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

Operating rooms present hospital leaders myriad challenges, from maintaining infection control standards to staying on schedule to communicating as a team. Lucas Higman, BABA, MBA, vice president of Soyring Consulting, shares the five biggest challenges of an OR and how hospital leaders can overcome them.

1. Block scheduling. "Block scheduling is hands down the biggest challenge the OR has," Mr. Higman says. Managing block time is challenging because it is very complex: The scheduler has to coordinate the type of case with each surgeon's average time for the procedure and availability while allowing time for add-on cases. Mr. Higman says one of the key strategies to block scheduling is gaining support from hospital administration, as aligning hospital executives' goals with OR leaders' goals is critical when facing physicians who are unsatisfied with their block scheduling arrangement. "Inevitably the physicians who [lose block time due to underutilization] may go straight to the top to voice their opinions," he says. Hospital administrators and OR managers need to take a united approach to increasing OR block utilization so surgeons do not receive conflicting messages.

Another strategy for addressing block scheduling is to allow surgeons to release block time if they are unable to use it. Instead of blocking 100 percent of the day, permitting release time can accommodate add-on cases and potentially increase the number of cases an OR can perform in the same amount of time, Mr. Higman says. Hospitals can also increase OR block utilization by tracking and analyzing data. Sharing data with surgeons can make them aware of time they are not using and its effects in both cost to the hospital and cost to the surgeon due to fewer cases performed. After sharing the data, Mr. Higman suggests giving surgeons an opportunity to increase their utilization before changing the block schedule.

2. Physician preference. Physician preference is a challenge in the OR because it can drive high costs and require more complex supply chain management. To standardize materials, OR leaders will need to garner administration support, gain buy-in from the major vendors and identify physician champions. "Vendors are willing to work with you to give you a better price because they may be able to increase their volume of sales," Mr. Higman says. "The key is maintaining compliance with the [vendor's] contract and having mechanisms in place within the material management system to maintain obligations."

A physician champion is helpful in influencing fellow physicians to agree to use one or a few products for each materials type instead of using multiple different products depending on personal preference. Mr. Higman says standardization does not necessarily mean the hospital has to choose one vendor or one product. There are many options available, but decreasing the number to two, for example, can still go a long way in lowering costs and improving supply chain efficiency, he says.

3. Turnover. Efficient turnover — the time between patient-out and patient-in — is critical for keeping the OR on schedule and avoiding costly delays. Completing turnover in a timely manner can be challenging if there is a lack of personnel, poor communication or unorganized workflows. Mr. Higman says taking a team approach to turnover can help OR managers overcome these challenges. He suggests anesthesia providers and surgeons join the nursing, tech, support and housekeeping staff in cleaning the OR because it can speed the process and improve morale. "[Having] the highest person on the totem pole within that room leading the charge [can make] everyone motivated to move quickly and get the next patient in."

To work as a team, all members must be willing to do whatever is necessary to complete turnover efficiently and keep the OR on schedule. "No one can say I'm above doing that particular task," Mr. Higman says. In addition, the team must communicate with each other to coordinate duties and prevent missing or duplicating processes. While some surgeons may oppose this plan or be unable to help all the time, any case in which a physician does pitch in can have a significant and positive impact on other staff and their performance, according to Mr. Higman.

4. Organizational structure. One of the challenges in developing an organizational structure, such as various dedicated service lines, in the OR is ensuring each service line has a sufficient number of staff and management to efficiently perform the services. The optimal organizational structure will vary depending on the particular hospital. Thus, one of the first steps in developing a strong structure is identifying the organization's needs, resources and size. For example, smaller hospitals cannot divide their staff into as many service lines as a larger hospital because they would be spread too thin.

ORs can determine the number of service lines to create by assessing whether the volume for each service is sufficient to warrant a separate service line and if there are enough staff with the necessary skills who are willing to perform these services, Mr. Higman says. For instance, while nursing staff may be capable of doing urological cases, they may not want to be assigned to only these cases while they are employed at the hospital. Furthermore, creating too many service lines may limit the OR's ability to offer certain services all the time because the staff and physicians who are skilled in a particular procedure may be on-call or otherwise unavailable when needed. Training all staff in high-volume procedures can prevent this issue. "Identify your most common emergent cases and make sure everyone within the organization is confident to do those," Mr. Higman says.

The structure of OR leadership may also depend on size. For example, a large organization's OR may have an OR coordinator who reports to an OR manager who then reports to a director. A small OR, however, may not need the director position, Mr. Higman says. In addition, structuring management in too many layers can impede communication, he says.

5. First case starts. First case starts are challenging because they require the patient, anesthesiologists, surgeons, staff and other personnel to coordinate preparation for surgery by a certain time. A slight change in the first case start can lead to significant delays by the end of the day. Mr. Higman says the OR should define what a first-case start is; he suggests using the time the patient is in the room as the start. To ensure the first case starts on time, the OR needs to have all preoperative testing and preparation completed before the day of the surgery. OR staff need to communicate with each patient — by phone for general cases and in person for more complex cases — before their surgery to complete the necessary paperwork and screening needed for the surgical case.

OR staff can prevent late patient arrivals from delaying first case starts by following up with patients to remind them of their appointment. The OR can also improve first case starts by ensuring complete preoperative preparation, which may include the anesthesiologist performing a block, Mr. Higman says. "There are things that are outside the facility's control, but the patient process and preoperative preparation are two factors that a facility can control and improve."

Learn more about Soyring Consulting.

Related Articles on OR Efficiency:

What is the Ideal Hospital OR-Administration Relationship? 3 Answers
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
Gaining Buy-in of Hospital Leaders for OR Initiatives: 3 Responses

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