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.
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.
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.”
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.”
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.
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.