decision-making process and enforces taking action as a unified front."

According to Dr. Penzi, North Shore- LIJ Health System highly values communication between its leaders as part of their methods in managing change to remain prepared for present and future occurrences relating to the OR. By holding biweekly meetings with a group of key stakeholders, issues that may affect the OR can be prioritized and discussed and solutions can be formulated across all areas of the OR collaboratively. "Balancing these issues and priorities is a delicate dance," Dr. Penzi says, "which is why it's very important that there is a very solid relationship between those four silos."

3. Be proactive. Once the perioperative director and other OR leaders identify priorities, they must be focused on creating new procedures and processes in order to reach their goals. "[We are] constantly fighting to not react to any individual occurrence, but to think about how to improve the overall function of perioperative services in a proactive manner," Dr. Penzi says. A multidisciplinary leadership group driving process change helps the OR make decisions based on future goals. "If you don't have a strategic operational group like that, what happens is that you respond to particular issues, which results in becoming a reactionary group and causes more harm than good," Dr. Penzi says.

For example, concerning the improvement of patient satisfaction in the NS-LIJ OR, anesthesiologists are beginning to provide their patients with cards that include their name, photograph and contact information. This enables patients to put a name to a face and have their physician's contact information readily available. "The operating room is an unusual environment because you spend a very brief time with the patient [when he or she is conscious], so there is a small window of time to build a trusting relationship with the patient. We have to do everything we can to make that brief interaction a satisfying experience for the patient," Dr. Penzi says. Instead of only reacting to patient satisfaction scores, the perioperative director started this initiative to boost satisfaction among patients and help to further improve the quality of care provided.

4. Communicate with end-users.
The perioperative director and OR leaders should communicate intended changes and policies to end-users before implementation, as their buy-in can significantly affect the success of the change, according to Dr. Penzi. He says it is important to create a clear operational infrastructure that engages all parties. At NS-LIJ, OR leaders explain to the physicians and staff why the leaders believe a change is necessary, the consequences of not making that change and what they think is the best course of action. The leaders then solicit input from physicians and staff on the proposed change to determine perceived challenges and potential flaws in the original proposal.

5. Reevaluate. After soliciting end-users' feedback, it is essential that the perioperative director and OR leaders meet to discuss and consider this gathered feedback. Based on leadership's priorities and goals, any input contributed that will make a positive impact in achieving their objectives should be integrated into the proposal. This demonstrates to the end-users that their feedback is valued and taken seriously in addition to being an integral part in the overall success of the OR.

Learn more about NAPA.

More Articles Featuring NAPA:

NAPA's Dr. John Di Capua Addresses Questions on OR Turnover, Adding Anesthesia Coverage and Other Critical Hospital Efficiency Issues
Assessing the Financial Viability of Anesthesia Coverage for a New Service: Q&A With Dr. John Di Capua of North American Partners in Anesthesia and North Shore-LIJ Health System
How to Determine Quality Indicators to Track: Q&A With Dr. John Di Capua of North American Partners in Anesthesia and North Shore-LIJ Health System

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