Eliminating inefficiencies that reduce patient and staff satisfaction and hurt the bottom line remains a big challenge for hospitals. But one Chicago-based health system says streamlined operating room processes it put in place in one of its hospitals in September are paying off.
In September, Modern Healthcare published a special report based on observing a weeklong “rapid improvement event” at Presence Health's Sts. Mary and Elizabeth Medical Center to reduce room turnover times in its busy surgical suite. The report focused on Presence Health's use of the Lean performance improvement method throughout its 11 hospitals.
Since that rapid improvement event in August, Presence Health leaders have tracked the outcomes. They say turnover times have dropped substantially and have been sustained. While it previously took an average of more than 30 minutes to turn over a room between surgeries, it now takes less than 25.
Presence Health leaders estimated that reducing OR turnover times between procedures by 6.5 minutes had the potential to increase revenue by $600,000 over the course of a year.
Experts say the operating room, as one of the highest-cost and potentially most profitable departments of a hospital, is a prime target for waste reduction initiatives, because the care-delivery process can be chaotic.
For example, a study released last month found that in one hospital the doors to the surgical suite opened every 2.5 minutes and stayed ajar for nearly 10 minutes on average. That compromised infection control in the OR, likely due to inefficient practices, the researchers said.
Similarly, Presence Health noticed in 2014 that nurses on average would leave the OR nearly five times per surgical case. “We calculated the number of steps they took per year, and estimated they were walking over 400 miles annually just to retrieve supplies,” said Ronald Guidizi, a former nurse who now works as one of 35 so-called breakthrough improvement facilitators at Presence Health hospitals. While that may be good for losing weight, it's not good for the system's bottom line.
The system introduced the Lean initiative in 2012 and has been using it to redesign clinical and business processes at its hospitals. The nine-step Lean problem-solving process includes analyzing workflows, identifying process gaps and pulling frontline staffers temporarily from their daily jobs to devise strategies for change. Changes designed by a multidisciplinary team of staffers during the weeklong rapid improvement events are promptly implemented the following week.
Yet, even with three years of experience with the Lean process at Presence Health, it wasn't easy to implement the recommended process changes to reduce OR turnover time. It took nearly two weeks to get all 50 OR staff up to speed on the new protocols.
“With surgery you can't just say, 'I'm going to go learn about a new process' and hand off your case to someone else,” said Kevin Hoak, director of perioperative services at the Sts. Mary and Elizabeth Medical Center.