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June 27, 2018
How Business Principles Can Improve Operating Room Efficiency

If the transition to value-based care is making it harder for providers and facilities to turn a profit, there may never be a better time to understand and apply the methods that help successful businesses identify and eliminate waste and inefficiency.

The challenges in health care are everywhere — from finding and improving inefficient workflows, to properly allocating precious minutes and hours in the operating room, to mining data so that physicians can treat patients more effectively before their conditions progress and consume greater resources.

Eliminating bottlenecks

More than a decade ago, researchers at the School of Engineering and Applied Sciences at the University of Buffalo determined that “many healthcare bottlenecks” could be eliminated by applying the principles used for factory production lines. The results, said researchers, would be “major improvements in efficiency, cost savings and patient care.”
The idea was to look at patients in a hospital setting the way engineers look at cars on highways and manufactured parts in a factory. What they all have in common, they figured, is that they all move. The challenge was to move patients more efficiently without dehumanizing patient care.

Animated simulations based on statistical analyses led to workable solutions for everyday problems. For example, they found that the elevators in a particular hospital were a bottleneck. The easy solution: dedicate one elevator for patient use only.

Lean approach

A decade later, the challenge at another hospital was to reduce OR turnaround times from an average of 30.55 minutes to 25 minutes. How? By using the lean quality improvement method pioneered by Toyota. That meant assigning a group of staff members to spend a full week watching their colleagues between surgeries to identify inefficiencies and suggest ways to streamline the process.

That may sound like a big commitment of man hours for what might be an elusive goal, but this is how Martin Judd, CEO of Saints Mary and Elizabeth Medical Center, in Chicago, describes his first experience with lean: “I drove the team crazy. I did not want to be there.” Then he saw the improvements the team was able to make: “I was floored by what they came up with,” he says. “It really demonstrated to me the power of giving the teams the gift of time to make the work better.”

Sandra Bruce, the former CEO of Presence Health, which owns Saints Mary and Elizabeth Medical Center, launched the turnaround-time initiative after seeing the extraordinary success of efforts to improve various perioperative services, including inpatient preparedness for surgery and making sure checklists were completed before patients reached the holding area.

“Frontline staffers know how to solve problems, but too often are never asked,” she says. “Engagement level and morale is higher when we bring them into the performance improvement work, let them describe the problems, seek out the data and come up with solutions.”

Multiple improvements

That’s what researchers did for a 2016 study published in the Journal of Health Management. By using lean principles at a hospital in Portugal, they improved supply management and storage, eliminated excess equipment and obsolete surgical material, improved the organization of operating rooms and equipment management, and reduced operating times.

“What lean production can do,” they conclude, is “promote teamwork and leadership, empower people, and teach hospital staff to focus on the most important aspect: client satisfaction.”

Essential need

Matthew Mazurek, MD, the medical director of Envision Physician Services, a multi-specialty physician group, argues that “applying business principles to operating room management is essential for hospitals and hospital systems to increase efficiency and provide a greater level of service.”

For example, he says, hospitals should always schedule their most complex cases as the first cases of the day, and thereby reduce the likelihood that turnover time will increase as the day goes on.

Furthermore, he says, facilities should be analyzing data in ways that can improve efficiency. For instance, by measuring surgical cut to surgical end times for each surgeon, as well as surgical end time to out-of-room time, they can more efficiently schedule procedures and match specific surgeons and anesthesiologists. Since slower surgeons and anesthesiologists may not be able to change, faster physicians can be paired with each other, and so can slower tandems.

“We have the capability to analyze and understand many more metrics in new ways to create a more efficient operating room,” he adds.

Optimizing revenue

Revenue cycle management is another area that’s ripe for improved efficiencies. Too often, the clinical side and the back office are siloed, and communication invariably suffers as a result, leading to reporting errors, downcoding and other reimbursement issues and delays.

LiveCode from QueueLogix links medical coders and certified scribes in a clinical, real-time environment, allowing point-of-service coding and same-day bill drop. It dramatically reduces suspended charts caused by missing documentation or unclear notes, discharged not final billed (DNFB) cases, non-compliance and days sales outstanding (DSO).

LiveCode also provides real-time access to analytics, dashboards and integrated feedback that can be customized for groups and individuals based on client preferences. It’s one more tool to improve efficiency at a time when it’s never been more important.

Care Navigators
As healthcare business models evolve, so should care teams.

Patients who are paired with Care Navigators report feeling less anxiety, and an increased ability to self-manage their conditions between visits. And providers report increased job satisfaction from improved efficiency, and knowing their patients have access to care teams, and strategic support.

Chronic Care Management
With an increased aging population managing two or more chronic illnesses, extending your care teams’ ability to communicate with patients is critical. We take a strategic approach to helping patients chart a path towards their health goals, while self-managing their chronic conditions between clinical visits.

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We deliver a robust AI Chatbot solution to help manage and sustain effective communication with patients. Care teams implement the conversational text messages and customize patient communication to deliver high quality care.

Nurse Care Team Assistants
Adding a qualified Nurse CTA to the care team increases quality of work-life and reduces stress on nurses. The nursing profession is also experiencing an alarming shortage due to increased clerical burdens and burnout.

Revenue Cycle Management
Transition Revenue Cycle Management into the modern age with a suite of software tools that will transform your billing and coding processes. Transact at lightning speed, with increased transparency and decreased siloes. The QueueLogix software application seamlessly integrates with existing EMRs to ensure the clinical activities and back-office operations are well aligned, monitored and successful.

Referral Management
Referrals scheduled by navigators in the clinical setting builds long term, patient care integrity across the care continuum. With the authority, along with the provider to search for specialists in network, navigators assess their schedules, and ensure appointment compliance.

Scribe Services
There’s a reason why we’re the nation’s most frequently used scribe company: we offer professionally trained medical scribes to meet the specific needs of our clients. We offer a variety of scribe programs, as well as technology and personnel solutions that address revenue cycle management, the transition to value-based care, and more through our HealthChannels family of companies.