When the COVID-19 pandemic first hit, many hospital operational leaders canceled elective procedures as an initial response. While necessary to reduce infection risk and protect hospital staff and resources, the step dealt a blow to hospital finances.
The perioperative value stream typically accounts for up to half of a hospital’s revenue, so slowly ramping up elective surgery volume will be essential to financial viability as hospitals resume elective procedures.
Below we explore how a focus on creative thinking, smarter workforces, data analysis, and other strategies can help your organization reach more robust and efficient elective surgery services.
Room for Improvement
When resuming operations, avoid attempts to simply return to normal practices; many hospitals have operating room (OR) utilization rates between 35% and 55%—leaving a great deal of room for improvement.
With some adjustments, there’s potential to boost rates to between 70% and 80%—in some cases possibly doubling your efficiency. Staffing a single OR can cost about $200,000-$275,000 annually—not including substantial anesthesiologist contracts—so investing in improved efficiencies could prove quite beneficial.
Five Building Steps
Following are five ways to build back the perioperative value stream with sustainability and integrity.
1. Identify excess capacity and work to increase utilization percentage.
Start with your operational stakeholders and ask for ideas. Those who are most invested—especially your frontline workforce—know the work best and will be excellent assessors of opportunity and waste.
From there, you can focus on the following activities:
- Collect data on first-case starts and late-case starts, turnover time, anesthesiology costs, and registered nurse (RN) and scrub tech staffing
- Model your room utilization by day, week, and time of day
- Study your block utilization and observe how your rooms are used and staffed
- Track case duration by surgeon and identify ways to support them
- Follow the path of a patient at every touchpoint—from arrival to inpatient transfer
Once you’ve assessed this information, make plans to improve processes based on your findings.
2. Focus on capacity utilization.
Given the outsized value of the OR, it’s important to make the most of the time spent there, available space, and the professionals who work in the operating rooms.
Capacity areas to focus on should include:
- Consolidating operating room usage to increase utilization and decrease the scheduling gap in time between cases
- Filling in schedule gaps to adjust labor and anesthesia costs and trigger cascading efficiencies throughout the perioperative setting
3. Collaborate with and support surgeons.
The way surgeons spend time in the OR varies by person, so it’s important to become familiar with data surrounding their activities to better meet their individual needs.
Mapping case durations for all surgeons can help identify where they need more support or resources, whether in staffing, time, or supplies. Facilitating streamlined communications, such as through telephonic medical evaluations, can also help reduce their administrative burdens.
It’s important to include surgeons in the process so they have agency and trust the data and results, but be cautious that the manner in which you do so honors their expertise and time.
4. Build a continuous improvement culture through a lean management system.
In the perioperative setting, every minute wasted erodes quality and financial well-being. Using lean methodologies to address these issues can make an enormous difference in quality, efficiency, and productivity.
Lean is a series of improvement strategies that takes a holistic approach to organizations to create continued progress. Lean works to identify potential issues early in your organization’s processes before they continue on to impact other stages.
Lean opportunities could include:
- Arranging improvement workshops to reduce waste and improve efficiency in sterile processing and inventory, labs, scheduling, and turnover time—and to help improve workflows for scheduling, setup time, instrument flow, and post-operative transfer
- Conducting 5S, or workplace organization events, for case carts to fulfill surgeons’ preferences and large equipment for safe storage, maintenance, and ease of use
- Implementing a daily management system to facilitate team engagement and rapid cycle improvements
5. Reassure patients through outreach and communication.
Patient activation and reassurance is also going to be an important focus area to make sure they feel comfortable proceeding with their surgeries. It could take time to regain patient trust as the public navigates a continued pandemic environment; taking the necessary steps up front can help build solid relationships.
Work to establish your OR as a safe setting that practices social distancing—and inform all patients of your new procedures and how you’re establishing a safe environment.
Reach out to patients through:
- Scripted outreach calls that describe safety protocols, including robust COVID-19 testing for patients, families, staff, physicians, and all workforce
- Proactive scheduling
- Signage around the hospital that reasserts safety policies and procedures
We’re Here to Help
To learn more about how these steps can help improve efficiency and boost your organization’s finances, contact your Moss Adams professional.
Note on COVID-19
During this unparalleled time, we’re closely monitoring the COVID-19 situation as it evolves so we can provide up-to-date guidance and support to help you combat uncertainty. For regulatory updates, strategies to help cope with subsequent risk, and possible steps to bolster your workforce and organization, please see the following resources: