March 15, 2019

Editorial

By: Elizabeth Wood
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Attendees at the annual OR Manager Conference have enjoyed the opportunity to ask experienced OR leaders questions about difficult managerial and clinical issues. The popularity of these “Ask Me Anything” sessions reflects the hunger for knowledge about how things are handled in ORs around the country, and they will be offered again in 2020.

But attending a conference isn’t the only way to learn from others’ experiences. OR Manager’s “Success Stories,” written by OR nurses, researchers, and other healthcare leaders, discuss ways to save time and money, and how to improve culture and safety.

In the past few years, we have published about two dozen Success Stories, providing a forum for peer-to-peer solutions to everyday problems in the OR. In this issue, “Protective Garments Get Makeover in New Cleaning Protocol” (p 20) tells how the discovery of contaminants on lead wearables led to the use of a cleaning service and dramatically reduced bioburden and the risk of infection.

In an upcoming issue, we’ll connect the dots between implementation of new technology and improvements in first case on-time starts, turnover time, and staff and surgeon satisfaction with a Success Story from a Florida healthcare facility.

Meanwhile, this seems like a good time to revisit some Success Stories that present process changes we believe could be adapted in a variety of healthcare settings.

We encourage you to think about these and consider whether you’d like to share an experience from your facility with your fellow OR Manager colleagues.

 

Patient safety

Virtually every issue of OR Manager addresses patient safety concerns. Success Stories from two different facilities reflect particularly impressive results:

• “Combine and Conquer: OR/CSPD Collaboration Dramatically Reduces IUSS Rates” (January 2016, 25-27; https://www.ormanager.com/search?s=OR%2FCSPD+collaboration) describes the journey undertaken at Banner Boswell Medical Center in Sun City, Arizona, to reduce immediate use steam sterilization from a high of more than 30% in 2012 to below 1% when the article was published. Leaders discuss how they analyzed faulty workflow, developed new processes, and improved working relationships to sustain their results.

• “Checklist Compliance Soars to 100% After Red Rule Implementation” (April 2017, 18-21, 25; https://www.ormanager.com/checklist-compliance-soars-100-red-rule-implementation/) illustrates how implementation of a fairly simple rule was the solution to poor compliance at Signature Healthcare Brockton Hospital, a teaching facility near Boston, in 2015. Their “red rule” stipulated that, for non-emergent cases, a patient could not be moved from the stretcher to the operating table if the surgeon was not present. The red rule gave them leverage for implementing a preoperative checklist, and the team also insisted on having a postprocedure debrief before any team member left the OR. Within a matter of months, checklist compliance rose from 44% to 100%, the authors say.

 

Cost savings

Data transparency—in particular, making surgeons aware of costs—can help reduce expenses. Business leaders at the University of California at San Diego came up with a “surgical receipt” a few years ago to do just that. The ability to provide actual product costs and usage/wastage data not only raised awareness of product use, it also improved communication and led to the creation of internal cost benchmarks (“Surgical Receipt Raises Quality Standards, Lowers Costs,” January 2017, 21-24; https://www.ormanager.com/surgical-receipt-raises-quality-standards-lowers-costs/).

“The biggest benefit resulting from this project is the increased communication between the surgeons, nurses, and administration,” the authors say. “Surgeons are giving clinical teams feedback on what to open and when.”

Perioperative services leaders at Bassett Healthcare in Cooperstown, New York, likewise improved communication with surgeons when they overhauled preference cards (“Preference Card Cleanup Projected to Cut Costs Across Departments,” June 2017, 20-21, 28; https://www.ormanager.com/preference-card-cleanup-projected-cut-costs-across-departments/). A clinical nurse specialist in informatics did an in-depth analysis of preference cards and unused instruments. Potential cost savings from changes in reusable and disposable instruments and sutures were then calculated, and the data were shared with surgeons. The overall average savings per surgeon for 1 year was projected to be just over $6,000.

 

Scheduling

OR Manager has received more contributed articles on scheduling than any other aspect of OR management.

One intriguing article comes from physicians at Stanford University School of Medicine in Stanford, California, who developed an algorithm to analyze scheduling delays and find solutions (“START Makes a Good Case for Greater Scheduling Accuracy,” June 2017, 15-19; https://www.ormanager.com/start-makes-good-case-greater-scheduling-accuracy/). START stands for Scheduled procedure analysis, Time stamp assessment, Actual procedure analysis, Review of algorithm, and Timely feedback and continuous improvement.

With the variety of procedures and large number of surgeons on staff at most hospitals, historical data aren’t necessarily the best predictors of case duration, the authors say. Instead, they advocate recognizing when the actual procedure performed differs from the scheduled procedure, and updating the descriptor of the surgery so that data will be accurate for future scheduling.

Staff scheduling is another major challenge in many ORs, and transitioning from a manual to an electronic system can be overwhelming. OR leaders from Geisinger Health System in Danville, Pennsylvania, share their journey in “Electronic Scheduling System Radically Improves OR Workflow” (August 2017, 25-27; https://www.ormanager.com/electronic-scheduling-system-radically-improves-or-workflow/). They describe the advantages of the new system and the hurdles they overcame to get staff on board with the changes.

“This project was internally driven and executed by Geisinger employees with relatively small capital expense,” they say. “Adopting an electronic staff assignment system not only has revolutionized the daily workflow at [Geisinger] but also continues to bridge communication gaps and enhance patient care across all groups of staff and geographic locations in our surgical suite.”

 

Culture

Several Success Stories from 2018 focus on improving culture and morale in the OR—notably, the three-part series, “Pledge Makes Positive Culture a Priority in the OR” (March 2018, 19-21, 27; https://www.ormanager.com/pledge-makes-positive-culture-priority-part-1/; April 2018, 19-22; https://www.ormanager.com/pledge-makes-positive-culture-priority-part-2/; May 2018, 25-27; https://www.ormanager.com/pledge-makes-positive-culture-priority-part-3/). These articles describe a remarkable transformation at Midland Memorial Hospital in Midland, Texas, that turned a negative workplace into a positive one and built a culture of ownership.

Employees made pledges to eliminate toxic emotional negativity from the workplace and take responsibility for their lives, and they participated in a 2-day course that taught them “The Twelve Core Action Values.” The authors say that completing that course had the biggest impact on the success of their culture of ownership initiative.

 

What’s your story?

OR Manager welcomes contributed articles because we know readers appreciate information on how their colleagues are managing the daily challenges of the OR, regardless of level of experience or facility size. To submit an article, visit https://www.ormanager.com/contribute-to-or-manager/. ✥

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