No Problem is an Island: Improving OR Efficiency Through Systems Thinking

The operating room, like every department in a hospital, is only one part of a greater whole. Thus, when solving a problem in the OR, people must consider how other departments and areas of the hospital are involved. In this way, even a seemingly simple problem, like an OR payroll over its allocation, requires a more complex thinking process, in which interactions between subsystems and upstream and downstream effects are the focus. This thought process is called systems thinking, according to J. Deane Waldman, MD, MBA, professor of pediatrics, pathology and decision science at the University of New Mexico in Albuquerque. He explains how systems thinking can help ORs more effectively improve efficiency.

Dr. Waldman gave the example of an OR with too many nurses that is trying to balance its budget in a research paper he wrote for Systems Research and Behavioral Science (2007). In a more linear style of thinking, people may try to solve the problem by simply reducing the number of OR nurses. However, Dr. Waldman showed that this "solution" can cause unintended consequences, such as decreased throughput, which may then cause employees to seek work elsewhere and physicians to refer patients to other facilities. If staff leave and physicians stop referring patients there, the OR may face increased costs to train new staff and reduced revenue from fewer patients. Because of the interconnectedness of the OR budget with other systems — referral patterns, employee satisfaction and patient outcomes — what seemed like a reasonable solution actually exacerbated the problem. "Bad outcomes happen when a solution for a problem in one part of a system does not include the other parts of the system with which it interacts," Dr. Waldman says.

Instead, he suggests OR leaders consider each part of their system in relation to all other parts of their system to gauge possible long-term effects of a change in process. "If you make all of the subsystems interact with each other, then suddenly you have good outcomes instead of bad outcomes," he says. A systems thinking approach to the problem of an unbalanced budget and excess OR nurses would begin by determining the optimum number of nurses for the OR's surgery volume. "It's not a question of budget, but of how many operations do we do, who is waiting for operating rooms, how many rooms do we need?" Dr. Waldman says. Staffing the OR to eliminate delays would increase throughput, which could increase referrals and staff retention, and thus revenue. "The operating room does not work in isolation," Dr. Waldman says. "You need to look at the entire 'process' or system we call hospital care."

Related Articles on OR Efficiency:

5 Top Challenges in the Hospital OR — And How to Overcome Them
What is the Ideal Hospital OR-Administration Relationship? 3 Answers

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