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March 6, 2018 Article 5 min read
With unprecedented data at their fingertips, hospital executives are often tempted to promote OR transformation through imposing KPI targets – only to see a short-lived uptick in performance. Here are five tips to drive sustainable change in the OR.

Picture of a female nurse moving medical equipment in an operating room.

Block utilization. Average room turnover time. First case on-time start (FCOTS) rate. Every hospital executive responsible for surgical services is keenly familiar with these operating room (OR) key performance indicators (KPIs). If you’ve led efforts to improve OR performance with policies focused purely on driving KPIs, you may have found your results to be short-lived, with those efforts creating unintended consequences.

Like the nostalgic whack-a-mole arcade game, applying pressure to improve one KPI often opens the door for other problems to creep in.

Like the nostalgic whack-a-mole arcade game, applying pressure to improve one KPI often opens the door for other problems to creep in.

For example, efforts exclusively focused on improving block utilization may come at the cost of increasing same-day cancellations as physician offices push to schedule cases with limited time for an effective pre-anesthesia screening process. Or your OR director may find scheduling more ancillary staff to be a stop gap solution for improving room turnover — but at the expense of lower labor productivity.

Achieving — and sustaining — OR operational excellence requires you to be a creative healthcare leader who can champion effective policy and still empower authentic change at an operational level.

Here are five tips for driving sustainable change in the OR:

  1. Acknowledge where traditional KPIs fall short.
  • Don’t be fooled — measuring your OR’s FCOTS rate and block utilization is essential, but remember these metrics don’t tell the whole story.
  • Is your FCOTS rate low because of problems in the patient registration process or because your surgeon is tardy? Is a surgeon’s block utilization truly best-in-class even though their block is consistently boarded with add-ons?
  • Even the straightforward room turnover metric has more layers than expected. Is your turnover rate poor because of inefficient room cleaning processes, equipment issues, or because your surgeons are rounding on the floor between cases?  
  • Bottom line: Manage your KPIs, don’t let them manage you.

  1. Use your data, not your dashboards.
  • As a leader, it’s important that you set the expectation — and provide the resources — for your team to look deeper into their data than what’s reported through your leader-level dashboards. Dashboards answer a concise list of predefined questions, but do they get to the “why”? Take the room turnover question: Do your OR leaders have the right data, tools, and skillsets to uncover the root causes for high room turnover times?
  • Even if a hospital has the ability to analyze data, it’s often stymied by the inability to collaborate. Do you include your registration and benefits verification team in your planning and data review? Working with a member of that team to understand authorization issues the day before surgery can significantly improve your FCOTS rate.
  • Bottom line: Build an environment focused on data analytics and collaboration across teams to provide more actionable insight.

  1. Leave your carrots and sticks at home.
  • To improve KPIs, your first inclination may be to parade carrots and sticks in front of your surgeons and OR staff. In our experience, this works — for a season. After they adapt to the “new rules of the game” and other KPIs drop, you’ll find you’ve trained them to be more focused on the incentive than the core mission. Instead, empower their intrinsic motivation through sponsoring genuine change.
  • Trust that none of your surgeons or staff wake up in the morning intending to do a bad job. They care about their patients. They understand the importance of their work. Sometimes, however, your OR environment has procedures that inadvertently inhibit streamlined work processes. Could your current methods actually be creating a barrier to success?
  • Bottom line: Change underlying processes, not underlying motivations.

  1. Turn talk into action — and do it rapidly.
  • Next time you walk on the sterile side of the red line, ask a surgeon what could help her increase case volume. Ask a circulating nurse about his greatest pain point. You may be surprised to hear the simplicity of their responses.
  • After a dozen conversations, you may also be surprised to learn how upstream processes in the surgical value stream negatively affect their day (and how much their actions unknowingly impact their downstream colleagues).
  • Collect your list of opportunities, but don’t sit on it. Don’t let developing a perfect plan prevent you from moving forward. When in doubt, call on an experienced advisor to help navigate the changes.
  • Bottom line: Walk with your frontline team, collect ideas for improvement, and turn them into reality.

  1. Embrace a human-centric process.
  • Change is tough. Be a great listener, and also be great at sharing the message of change with all who are touched by it — over and over again. The complex relationship between surgeons and hospitals requires great care and a human-centric approach. Be wary of fostering an “us vs. them” environment.
  • Remember to build a trusting relationship before the change. No change will be sustainable unless your surgeons and staff trust you and your motivations.
  • Consider bringing in an external voice with a unique role that can stimulate cooperation and provide an outside perspective when your internal groups become entrenched.
  • Bottom line: Remember that the heart of your OR is the people who serve there. They deserve a voice at the table and an ear from their leadership.

It’s time to enter a new era of OR leadership — one that embraces genuine, sustainable change over short-lived upticks.

It’s time to enter a new era of OR leadership — one that embraces genuine, sustainable change over short-lived upticks.

One that looks beyond KPIs and dashboards. One that values what their staff have to say. And one that knows the best strategy for beating whack-a-mole is not playing the game.