OR Manager November/December 2021 - 30

Leadership
Continued from page 29
take this step back in house and
assign it to staff in scheduling, registration,
or pre-surgical testing who
have access to an up-to-date OR
schedule.
* Choreograph nursing check-in.
Start with " arrive at bedside " times
for both OR and preoperative nurses
and work backwards. Like the example
above, perform a simple time
study tracing the actual path from
punch-in to scrub-in to bedside.
* Build in extra time for patient
arrival. This is probably intuitive, but
ORs that want patients to register at
6 a.m. should ask them to arrive at
the hospital at 5:45 a.m.
* Promote online registration.
An online registration system can
shave several minutes off the patient
check-in process. ORs that do
not use online registration should
work to set up a system. If online
registration exists but utilization is
low, emphasize this option in patient
communications.
* Enlist overnight staff. Night shift
nurses can use downtime between
cases to help prepare the department
for a smooth morning start,
which will help avoid delays due to
room and equipment issues. When
workload allows, overnight staff can
do tasks such as validating preference
cards, picking supplies, and
getting started on setup for morning
cases.
* Plan for " non-failure. " Many OR
management teams hold a daily
meeting to plan the next-day schedule.
Make sure this daily huddle
includes a process for identifying
special patient needs and assessing
their impact on patient flow. For example,
patients coming to the hospital
from a skilled nursing facility
could easily run into transportation
issues. Avoid scheduling these patients
as the first case of the day.
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OR Manager | Nov/Dec 2021
Plan for a successful start by reserving
the first slot for uncomplicated
procedures and patients.
Reach out to physicians
There are a lot of moving parts to an
FCOTS initiative, but project teams can
usually get all the processes lined up
and working well within a few months.
When the department is consistently
achieving its " patient in OR " target, the
next step is to get physicians involved.
Based on best practice in well-run
ORs, the tipping point is an FCOTS rate
between 70% and 80%. At this level of
performance, the nursing organization
has solved its side of the efficiency
problem. OR leaders can then reach
out to surgeons and anesthesia providers
to request compliance with arrival
times.
In our experience, once surgeons
see that their first-case patients are
reliably in preoperative holding at the
agreed-upon time, they will gladly adjust
their arrival times to match department
standards. After all, surgeons as well
as anesthesia providers also want to
make the most of their OR time.
Some organizations impose fines on
late surgeons. This can be effective in
some cases, but it tends to perpetuate
an adversarial environment in the OR.
Instead, we recommend a collaborative
approach based on data transparency.
Share individual FCOTS performance
data with surgeons who are not meeting
expectations. If data is validated by
a collaborative governance committee
(more on that below), OR leaders can
also post de-identified provider timeliness
data in the surgeon lounge.
Leverage success
The efficiency gain of a successful
FCOTS project is real but relatively
modest. The greatest value of starting
with this initiative is that it creates a
template for organizational change. OR
leaders are then able to apply the same
approach to bigger opportunities.
For example, an OR that has just
led a successful FCOTS project could
follow up with an initiative to decrease
turnover time (TOT) between cases.
The approach is the same: establish
metrics and a performance target,
convene relevant stakeholders, and
choreograph activities by finetuning
processes and policies.
The main challenge of a TOT initiative
is that it requires the adoption of
parallel workflows. This can be difficult
for OR professionals who may have
historically thought in terms of sequential
processes.
One solution to this challenge is to
start small. Do not begin by trying to fix
turnover across the entire department.
Launch a TOT initiative with a single
specialty or even a single surgeon.
In addition, work with individuals who
are personally interested in this issue
and are willing to work with OR leadership
to improve their TOT. These individuals
are not necessarily the OR's
loudest critics or its biggest revenue
generators. The ideal partner is a clinically
respected surgeon who is highly
visible to his or her colleagues. More
bluntly, their opinion should matter to
other surgeons.
Decreasing TOT for one surgeon can
be a powerful starting point. From there,
OR leaders can extend TOT learnings to
other surgeons and divisions, creating
the potential for substantial gains in
department revenue.
As the entire organization gains experience
with collaborative improvement,
OR leaders can progressively
tackle more challenging opportunities
such as block utilization performance,
preference card cleanup, specialty nursing
team alignment, and sterile processing
workflow optimization.
Two prerequisites
Regardless of what issue OR leaders
are focusing on, two elements need to
be in place to ensure the success of an
improvement initiative.
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OR Manager November/December 2021

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