Efforts to boost OR efficiency are starting to pay off

Steps under way to improve OR efficiency

Disaster drill

Profile: Andrew Newman (scuba diver/ pulmonologist)

Completion of cancer center expected in late fall 2003

Device tested at Stanford may improve breast cancer diagnosis and treatment

Efforts to boost OR efficiency are starting to pay off

Soon after becoming medical director of operating room services at Stanford Hospital last November, Richard Whyte walked the halls of the OR one morning at 7:30 when the day's first operations were scheduled to begin.

What he saw hinted at the challenges that lay ahead as he embarked on an effort to boost the efficiency and effectiveness of OR services: Only half the rooms had patients in them. That meant half of the morning's first cases would start late, which would delay many of the day's subsequent scheduled operations, which would ultimately mean lost time, lost money, dissatisfied patients and frustrated doctors.

Whyte knew that his job - a newly created position at Stanford Hospital - wouldn't be easy. He knew that scheduling ORs effectively is an art rather than a science, for it depends on numerous interdependent factors. While some of those factors are beyond a surgeon's control - such as unexpected complications during surgery, or the arrival of an emergency case - there are many small, preventable delays that can bog down the entire system: incomplete paperwork; a patient who hasn't been properly checked in; a missing piece of surgical equipment; an OR that isn't available because the surgeon doing the previous case didn't schedule enough time for the operation; and patients who have to remain in the OR long after surgery because all the ICU beds are full.

"It's not like there's one simple problem you can fix and then everything goes smoothly. It's extremely complex," said Whyte, associate professor of cardiothoracic surgery and chief of the Division of Thoracic Surgery.

Despite the challenges, Whyte and his colleagues - notably OR services director Joann Rickley - say they are making discernable progress. They've taken several steps to run the ORs more efficiently (see chart), and in the process they've opened up communication among physicians and staff. Their efforts have led to a modest but noticeable reduction in delays before and between cases. These days, when Whyte walks the halls of the OR at 7:30 a.m., he finds that operations are starting on time in 80 to 90 percent of the rooms.

The changes are just beginning. Come December, Whyte and his department will implement a computerized management system that will help the ORs run more efficiently by automating several key processes.

"Richard's efforts have brought a sense of hope - a sense that somebody is listening to (physicians') concerns and that things can be changed," said Rickley. She added that during the past few months she has noticed a significant drop in physician complaints about OR services - and has even heard a few words of praise.

Whyte has relied on a basic key principle: For surgeries to be scheduled appropriately, to start on time and run smoothly, there must be open communication and collaboration among surgeons, anesthesiologists and nursing staff.

"If you imagine the three components of the OR (anesthesia, surgeons and nursing) as cogs in a wheel, they all have to move in synchrony for things to happen efficiently," Whyte said.

Seeking to understand the issues involved, Whyte spent his first several weeks talking and listening to a variety of people. He distributed a questionnaire to all of the hospital's surgeons, anesthesiologists, OR nurses and staff, asking about their experiences with and suggestions for improving OR services. He convened groups of nurses, surgeons and anesthesiologists for brain-storming sessions. He established a regular monthly meeting attended by the heads of OR services, anesthesia and nursing; he also created an OR scheduling committee that meets monthly. "I've facilitated millions of meetings," Whyte said hyperbolically.

But he believes the meetings have spurred real progress. "A lot of substantive issues have come out by just getting everybody to sit in the same room and talk. It's a big step forward."

Recognizing that each type of surgery has its own unique dynamics and challenges, Whyte concluded that improvements would most readily come from small working groups within a particular type of surgery. He established two pilot projects - in pediatric surgery and adult cardiac surgery - whereby a committee in each area meets regularly to discuss obstacles to efficiency and develop solutions. If these projects are successful, Whyte said, the approach will be expanded to other areas of surgery.

A big part of Whyte's job is simply making himself available and visible. He routinely walks around the ORs and checks to make sure things are running smoothly - and if not, why not.

The attention is most welcome, said Jay Brodsky, clinical professor of anesthesia. "For the first time, we have a medical director who's approachable, available and interested not just in the big picture but in the day-to-day problems," he said. "Richard has taken an active role in building consensus and seeking out solutions."

Brodsky recently approached Whyte to suggest that more operations be moved from the main OR to the ambulatory surgery center, when appropriate, to free up OR space for complex cases. "This has been an issue for years," he said. "Then within a day or two of our conversation, a system was in place and working nicely."

Whyte said he is encouraged by the progress he has seen, and emphasizes that the ongoing work to streamline OR services will lead to higher satisfaction among patients and physicians alike. "As our efficiency increases, people are more satisfied with their jobs. They get their cases done, and then they can go home."