Abstract Background Two approaches prevail for reserving operating room (OR) capacity for emergency surgery: (1) dedicated emergency ORs and (2) evenly allocating capacity to all elective ORs, ...thereby creating a virtual emergency team. Previous studies contradict which approach leads to the best performance in OR utilization. Methods Quasi-experimental controlled time-series design with empirical data from 3 university medical centers. Four different time periods were compared with analysis of variance with contrasts. Results Performance was measured based on 467,522 surgical cases. After closing the dedicated emergency OR, utilization slightly increased; overtime also increased. This was in contrast to earlier simulated results. The 2 control centers, maintaining a dedicated emergency OR, showed a higher increase in utilization and a decrease in overtime, along with a smaller ratio of case cancellations because of emergency surgery. Conclusion This study shows that in daily practice a dedicated emergency OR is the preferred approach in performance terms regarding utilization, overtime, and case cancellations.
Background A new method of scheduling anesthesia-controlled time (ACT) was implemented on July 1, 2012 in an academic inpatient operating room (OR) department. This study examined the relationship ...between this new scheduling method and OR performance. The new method comprised the development of predetermined time frames per anesthetic technique based on historical data of the actual time needed for anesthesia induction and emergence. Seven “anesthesia scheduling packages” (0 to 6) were established. Several options based on the quantity of anesthesia monitoring and the complexity of the patient were differentiated in time within each package. Study Design This was a quasi-experimental time-series design. Relevant data were divided into 4 equal periods of time. These time periods were compared with ANOVA with contrast analysis: an intervention, pre-intervention, and post-intervention contrast were tested. All emergency cases were excluded. A total of 34,976 inpatient elective cases performed from January 1, 2010 to December 31, 2014 were included for statistical analyses. Results The intervention contrast showed a significant decrease (p < 0.001) of 4.5% in the prediction error. The total number of cancellations decreased to 19.9%. The ANOVA with contrast analyses showed no significant differences with respect to under- and over-used OR time and raw use. Unanticipated results derived from this study, allowing for a smoother workflow: eg anesthesia nurses know exactly which medical equipment and devices need to be assembled and tested beforehand, based on the scheduled anesthesia package. Conclusions Scheduling the 2 major components of a procedure (anesthesia- and surgeon-controlled time) more accurately leads to fewer case cancellations, lower prediction errors, and smoother OR workflow in a university hospital setting.
Abstract Background First-case tardiness is still a common source of frustration. In this study, a nationwide operating room (OR) Benchmark database was used to assess the effectiveness of ...interventions implemented to reduce tardiness and calculate its economic impact. Methods Data from 8 University Medical Centers over 7 years were included: 190,295 elective inpatient first cases. Data were analyzed with SPSS statistics and multidisciplinary focus-group study meetings. Analysis of variance with contrast analysis measured the influence of interventions. Results Seven thousand ninety-four hours were lost annually to first-case tardiness, which has a considerable economic impact. Four University Medical Centers implemented interventions and effectuated a significant reduction in tardiness, eg providing feedbacks directly when ORs started too late, new agreements between OR and intensive care unit departments concerning “intensive care unit bed release” policy, and a shift in responsibilities regarding transport of patients to the OR. Conclusions Nationwide benchmarking can be applied to identify and measure the effectiveness of interventions to reduce first-case tardiness in a university hospital OR environment. The implemented interventions in 4 centers were successful in significantly reducing first-case tardiness.
Background Poor inter-professional collaboration might negatively influence adequate planning of operative procedures. Interventions capable of improving inter-professional collaboration will ...positively impact professional practice and health care outcomes. Radboud University Medical Center (UMC) redesigned their operating room (OR) scheduling method by implementing cross-functional teams (CFTs). In this center, positive effects of CFTs were already demonstrated in a mono-center study. This study aims to confirm these effects by comparing the Radboud data with data from 6 other similar centers using a nationwide OR benchmark collaborative. Study Design The effect of CFTs was measured by the performance indicator “raw utilization.” The Kruskal-Wallis one-way ANOVA was applied to compare OR performance among all 7 centers. The Wilcoxon-Mann-Whitney test was used to determine differences in OR performance between Radboud UMC and the control group. Results Operating room performance differed significantly among all 7 centers (p < 0.0005). Radboud UMC demonstrated the highest median raw utilization of 94% vs 85% in the control group (p < 0.0005). Box-and-whisker plots validated the reduced variation during the years, indicating an organizational learning effect. Therefore, not only a better performance than the control group, but also a gradual improvement of this performance during the years. Conclusions This study shows that multidisciplinary collaboration in CFTs during the perioperative phase has a positive influence on OR scheduling and use of OR time. Other national databases considering mortality rates also support the idea that introducing CFTs is not only an important condition for improving OR performance, but also for improving quality of care.
Purpose
– The aim of this paper is to describe the factors that contribute to understanding how collaboration improves performance in operating rooms (ORs) after introducing the concept of ...cross-functional OR scheduling teams.
Design/methodology/approach
– The concept was investigated at Radboud University Nijmegen Medical Center (RUNMC) in The Netherlands and used on an innovative path based on socio-technical systems (STS) principles designed to address non-routine tasks, variety, interferences and errors related to OR scheduling, with the aim of increasing both staff productivity and patient safety. The effects of implementing preoperative cross-functional teams in the OR were compared qualitatively. The researcher observed all of the team meetings, available data and documentation, and 13 semi-structured interviews were performed with team members for collecting additional data.
Findings
– In the literature, it was found that the theory of socio-technical systems and the fields of group dynamics and self-managing teams fit the OR setting. The author applied six elements of these theories (setting common goals, cohesion, openness, single-loop and double-loop learning, feedback, and control options) to the aspects found in the study. The qualitative findings revealed that high-performing teams were able to identify bottlenecks in order to improve continuity of care. The cross-functional teams used several performance indicators to gain insight into their own performance. Consequently, through collaboration, these teams were able to minimise interference and therefore learn. Cross-functional teams learned how to address interferences and improve their quality of service through improved collaboration and the improved use of control mechanisms.
Practical implications
– This research highlights the importance of team-based approaches and the need to improve collaboration between healthcare professionals.
Originality/value
– The paper confirms the value of implementing the socio-technical systems theory to improve collaboration between healthcare professionals. This case study is a valuable contribution, as it focuses on team-based organisation in preparing an OR schedule.
Abstract Background The purpose of this study was to assess the direct and indirect relationships between first-case tardiness (or “late start”), turnover time, underused operating room (OR) time, ...and raw utilization, as well as to determine which indicator had the most negative impact on OR utilization to identify improvement potential. Furthermore, we studied the indirect relationships of the three indicators of “nonoperative” time on OR utilization, to recognize possible “trickle down” effects during the day. Materials and methods (Multiple) linear regression analysis and mediation effect analysis were applied to a data set from all eight University Medical Centers in the Netherlands. This data set consisted of 190,071 OR days (on which 623,871 surgical cases were performed). Results Underused OR time at the end of the day had the strongest influence on raw utilization, followed by late start and turnover time. The relationships between the three “nonoperative” time indicators were negligible. The impact of the partial indirect effects of “nonoperative” time indicators on raw utilization were statistically significant, but relatively small. The “trickle down” effect that late start can cause resulting in an increased delay as the day progresses, was not supported by our results. Conclusions The study findings clearly suggest that OR utilization can be improved by focusing on the reduction of underused OR time at the end of the day. Improving the prediction of total procedure time, improving OR scheduling by, for example, altering the sequencing of operations, changing patient cancellation policies, and flexible staffing of ORs adjusted to patient needs, are means to reduce “nonoperative” time.
Network platforms are interesting for integrated care governance as they seek solutions for the problem of competition and tensions between networks. In this paper, we analyse how a network platform ...functions for the actors involved, and how it is used in their work.
We employed a case study in a Dutch urbanised hospital region, and conducted 17 interviews with hospital physicians, directors, and supporting staff who are involved in a network platform called "BeterKeten" (BK).
Actors assign different functions and purposes to BK: facilitating and legitimising professional (learning) communities; adapting to a changing policy context; enlarging professionals' and the networks' circle of influence; and extending governing possibilities. Network platform' dynamics and frictions entail changing professional and managerial practices; embedding a BK network in a partner network; and alignment of (conflicting) network platforms.
Network platforms are a promising strategy to govern, facilitate, and nurture network-building actions to enhance integrated care, offering new ways of working to cope with its multi-level nature.
BK is a dynamic actor with steering capacities that enables the co-existence of multiple purposes. Further research could pay attention to how network platforms are able to develop modalities of integrated care governance that suit healthcare system's networked character.
Purpose
– Benchmarking is increasingly considered a useful management instrument to improve performance in healthcare. The purpose of this paper is to assess if a nationwide long-term benchmarking ...collaborative between operating room (OR) departments of university medical centres in the Netherlands leads to benefits in OR management and to evaluate if the initiative meets the requirements of the 4P-model.
Design/methodology/approach
– The evaluation was based on the 4P-model (purposes, performance indicators, participating organisations, performance management system), developed in former studies. A mixed-methods design was applied, consisting of document study, observations, interviews as well as analysing OR performance data using SPSS statistics.
Findings
– Collaborative benchmarking has benefits different from mainly performance improvement and identification of performance gaps. It is interesting that, since 2004, the OR benchmarking initiative still endures after already existing for ten years. A key benefit was pointed out by all respondents as “the purpose of networking”, on top of the purposes recognised in the 4P-model. The networking events were found to make it easier for participants to contact and also visit one another. Apparently, such informal contacts were helpful in spreading knowledge, sharing policy documents and initiating improvement. This benchmark largely met all key conditions of the 4P-model.
Research limitations/implications
– The current study has the limitations accompanied with any qualitative research and particularly related to interviewing. Qualitative research findings must be viewed within the context of the conducted case study. The experiences in this university hospital context in the Netherlands might not be transferable to other (general) hospital settings or other countries. The number of conducted interviews is restricted; nevertheless, all other data sources are extensive.
Originality/value
– A collaborative approach in benchmarking can be effective because participants use its knowledge-sharing infrastructure which enables operational, tactical and strategic learning. Organisational learning is to the advantage of overall OR management. Benchmarking seems a useful instrument in enabling hospitals to learn from each other, to initiate performance improvements and catalyse knowledge-sharing.
Purpose
– The purpose of this paper is to present the effect of the introduction of cross-functional team (CFT)-based organization, rather than, on planning and performance of OR teams.
...Design/methodology/approach
– In total, two surgical departments of the Radboud University Nijmegen Medical Center (RUNMC) in the Netherlands were selected to illustrate the effect on performance. Data were available for a total of seven consecutive years from 2005 until 2012 and consisted of 4,046 OR days for surgical Department A and 1,154 OR days for surgical Department B on which, respectively 8,419 and 5,295 surgical cases were performed. The performance indicator “raw utilization” of the two surgical Departments was presented as box-and-whisker plots per year (2005-2011). The relationship between raw utilization (y) and years (x) was analyzed with linear regression analysis, to observe if performance changed over time.
Findings
– Based on the linear regression analysis, raw utilization of surgical Department A showed a statistically significant increase since 2006. The variation in raw utilization reduced from IQR 33 percent in 2005 to IQR 8 percent in 2011. Surgical Department B showed that raw utilization increased since 2005. The variation in raw utilization reduced from IQR 21 percent in 2005 to IQR 8 percent in 2011.
Social implications
– Hospitals need to improve their productivity and efficiency in response to higher societal demands and rapidly escalating costs. The RUNMC increased their OR performance significantly by introduction of CFT-based organization in the operative process and abandoning the so called functional silos.
Originality/value
– The stepwise reduction of variation – a decrease of IQR during the years – indicates an organizational learning effect. This study demonstrates that introducing CFTs improve OR performance by working together as a team.
Purpose
– Benchmarking is increasingly considered a useful management instrument to improve performance in healthcare. The purpose of this paper is to assess if a nationwide long-term benchmarking ...collaborative between operating room (OR) departments of university medical centres in the Netherlands leads to benefits in OR management and to evaluate if the initiative meets the requirements of the 4P-model.
Design/methodology/approach
– The evaluation was based on the 4P-model (purposes, performance indicators, participating organisations, performance management system), developed in former studies. A mixed-methods design was applied, consisting of document study, observations, interviews as well as analysing OR performance data using SPSS statistics.
Findings
– Collaborative benchmarking has benefits different from mainly performance improvement and identification of performance gaps. It is interesting that, since 2004, the OR benchmarking initiative still endures after already existing for ten years. A key benefit was pointed out by all respondents as “the purpose of networking”, on top of the purposes recognised in the 4P-model. The networking events were found to make it easier for participants to contact and also visit one another. Apparently, such informal contacts were helpful in spreading knowledge, sharing policy documents and initiating improvement. This benchmark largely met all key conditions of the 4P-model.
Research limitations/implications
– The current study has the limitations accompanied with any qualitative research and particularly related to interviewing. Qualitative research findings must be viewed within the context of the conducted case study. The experiences in this university hospital context in the Netherlands might not be transferable to other (general) hospital settings or other countries. The number of conducted interviews is restricted; nevertheless, all other data sources are extensive.
Originality/value
– A collaborative approach in benchmarking can be effective because participants use its knowledge-sharing infrastructure which enables operational, tactical and strategic learning. Organisational learning is to the advantage of overall OR management. Benchmarking seems a useful instrument in enabling hospitals to learn from each other, to initiate performance improvements and catalyse knowledge-sharing.
