OR Manager Research Articles

A Relative Review of Operation Theater Environment Management

The operation theater is a very critical area, and everything needs to be done in an ordinate manner to maintain efficacy. However, managers are needed to maintain the functionality of the OT suite. An OR manager is responsible for many things, like scheduling OT but most importantly, OT efficiency. An OR manager faces different challenges during management of an OR suite. These vary from organization to organization. The most common types of diversity found in OT are cultural diversity, religious diversity, organizational and environmental diversity, and so on. An OR manager should manage these diversities ethically and professionally to overcome an ethical dilemma. OR managers should encourage ethical behavior to improve OT efficacy and effectiveness, but change may reduce or hinder OT effectiveness due to resistance to change. Ideally, the OR manager should manage sustainability to reduce resistance to change without compromising OT efficacy or inducing socio-ethical conflicts among the OR team. For this, OR teams are managed in such a way to facilitate high-quality teamwork and promote good communication skills. However, many barriers hinder communication, which may cause misconceptions and compromise efficacy. Many tactics and strategies are used to reduce these conflicts peri-operatively and OT performance indicators are used to determine the efficiency. To increase productivity, efficiency, and effectiveness as needed while lowering personnel costs, an OR manager organizes and schedules the OT.

From poster to publication: Seven steps to success

From poster to publication: Seven steps to success

AIUM Practice Parameter for the Performance of Sonohysterography and Hysterosalpingo-Contrast Sonography.

AIUM Practice Parameter for the Performance of Sonohysterography and Hysterosalpingo-Contrast Sonography.

Writing Resources—An Annotated List of Helpful Books

Writing Resources—An Annotated List of Helpful Books

Implementing Technology to Drive Improvements within a High Volume Brachytherapy Program

The introduction of new techniques and technologies in radiation therapy has the potential to improve outcomes; however, initial implementation is often associated with a steep learning curve and decreased efficiencies. We describe the development, implementation and evaluation of implementing an operating room scheduling system, electronic documentation software and a patient tracking system within a high throughput, high volume brachytherapy program. In 2017, a small interprofessional team came together to introduce two key technologies into the brachytherapy program; 1) TrackOR to improve patient flow through the unit and 2) PICIS OR Manager to centralize scheduling to provide targeted access to the unit and collect specialized data elements related to the program and provincial initiatives. In addition, the program shifted all documentation to an electronic platform to align documentation practice with the rest of the Radiation Treatment Program and provide access of care notes to healthcare teams across the organization. To promote adoption into clinical practice, a multistep approach was used. Current state workflow maps were created with feedback from all key stakeholders. Future state workflows were created layering the new technologies and process at the key points within the pathway. Training and education was completed with all end users and dry runs of the future state workflow was completed prior to implementation. To ensure success, intensive support was provided during the first two weeks of implementation with debriefs occurring near the end of each clinical day with the interprofessional team to address issues and concerns. The implementation of the scheduling and patient tracking software provides the ability to maximize OR utilization through the assignment of procedures in a systematic way. In addition, the program monitors the timing of procedures by physician which allows for optimized daily scheduling. In addition, the system tracks start and stop times to improve throughput and minimizes staff overtime. Challenges were seen in moving documentation practice to an electronic platform as there was a learning curve to using the software in real time. Integration of this software has allowed for the optimization of brachytherapy OR utilization to nearly 100% month over month and has allowed for provincial access to brachytherapy treatment targets to be reached and maintained.

Take the initiative to reduce surgical site infections

Take the initiative to reduce surgical site infections

Operating room scheduling under waiting time constraints: the Chilean GES plan

In 2000, Chile introduced profound health reforms to achieve a more equitable and fairer system (GES plan). The reforms established a maximum waiting time between diagnosis and treatment for a set of diseases, described as an opportunity guarantee within the reform. If the maximum waiting time is exceeded, the patient is referred to another (private) facility and receives a voucher to cover the additional expenses. This voucher is paid by the health provider that had to do the procedure, which generally is a public hospital. In general, this reform has improved the service for patients with GES pathologies at the expense of patients with non-GES pathologies. These new conditions create a complicated planning scenario for hospitals, in which the hospital’s OR Manager must balance the fulfillment of these opportunity guarantees and the timely service of patients not covered by the guarantee. With the collaboration of the Instituto de Neurocirugia, in Santiago, Chile, we developed a mathematical model based on stochastic dynamic programming to schedule surgeries in order to minimize the cost of referrals to the private sector. Given the large size of the state space, we developed an heuristic to compute good solutions in reasonable time and analyzed its performance. Our experimental results, with both simulated and real data, show that our algorithm performs close to optimum and improves upon the current practice. When we compared the results of our heuristic against those obtained by the hospital’s OR manager in a simulation setting with real data, we reduced the overtime from occurring 21% of the time to zero, and the non-GES average waiting list’s length from 71 to 58 patients, without worsening the average throughput.

Ergonomics and Prevention of Injuries From Needles Sticks and Sharps in the OR

Aim: Implement ergonomic process improvement within the OR, to decrease incidence of injuries from sharps and needle sticks among the OR teams. Method: A pre and post intervention design was adopted. The number of reported incidents related to needle sticks and sharps over a seven month period prior to the implementation of the ergonomic process improvement(January to July 2014) and over a seven month period following implementation(January to July 2015), were compared. A participatory approach was adopted, for conducting the study and the study team included an ergonomist, surgery educators, two surgeons, operations leader, department manager, team lead, risk manager and two pre-med students functioning as study assistants. Ergonomics training for the prevention of injuries from sharps and needle sticks was developed, which incorporated physical, cognitive and teamwork measures alongside the prevention measures outlined by AORN and evidence based measures identified following a literature review. The Surgery Educator, the Ergonomist and an Attending Surgeon, participated in delivering the ergonomics injury prevention training. The management, including the Team Lead and OR Manager participated in supporting and facilitating the implementation of the injury prevention measures, where possible, such as double gloving; safe passing zones; verbal feedback; silence or task related communications only during critical phases, etc. Results: A significant difference was found in the frequency of the overall sharps and needle stick related incidents over the pre and post implementation time periods of interest(Wilcoxon Signed Rank test - significant at p≤ 0.05 level, where the W-value is 2 and the critical value for W with N=6 is 2). 63.51% decrease in incidence rate was found among the OR staff, and 44.25% decrease in incidence rate was found among students and residents, pre and post implementation. Overall, a 55% decrease was found in the incident rate of events related to sharps and needle sticks among the OR teams(experts and novices combined), over the first seven months of implementing the ergonomic process improvement. Conclusion Within the complex task and team work environments of the operating room in teaching hospitals, ergonomics and human factors fundamentals related to individual task performance, team work and work design could help improve the effectiveness of the safety measures.

Engaging Employees in Robotic Surgery Across The Perioperative Care Continuum

An active robotic surgical service at an Academic, Community, Magnet designated, Level One Trauma Center expanded their repertoire by implementing the single-site gallbladder procedure. Prior to the onset of the first procedure, nursing leadership sought to ensure staff competency and familiarity with robotics across the Perioperative care continuum. The managers within Perianesthesia and the Operating Room environments partnered to develop an action plan for nurses in these settings. An educational visit to an Epicenter currently performing single-site gallbladder procedure allowed the OR Manager to gain and share much needed information and knowledge. Mock procedures allowed the OR team specifically trained in robotic surgery to participate in a simulation environment to achieve single-site surgery competencies for the team members. Through these interactions, additional interest in viewing actual procedures was gained. Management set up observations for the Perianesthesia staff members to allow additional insight into caring for the patients both preoperatively and postoperatively.

Educating for the Future

The current lack of perioperative clinical rotations in nursing schools makes it imperative that perioperative nurses create ways to entice the next generation of nurses to work in the OR. At Danbury Hospital, Danbury, Connecticut, the OR manager and clinical educators looked at the challenges that nursing students face in the perioperative clinical setting and created an orientation to help to ease their fears about observing in the OR, familiarize them with the perioperative nursing role, and perhaps encourage more nursing students to consider perioperative nursing as a career. We used the “AORN guidance statement: The value of clinical learning activities in the perioperative setting in undergraduate nursing curricula” as a framework for a perioperative orientation class that addresses the challenges and meets the students' academic goals. We also used the nursing curriculum objectives from Western Connecticut State University, Danbury, to plan the students' clinical experience in surgery. Our approach has attracted more student interest in perioperative nursing than in previous years, resulting in more students requesting a perioperative clinical rotation or senior practicum.

Surgical Count Practice Variability and the Potential for Retained Surgical Items

Validating existing count practices and reducing individual practice variance are necessary to decrease the risk for retained surgical items. A quality improvement project was undertaken at one large city hospital to identify best practice and eliminate variability in count practices. The project included an analysis of 20 surgical count policies from hospitals across the country and a review of count practices among nurses and surgical technologists at the facility. Assessment of the policies and practices indicated that clinical practice requirements in the policies varied greatly, and there was a high degree of count practice variability among staff members. The facility OR manager and OR quality coordinator collaborated with staff nurses and surgical technologists to identify practices that created variability and then addressed each one to create a new count policy and reduce the risk of retained surgical items.

Contributors

Contributors

Managing Tissue Bank Access to the OR for Tissue Recovery

Hospitals often have tissue recovery service agreements with regional tissue banks to facilitate the donation process. The agreements that outline the tissue bank–hospital relationship frequently allow tissue bank personnel to perform tissue recovery procedures in the referring hospital's OR and may or may not specify any preparatory orientation or any written protocols for tissue bank staff members to follow. This creates the potential for unintentional breaches of protocol that can affect operation of equipment or result in contamination that may put surgical patients and staff members at risk. The OR manager is responsible for establishing appropriate orientation plans for tissue bank employees to ensure they understand and adhere to the hospital's protocols.

The Göttingen manual for OR managers

Economic pressures are forcing German hospitals to take measures to secure the cost effectiveness of medical care. Surgical facilities are particularly affected as a high-cost segment. As a consequence hospital operators and administrators have begun to hire surgical facility (OR) managers whose task it is to implement efficiency-oriented steps and reorganization measures aimed at increasing productivity and profitability of the surgical services. The OR manager is confronted with high expectations in a complex environment full of potential conflicts. With this in mind, the following article defines and comments on the most important aspects of OR managerial duties and responsibilities. The authors are experienced in OR management and are able to give the reader not only the theoretical fundamentals but also recommendations and guidelines which are particularly valuable to those contemplating a career as OR manager.

From the Editor: Is Interfaces Meeting Its Mission?

AboutSectionsView PDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked InEmail Go to Section HomeInterfacesVol. 39, No. 4 From the Editor: Is Interfaces Meeting Its Mission?Jeffrey D. CammJeffrey D. CammPublished Online:7 Jan 2014https://doi.org/10.1287/inte.1090.0457"From the Editor: Is Interfaces Meeting Its Mission?." Interfaces, 39(4), pp. 305–306 Back to Top Next FiguresReferencesRelatedInformation Volume 39, Issue 4July-August 2009Pages 305-383 Article Information Metrics Information Published Online:January 07, 2014 Copyright © 2009, INFORMSCite asJeffrey D. Camm (2014) From the Editor: Is Interfaces Meeting Its Mission?. Interfaces 39(4):305-306. https://doi.org/10.1287/inte.1090.0457 Keywordseditorial commentsPDF download

Effects of an OR Manager on Workflow Effectiveness and Organizational Hierarchy in the OR Suite

Institute for Anesthesiology and Operative Intensive Medicine, Klinikum Mannheim, Mannheim, Germany

Control or Lead? It's Your Choice

AS AN IT EXECUTIVE OR MANager today, just how much and what do you think you can really control? Projects? Change management initiatives? Processes? Budgets? Schedules? Time? People? Given that time appears to be the scarcest resource today, there is a tendency to think we can control all of these items. When running full out, we often fall back on a command-and-control management style, believing that we will achieve better or faster results by holding a tight rein on those who work for us.

OP-Management aus der Sicht des Chirurgen

Eine der wichtigsten Betriebsstellen der Krankenhäuser ist der Operations-(OP-)Bereich. Aufgrund seiner zentralen Funktion mit Schnittstellen zu anderen Abteilungen wird der OP-Bereich zu einer Art Kristallisationspunkt vorhandener Mängel in Abläufen und Prozessen. Eine Personalbefragung in einem chirurgischen Zentral-OP ergab als Hauptmängel Kommunikationsprobleme und unzuverlässige OP-Planung ohne Berücksichtigung von Bedürfnissen der Patienten oder der Mitarbeiter. Allgemeiner Wunsch war die Etablierung einer zentralen OP-Organisation sowie die Benennung eines Ansprechpartners für die OP-Organisation (gleichbedeutend OP-Manager). Kurz nach Ernennung eines OP-Managers konnte eine spürbare Verbesserung der Personalzufriedenheit verzeichnet werden. Es konnte eine Kapazitätssteigerung erzielt werden, die Organisierbarkeit war deutlich besser. Notfälle konnten früher eingebunden werden und die Belastungen der Mitarbeiter während der Bereitschaftsdienstzeiten konnte reduziert werden. Das vorliegende Beispiel konnte zeigen, dass wenige Grundmaßnahmen innerhalb kürzester Zeit (1 Jahr) dazu führen, dass grundlegende Organisationsstrukturen geändert werden, dass die Kapazität erweitert werden kann unter Beibehaltung der Rahmenbedingungen und dass die Belastung des Personals reduziert werden kann. Dennoch ist das Projekt nicht abgeschlossen. Strukturelle Verbesserung für die Zukunft sind im OP-Monitoring zu sehen. Auch das verbesserte OP-Controlling wird in der Zukunft dazu führen, dass weitere Eingriffe in die Betriebszeiten erforderlich sein werden. Im Hinblick auf die zu erwartende DRG-Problematik ist auf diese Weise eine Transparenz des Operationsbetriebes möglich.

Weekend Operating Room On Call Staffing Requirements

This article describes a statistical method used to determine the minimum number of OR teams that should be on call for urgent procedures, in-house versus on standby from home, to minimize labor costs. The OR manager obtains the number of ORs staffed at each hour of the 24-hour period of interest (e.g., 7 AM Saturday to 7 AM Sunday) from the surgical suite's information system. The minimum number of total staffed hours needed to care for patients is calculated for a prespecified level of the acceptable risk of inadequate staffing. A method used to determine whether each staff member should work in-house or on standby from home then is introduced. This method enumerates all possible combinations of shifts to find the one with the lowest cost, and it ensures a prespecified service level. An example based on 248 weeks of data collected from a large surgical suite is presented, and staffing for emergency procedures is reviewed.

Surviving OR Construction Projects from Conception to Completion

Suppose an OR needs a new floor, new sterilizers, a new ventilation system, overhead lights, or a floor-to-ceiling renovation. How can an OR manager or director manage a project of this magnitude and continue to provide safe, effective, and efficient patient care? This article explains how, with proper planning, construction projects can be managed safely, effectively, and efficiently for patients, staff members, physicians, and contractors.