Reports From the Field

Applying a Quality Improvement Framework to Operating Room Efficiency in an Academic-Practice Partnership

Journal of Clinical Outcomes Management. 2016 March;23(3)

Author(s):

Danielle O'Rourke-Suchoff

Sarah Hyman, Taylor Young, LSW, MSSA

Chris Maeder, CPA, MBA

Mary A. Dolansky, BSN, PhD

References

1. The right strategies can help increase OR utilization. OR Manager 2013;29:21–2.

2. Jackson RL. The business of surgery. Managing the OR as a profit center requires more than just IT. It requires a profit-making mindset, too. Health Manage Technol 2002;23:20–2.

3. Institute of Medicine. Crossing the quality chasm: A new health system for the 21st century. Washington (DC): National Academy Press; 2001.

4. Hand R, Dolansky MA, Hanahan E, Tinsley N. Quality comes alive: an interdisciplinary student team’s quality improvement experience in learning by doing—health care education case study. Qual Approaches Higher Educ 2014;5:26–32.

5. Scholtes PR, Joiner BL, Streibel BJ. The team handbook. Oriel; 2003.

6. Institute for Healthcare Improvement. Open School. 2015. Accessed 13 Apr 2015 at www.ihi.org/education/ihiopenschool/Pages/default.aspx.

7. Ogrinc GS, Headrick LA, Moore SM, et al. Fundamentals of health care improvement: A guide to improving your patients’ care. 2nd ed. Oakbrook Terrace, IL: Joint Commission Resources and the Institute for Healthcare Improvement; 2012.

8. Managing patient flow: Smoothing OR schedule can ease capacity crunches, researchers say. OR Manager 2003;19:1,9–10.

9. Harders M, Malangoni MA, Weight S, Sidhu T. Improving operating room efficiency through process redesign. Surgery 2006;140:509–16.

10. Paynter J, Horne W, Sizemore R. Realizing revenue opportunities in the operating room. 2015. Accessed 13 Apr 2015 at www.ihi.org/resources/Pages/ImprovementStories/RealizingRevenueOpportunitiesintheOperatingRoom.aspx.

11. Cima RR, Brown MJ, Hebl JR, et al. Use of Lean and Six Sigma methodology to improve operating room efficiency in a high-volume tertiary-care academic medical center. J Am Coll Surg 2011;213:83–92.

12. Day R, Garfinkel R, Thompson S. Integrated block sharing: a win–win strategy for hospitals and surgeons. Manufact Serv Op Manage 2012;14:567–83.

13. Pardini-Kiely K, Greenlee E, Hopkins J, et al. Improving and Sustaining core measure performance through effective accountability of clinical microsystems in an academic medical center. Jt Comm J Qual Improv Pt Safety 2010;36:387–98.

14. Hall LW, Headrick LA, Cox KR, et al. Linking health professional learners and health care workers on action-based improvement teams. Qual Manag Health Care 2009;18:194–201.

15. Ogrinc GS, Nierenberg DW, Batalden PB. Building experiential learning about quality improvement into a medical school curriculum: The Dartmouth Experience. Health Aff 2011;30:716–22.

16. Interprofessional Education Collaborative Expert Panel. Core competencies for interprofessional collaborative practice. Washington, DC: Interprofessional Education Collaborative; 2011.

17. World Health Organization. Framework for action on inerprofessional education and collaborative practice. Geneva: World Health Organization; 2010.

From the Case Western Reserve University School of Medicine, Cleveland, OH.

Abstract

Objective: To improve operating room (OR) scheduling efficiency at a large academic institution through the use of an academic-practice partnership and quality improvement (QI) methods.
Methods: The OR administrative team at a large academic hospital partnered with students in a graduate level QI course to apply QI tools to the problem of OR efficiency.
Results: The team found wide variation in the way that surgeries were scheduled and other factors that contributed to inefficient OR utilization. A plan-do-study-act (PDSA) cycle was applied to the problem of discrepancy in surgeons’ interpretation of case length, resulting in poor case length accuracy. Our intervention, adding time on the schedule for cases, did not show consistent improvement in case length accuracy.
Conclusion: Although our intervention did not lead to sustained improvements in OR scheduling efficiency, our project demonstrates how QI tools can be taught and applied in an academic course to address a management problem. Further research is needed to study the impact of student teams on health care improvement.

Operating rooms are one of the most costly departments of a hospital. At University Hospitals Case Medical Center (UHCMC), as at many hospitals, operating room utilization is a key area of focus for both operating room (OR) and hospital administrators. Efficient use of the OR is an important aspect of a hospital’s finances and patient-centeredness.

UHCMC uses block scheduling, a common OR scheduling design. Each surgical department is allotted a certain number of blocks (hours of reserved OR time) that they are responsible for filling with surgical cases and that the hospital is responsible for staffing. Block utilization rate is a metric commonly used to measure OR efficiency. It divides the time that the OR is in use by the total block time allocated to the department (while accounting for room turnaround time). An industry benchmark is 75% block utilization [1], which was adopted as an internal target at UHCMC. Achieving this metric is necessary because the hospital (rather than each individual surgical department) is responsible for ensuring that the appropriate amount of non-surgeon staff (eg, anesthesiologists, nurses, scrub techs, and facilities staff) is available. Poor utilization rates indicate that the staff and equipment are inefficiently used, which can impact the hospital’s financial well-being [2]. Block utilization is the result of a complex system, making it challenging to improve. Many people are involved in scheduling, and a large degree of inherent uncertainty exists in the system.

At UHCMC, block utilization rates by department ranged from 52% to 80%, with an overall utilization of 64% from February to July 2014. Given this wide variation, higher level management staff in the OR initiated a project in which OR administrators partnered with students in a graduate level QI course in an effort to improve overall block utilization. They believed that improving block utilization rate would improve the effectiveness, patient-centeredness, and efficiency of care, health care delivery goals described by the Institute of Medicine [3].

Methods