Durable Improvements in Efficiency, Safety, and Satisfaction in the Operating Room

Martin J. Heslin, Barbara E. Doster, Sandra L. Daily, Michael Waldrum, Arthur M. Boudreaux, A. Blair Smith, Glenn Peters, Debbie B. Ragan, Scott Buchalter, Kirby I. Bland, Loring W. Rue

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background: Enhanced productivity and efficiency in the operating room must be balanced with patient safety and staff satisfaction. In December 2004, transition to an expanded replacement hospital resulted in mandatory overtime, unpredictable work hours, and poor morale among operating room (OR) staff. A staff-retention crisis resulted, which threatened the viability of the OR and the institution. We report the changes implemented to efficiently deliver safe patient care in a supportive environment for surgeons and OR staff. Study Design: University of Alabama at Birmingham University Hospital OR data were evaluated for fiscal year 2004 and compared with fiscal years 2005 and 2006. Case volumes, number of operational ORs, and on-time case starts were evaluated. OR adverse events were tabulated. Percentage of registered nurse hires and staff departures served as a proxy for staff satisfaction. Results: Short, intermediate, and longterm strategies were implemented by an engaged OR management committee with the guidance of surgical, anesthesia, and hospital leadership. These included new block time release policies; use of traveling nurses until new staff could be hired and trained; and incentive-based, voluntary, employee-scheduled overtime. Mandatory nursing education time was blocked weekly. Enforcement of the National Patient Safety Goals were implemented and adjudicated with a "surgeon-of-the-day" system providing backup for nurse management. We demonstrated an increase in operations per year, on-time starts, and registered nurse hires in fiscal years 2005 and 2006. During this same time, we were able to markedly decrease the number of adverse events, admitting delays, and staff departures. Conclusions: Change is difficult to accept but essential when vital clinical activities are impaired and at risk. To maintain important clinical environments like the OR in an academic center, we developed and implemented effective, data-driven changes. This allowed us to retain critical human resources and restore a supportive environment for the patients, the doctors, and the staff.

Original languageEnglish (US)
Pages (from-to)1083-1089
Number of pages7
JournalJournal of the American College of Surgeons
Volume206
Issue number5
DOIs
StatePublished - May 2008
Externally publishedYes

Fingerprint

Operating Rooms
Safety
Nurses
Patient Safety
Morale
Nursing Education
Proxy
Motivation
Patient Care
Anesthesia

ASJC Scopus subject areas

  • Surgery

Cite this

Durable Improvements in Efficiency, Safety, and Satisfaction in the Operating Room. / Heslin, Martin J.; Doster, Barbara E.; Daily, Sandra L.; Waldrum, Michael; Boudreaux, Arthur M.; Smith, A. Blair; Peters, Glenn; Ragan, Debbie B.; Buchalter, Scott; Bland, Kirby I.; Rue, Loring W.

In: Journal of the American College of Surgeons, Vol. 206, No. 5, 05.2008, p. 1083-1089.

Research output: Contribution to journalArticle

Heslin, MJ, Doster, BE, Daily, SL, Waldrum, M, Boudreaux, AM, Smith, AB, Peters, G, Ragan, DB, Buchalter, S, Bland, KI & Rue, LW 2008, 'Durable Improvements in Efficiency, Safety, and Satisfaction in the Operating Room', Journal of the American College of Surgeons, vol. 206, no. 5, pp. 1083-1089. https://doi.org/10.1016/j.jamcollsurg.2008.02.006
Heslin, Martin J. ; Doster, Barbara E. ; Daily, Sandra L. ; Waldrum, Michael ; Boudreaux, Arthur M. ; Smith, A. Blair ; Peters, Glenn ; Ragan, Debbie B. ; Buchalter, Scott ; Bland, Kirby I. ; Rue, Loring W. / Durable Improvements in Efficiency, Safety, and Satisfaction in the Operating Room. In: Journal of the American College of Surgeons. 2008 ; Vol. 206, No. 5. pp. 1083-1089.
@article{a14cc9b43972444dbfe9fb19a49382ed,
title = "Durable Improvements in Efficiency, Safety, and Satisfaction in the Operating Room",
abstract = "Background: Enhanced productivity and efficiency in the operating room must be balanced with patient safety and staff satisfaction. In December 2004, transition to an expanded replacement hospital resulted in mandatory overtime, unpredictable work hours, and poor morale among operating room (OR) staff. A staff-retention crisis resulted, which threatened the viability of the OR and the institution. We report the changes implemented to efficiently deliver safe patient care in a supportive environment for surgeons and OR staff. Study Design: University of Alabama at Birmingham University Hospital OR data were evaluated for fiscal year 2004 and compared with fiscal years 2005 and 2006. Case volumes, number of operational ORs, and on-time case starts were evaluated. OR adverse events were tabulated. Percentage of registered nurse hires and staff departures served as a proxy for staff satisfaction. Results: Short, intermediate, and longterm strategies were implemented by an engaged OR management committee with the guidance of surgical, anesthesia, and hospital leadership. These included new block time release policies; use of traveling nurses until new staff could be hired and trained; and incentive-based, voluntary, employee-scheduled overtime. Mandatory nursing education time was blocked weekly. Enforcement of the National Patient Safety Goals were implemented and adjudicated with a {"}surgeon-of-the-day{"} system providing backup for nurse management. We demonstrated an increase in operations per year, on-time starts, and registered nurse hires in fiscal years 2005 and 2006. During this same time, we were able to markedly decrease the number of adverse events, admitting delays, and staff departures. Conclusions: Change is difficult to accept but essential when vital clinical activities are impaired and at risk. To maintain important clinical environments like the OR in an academic center, we developed and implemented effective, data-driven changes. This allowed us to retain critical human resources and restore a supportive environment for the patients, the doctors, and the staff.",
author = "Heslin, {Martin J.} and Doster, {Barbara E.} and Daily, {Sandra L.} and Michael Waldrum and Boudreaux, {Arthur M.} and Smith, {A. Blair} and Glenn Peters and Ragan, {Debbie B.} and Scott Buchalter and Bland, {Kirby I.} and Rue, {Loring W.}",
year = "2008",
month = "5",
doi = "10.1016/j.jamcollsurg.2008.02.006",
language = "English (US)",
volume = "206",
pages = "1083--1089",
journal = "Journal of the American College of Surgeons",
issn = "1072-7515",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - Durable Improvements in Efficiency, Safety, and Satisfaction in the Operating Room

AU - Heslin, Martin J.

AU - Doster, Barbara E.

AU - Daily, Sandra L.

AU - Waldrum, Michael

AU - Boudreaux, Arthur M.

AU - Smith, A. Blair

AU - Peters, Glenn

AU - Ragan, Debbie B.

AU - Buchalter, Scott

AU - Bland, Kirby I.

AU - Rue, Loring W.

PY - 2008/5

Y1 - 2008/5

N2 - Background: Enhanced productivity and efficiency in the operating room must be balanced with patient safety and staff satisfaction. In December 2004, transition to an expanded replacement hospital resulted in mandatory overtime, unpredictable work hours, and poor morale among operating room (OR) staff. A staff-retention crisis resulted, which threatened the viability of the OR and the institution. We report the changes implemented to efficiently deliver safe patient care in a supportive environment for surgeons and OR staff. Study Design: University of Alabama at Birmingham University Hospital OR data were evaluated for fiscal year 2004 and compared with fiscal years 2005 and 2006. Case volumes, number of operational ORs, and on-time case starts were evaluated. OR adverse events were tabulated. Percentage of registered nurse hires and staff departures served as a proxy for staff satisfaction. Results: Short, intermediate, and longterm strategies were implemented by an engaged OR management committee with the guidance of surgical, anesthesia, and hospital leadership. These included new block time release policies; use of traveling nurses until new staff could be hired and trained; and incentive-based, voluntary, employee-scheduled overtime. Mandatory nursing education time was blocked weekly. Enforcement of the National Patient Safety Goals were implemented and adjudicated with a "surgeon-of-the-day" system providing backup for nurse management. We demonstrated an increase in operations per year, on-time starts, and registered nurse hires in fiscal years 2005 and 2006. During this same time, we were able to markedly decrease the number of adverse events, admitting delays, and staff departures. Conclusions: Change is difficult to accept but essential when vital clinical activities are impaired and at risk. To maintain important clinical environments like the OR in an academic center, we developed and implemented effective, data-driven changes. This allowed us to retain critical human resources and restore a supportive environment for the patients, the doctors, and the staff.

AB - Background: Enhanced productivity and efficiency in the operating room must be balanced with patient safety and staff satisfaction. In December 2004, transition to an expanded replacement hospital resulted in mandatory overtime, unpredictable work hours, and poor morale among operating room (OR) staff. A staff-retention crisis resulted, which threatened the viability of the OR and the institution. We report the changes implemented to efficiently deliver safe patient care in a supportive environment for surgeons and OR staff. Study Design: University of Alabama at Birmingham University Hospital OR data were evaluated for fiscal year 2004 and compared with fiscal years 2005 and 2006. Case volumes, number of operational ORs, and on-time case starts were evaluated. OR adverse events were tabulated. Percentage of registered nurse hires and staff departures served as a proxy for staff satisfaction. Results: Short, intermediate, and longterm strategies were implemented by an engaged OR management committee with the guidance of surgical, anesthesia, and hospital leadership. These included new block time release policies; use of traveling nurses until new staff could be hired and trained; and incentive-based, voluntary, employee-scheduled overtime. Mandatory nursing education time was blocked weekly. Enforcement of the National Patient Safety Goals were implemented and adjudicated with a "surgeon-of-the-day" system providing backup for nurse management. We demonstrated an increase in operations per year, on-time starts, and registered nurse hires in fiscal years 2005 and 2006. During this same time, we were able to markedly decrease the number of adverse events, admitting delays, and staff departures. Conclusions: Change is difficult to accept but essential when vital clinical activities are impaired and at risk. To maintain important clinical environments like the OR in an academic center, we developed and implemented effective, data-driven changes. This allowed us to retain critical human resources and restore a supportive environment for the patients, the doctors, and the staff.

UR - http://www.scopus.com/inward/record.url?scp=42949148611&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=42949148611&partnerID=8YFLogxK

U2 - 10.1016/j.jamcollsurg.2008.02.006

DO - 10.1016/j.jamcollsurg.2008.02.006

M3 - Article

C2 - 18471761

AN - SCOPUS:42949148611

VL - 206

SP - 1083

EP - 1089

JO - Journal of the American College of Surgeons

JF - Journal of the American College of Surgeons

SN - 1072-7515

IS - 5

ER -