The Fundamentals of OR Management Certificate of Mastery (FORM COM) program is designed to familiarize leaders and managers in surgical services with business skills and knowledge needed to perform in this demanding work environment. The FORM COM program is built on the findings of the Certified Surgical Services Manager (CSSM) Job Analysis performed by the Competency and Credentialing Institute (CCI) in 2020. That job analysis study compiled descriptive information about the tasks performed by surgical services leaders and managers as well as the knowledge needed to perform those tasks.
This certificate of mastery course will concentrate in the areas of the business administration of surgical services to include supply chain management and operations. This certificate program will facilitate the stated learning outcomes through education, training, and learning activities, and is designed for nursing and non-nursing staff who concentrate in business operations for the OR. The Fundamentals of OR Management Certificate of Mastery is awarded upon satisfactory completion of all course activities. It designates that participants have completed the required education/training and demonstrated accomplishment of the learning outcomes.
*Additional fee applies
Attendees who successfully complete all learning will earn a certificate of completion as well as 6.0 CE credits.
The mindsets and concepts of great leadership have been taught forever. In fact, we all know what to do; the difficulty comes in finding ways to do it consistently, even in the face of disengagement and business and personal pressures. An added challenge is that we all have “blind spots” when it comes to our own thoughts and behaviors that are hard for us to recognize and even harder for others to tell us. In this entertaining and enlightening program, Sandy shares stories and insights that help leaders identify the daily actions and behaviors they can do to inspire employee engagement and contribution. She will share a successful formula for creating cultural consistency in the midst of human inconsistency and allowing everyone to respond respectfully and compassionately when human mishaps occur so everyone can get back to the business of caring for patients ASAP.
Escalating costs in today's perioperative environment are a significant concern, undermining the financial viability of many hospitals amid the pandemic. Hospitals are facing extraordinary challenges effectively balancing the cost of clinical care, managing escalating medical supply costs, and addressing capacity issues with higher acuity and increased co-morbidities among patients. Creating a multifaceted approach to address these issues requires "all hands-on-deck" and innovative solutions led collectively by nurses, physicians, and hospital administrators.
A tertiary, academic medical center has implemented a multidimensional strategy to effectively address and monitor these issues. The roadmap begins with ensuring the clinical care is completed in the most appropriate environment. Transitioning elective outpatient procedures from a traditional inpatient OR environment to an ambulatory setting is not only cost effective, but is often driven by patient- and family-centered care amenities. The team developed a methodology to review elective outpatient procedures based on clinical, regulatory, environment, supplies and equipment, and staffing competencies required for the procedures.
The ability to transition elective outpatient procedures to the appropriate environment of care also created additional capacity for the surgical inpatient hospital needs. Providing cost transparency information to the surgeons and clinical teams created the opportunity to decrease cost of care by creating a cost-per-case receipt at the conclusion of each surgical procedure. Optimizing inventory and supplies by increasing ownership among the multidisciplinary committee managing value analysis, new product entry, and supply standardization created additional savings.
Take-home tool: An outline of a strategic plan to identify cost saving opportunities for surgical care by using several quality improvement tools to implement solutions and measure outcomes.
The surgical supply inventory can be overwhelming, but Cincinnati Children’s Hospital Medical Center (CCHMC) has successfully used a multidisciplinary, data-driven approach to right-size and distribute its surgical supplies. The approach blends data-driven decision making with engagement from frontline clinical staff to make best use of limited staff, space, and budget. CCHMC has identified opportunities for nearly $2 million in savings by reducing low and slow-moving items and adjusting par levels to more closely match supply with demand. Attend this session to discover how to harness the power of data and staff to increase efficiency.
Take-home tool: A one-page dashboard of statistics and step-by-step tips.
Anesthesia providers are vital components of an efficient operating room; however, alignment with these key partners is erratic at best. Therefore we ask, in your perioperative improvement efforts, do you consider anesthesia a friend or foe?
In this presentation, Dr. Robert Stiefel, Enhance Healthcare principal, will discuss reasonable roles and expectations to be provided by anesthesia groups in optimizing OR performance from pre-operative preparation to patient discharge. Examples of mechanisms used to improve alignment, appropriate terms to include in anesthesia contracts, and anesthesia metrics and KPIs will be reviewed. The concepts of Enhanced Recovery After Surgery and the role of your anesthesia partners in these initiatives will be presented as well.
Ultimately, this presentation will provide a framework to align your hospital with your anesthesia providers and create another group of "friends" to help drive operating room performance.
Examples of anesthesia performance dashboards will be shared with attendees.
The day-to-day logistics of an OR, procedural area, or central sterile supply room are enough to keep hundreds of staff busy 24/7. Concurrent with the core functionality of the department, OR staff are also asked to manage and direct process improvement projects, facilitate change management, develop staff, and create bench strength for their teams. At our organization, we have a culture that is constantly looking for better ways to achieve outcomes and increase efficiency. We start multiple projects and then find our staff trying to determine how to do their “day jobs” plus this work. We needed to align the right people with the right opportunities and find the time to make it happen.
In this presentation, we will outline the tools we used to inventory the capacity of our team members, the daily work taking place, the additional projects we wanted to tackle, and what our staff needed from leadership to grow and develop professionally. This inventory led to a shift both tactically and strategically in how we approach our work, giving special consideration to resource involvement and alignment with long term strategy. We will summarize the benefits we have seen from this change, including clear communication and advancement of work using common templates and work structures, as well as additional allowances for staff to develop professionally. Audience members will be provided with take-home tools to replicate these exercises at their own institutions.
Take-home tool: A template to incorporate project specific tools to optimize staff planning and inventory management.
For most hospitals, ORs are the economic engine. It is frustrating for hospital leaders and managers to base very expensive decisions on anecdotal or inaccurate OR utilization information. For example: do you really need to build a new OR? Do you need to add an additional robot? It is also stressful to have difficult conversations with surgeons about block utilization, particularly when the surgeons have options to take their cases elsewhere. The key to OR utilization and performance improvement lies in access to accurate, timely, and transparent data. Unfortunately, this is not the type of data delivered by traditional EHRs.
Join Northwestern’s director of business operations, surgical services, to hear how the health system decided to adopt a cloud-based software solution to gain access to transparent data, defensible metrics, powerful visualizations, and easy-to-use tools “on the fly.” Hear how the adoption has improved data transparency and decision making; filled valuable time during the day that had previously gone unused; and even delivered a solid ROI within a very short timeframe.
Ensuring your ORs are efficiently staffed but not too lean is always a challenge. Our team developed a staffing model tool that has allowed the department to accurately assess the number of staff needed at any given time of day, arrange shifts to cover those times, and successfully demonstrate the need for nursing and hospital leadership to gain support.
There are four key steps:1) Understand the staffing needs by case type, break requirements.2) Collect historic case data and model planned growth.3) Optimize the model for consistency of shifts and shift duration.4) Once validated with key stakeholders, socialize with staff and leadership for support.
The process begins with an understanding of what is needed to support casework. We then analyze historic trends to identify specificity by day. The next step is to collect and organize case data and any projected growth. This includes number of cases by day of week, average case duration, and turnaround times. Information relative to paid time off for the staff, break frequency and duration, and other scheduling data will also need to be collected. For step three, the model marries both sets of information previously collected to identify the number of staff needed by hour for each weekday. Once shifts are overlaid, break relief is measured and adjusted. Finally, the model optimizes by shift mix of eights, tens, and twelves to minimize waste.
The last step of the assessment and implementation is socializing the information. Often, the analysis will display times when the current staffing may not meet the ideal needs of the unit and it is easy to visualize this change. This is particularly useful when current staff may be asked to change their start times or shift duration to match department needs. It may be necessary to add staff; the model, with clear steps and targets, makes it easy to see where those needs are.
Take-home tool: A step-by-step worksheet detailing the processes to develop a meaningful staffing model that will align staffed hours and case needs.
The Massachusetts General Hospital central sterile processing and supply department launched a strategic initiative to optimize OR supply management. After a comprehensive evaluation of existing supply workflows, senior leadership identified two strategic opportunities to increase OR supply management efficiency: realign role groups to work at the top of their skillsets and redistribute responsibilities across shifts. The most critical component of the resulting operational plan was to move stock replenishment functions from the day shift to the night shift, and in this new model, elevate existing inventory specialists to perform advanced supply management functions on the day shift.
Minimal disruption to the OR, as determined by feedback from perioperative administration, physicians, and nursing, was crucial to successfully transition replenishment activities to the night shift. While planning the transition, the team identified a major potential barrier to success: informal communication channels that would obscure and further silo inventory management work. To increase visibility for leadership, enhance accountability, and support collaboration between the night and day shift staff, the team developed a portfolio of Smartsheet-based tools that are adaptable, user-friendly, and capable of facilitating complex workflows involving multiple teams.
The team mapped existing and future workflows, identified process owners, and designed Smartsheet tools to support inventory management optimization efforts. As a result of deliberate stakeholder engagement, user-testing, training, and staged implementation, the Smartsheet tools have supported the successful transition of stock replenishment to the night shift and greatly improved visibility into the current scope of operational challenges in OR inventory management.
Take-home tool: A step-by-step guide on implementing Smartsheet automations, reporting, and dashboard functionality to drive operational efficiencies and help dynamic teams achieve strategic goals.
ASC's play an important role in the value-based care environment. Those that are poised with the ability to provide a bundled payment strategy can leverage this as a financial opportunity. Bundled payments can be used with commercial payer negotiations, to contract directly with self-funded employers, as well as to attract cash paying healthcare consumers. This session will define the bundle payment strategy and provide insights in determining if it is a fit for your center as well as practical steps for implementation.
Discuss strategies to determine if bundled payments are a fit and practical steps for implementation.
The exact number of American perioperative nurses is not known with any certainty. Nor is there reliable information on the demographic makeup of these nurses. There are reports of staffing shortages in the specialty which have been exacerbated by the COVID pandemic. The lack of meaningful perioperative nursing content in pre-licensure education courses makes recruiting problematic for the profession. The operating room is the economic engine of the hospital but that engine must be staffed by perioperative nurses. Researchers from the Competency and Credentialing Institute will present findings from 2021-2022 research study which sought to gather detailed demographic information on the specialty. Workforce planning and recruiting into the complex specialty of perioperative nursing is difficult and recent OR Manager surveys reinforce the data on staffing shortfalls. The information presented in this session will clarify the makeup of the profession and will also serve to guide recruiting and retention efforts for employers. Attendees will gain a better understanding of the makeup of the perioperative nursing specialty and the unique recruiting challenges inherent to staffing an operating room.
All attendees will be given a summary of the findings from the recent research done by the Competency and Credentialing Institute regarding the demographic makeup of the perioperative nursing workforce.
Calculating an accurate duration for scheduling surgical cases can be very complex due to significant variability found between patients, procedures, and surgeons. Northwestern Memorial Hospital (NMH) has made enhancements to the case request workflow and built a custom case duration predictive model to improve our scheduled case duration accuracy. At NMH, case duration accuracy is defined by a case finishing within 15%, or within 10 minutes, of the scheduled case duration. The predictive model is expected to improve our case duration accuracy from 42% to 53% across all service lines, including add-ons.
This predictive model is a gradient boosting tree model that takes the Epic generated duration and modifies it based off many different case specific factors. Some key factors that most impact the case duration (as identified in the model) are patient weight, surgeon requested time, clinical risk factors, procedural regions, and anesthesia type, among others. The predicted duration is not only expected to be more accurate for single procedure cases; for cases with multiple procedures, the predictive model is significantly more accurate than Epic's average duration calculator. Additionally, it is expected to be more accurate across all service lines and 90% of individual surgeons.
When implemented, the predicted case duration will be built into the case details where our scheduling team will be able to review, utilize, and refresh as necessary. The predicted time will calculate soon after the case is requested, allowing the case to be booked with the appropriate time from the start. The expected impact of the increased accuracy will both reduce our patient delays and unexpected overtime as well as improve surgeons’ ability to schedule the appropriate number of cases in their allocated block. We expect the percentage of cases that run pasts the scheduled duration to reduce from 32% to 24%, and cases that finish ahead of their scheduled duration to reduce from 26% to 23%.
Market forces and healthcare reform require nimble, creative teams to ensure ongoing delivery of innovative, high-quality care while keeping organizations solvent. Within hospitals, this requires input from many stakeholders including physicians, nurses, and hospital administrators. To be most effective, interdisciplinary alliances must transcend cooperation to form true partnerships. While diverse perspectives have been shown to produce enhanced outcomes, leveraging them is often challenging due to the differences in focus and priorities, distrust, and tension between clinical and non-clinical disciplines.
In this breakout session, three perioperative leaders from different disciplines—a nurse, a physician, and an executive—will share their experiences in building strong, interdisciplinary partnerships as well as a framework to support shared governance in their institution. This session will illustrate how galvanizing diverse backgrounds and viewpoints led to cost savings and enhanced patient outcomes.
Take-home tool: A step-by-step guide to collaborative leadership to develop cost savings initiatives and to enhance patient outcomes.
Preceptors need guidance and techniques in transferring knowledge and skills when orientating. The perioperative STAR preceptor development program aims to address this need using the STAR technique. The program launched in 2020 at the height of the pandemic. It continued as a month-to-month class; one year later in August 2021, the program had trained 61 RN preceptors. Each of the five different OR campuses as well as the preoperative and PACU units of these campuses have been represented. The ratio of 321 perioperative RNs to 61 RN preceptors account for 19% of trained preceptors who have been taught the concepts of adult learning. In the span of one year, 17% improvement of preceptor availability is observed. Further evaluation would determine perceptions of impact of the use of adult learning strategies during orientation. Retention improvement has been obvious and job satisfaction levels are improving.
Take-home tool: A guide detailing concepts and examples of structured learning episodes and how to apply them to your facility.
In an ever-changing healthcare environment, it is of utmost importance to ensure that effective communication occurs across multiple ancillary departments. But what does this look like? Doing more with less resources requires both business services and operations to seek creative ways to manage their new norm. Leading working groups consisting of supply chain analysts, contracting, finance, and IT colleagues to complete operational builds of newly acquired facilities are essential to successful integration of a network.
Perioperative services at Lehigh Valley Health Network encompass a centralized team responsible for all scheduling and billing of perioperative surgical cases. This is a multidisciplinary approach that creates value in the workplace and a positive impact to our clinical colleagues. This session will focus on what it takes to engage front-line and departmental colleagues, provide tools and key points on integrating acquired health care systems, and define KPIs to create an operational dashboard. This dashboard serves as a transparent tool for leadership to analyze and track targeted performance metrics within our system.
Take-home tool: A step-by-step guide on analyzing operational data and creating working groups to effectively complete successful integrations of facilities.
This interactive presentation will focus on the financial and quality implications of unprofessional behavior in the OR. Participants will define behavior that is a risk to patient safety and leads to poor outcomes; discuss the importance of a culture where co-workers feel safe to report these behaviors and trust the organization will address them; and become familiar with a process to address patterns of behavior inconsistent with the values of the organization. Attendees will be able to define unprofessional behavior in the OR and its impact on team effectiveness and patient outcomes; discuss research that associates unprofessional behavior with higher malpractice costs and poorer surgical outcomes; and identify a tool and process to promote professional accountability and address observations of unprofessional behavior in the OR.
Take-home tool: Step-by-step guide to address unprofessional behavior, which has quality, safety, and financial implications for the organization and the OR.
Unicorns, or one of a kind stand-alone instrumentation in an OR setting, can create multiple challenges in efficiency. The Medical Center of Aurora focused on instrument management as an initiative to drive OR efficiencies by optimizing a focus group approach. The main objectives of the focus group were to: reduce the number of unique or unicorn instruments in our instrument fleet; identify instrument tray quantity needs; and improve case management through effective team engagement.
Unicorn instruments create continued concern for immediate use steam sterilization, generating a negative impact on scheduling efficiency and instrument availability as well as creating inefficiency for both the OR and sterile processing teams. The focus group centered on improving communication and relationships between the OR and sterile processing, creating an intimate understanding of the workflow and needs for both departments and resulting in improved instrument management inside and outside of the OR.
Implementing the focus group approach to improve OR efficiency through instrument management yielded more than improving instrument inventory and OR efficiencies; it created team harmony in the OR space, eliminating unicorns of all kinds (instruments and personnel) in teams. The group was able to clearly determine quantity of instrument trays and peel packs necessary to support the forecasted schedule.
Take-home tool: An instrument matrix to evaluate the appropriate numbers of specific instruments to support scheduled cases and block schedules.
Boston Children's Hospital was historically applying a flat time charge regardless of the resource intensity of an operative case. The opportunity to reassess this structure was raised previously but never successfully implemented. This presentation describes the partnership between OR leadership and the finance department to internally create a scoring process, communicate and develop acceptance for the change, implement and monitor the levels, and provide ongoing reporting of the financial impact of the change.
The aim of this was to meet the following goals: 1) Assign a lower and more competitive time charge for the types of cases that are done on a community setting. 2) Capture additional revenue for the cases where Boston Children's Hospital is a destination for care and to better align the revenue with the underlying additional staffing or equipment expenses of the operation. 3) Align ourselves with the more common leveled pricing that is seen elsewhere in the market.
Given that this was implemented during the time that services were ramping back up from reductions due to COVID-19, the financial impact of this change was beyond expectations. As part of the strategy, this new model poised us to more accurately charge a higher rate for the higher acuity cases. It was put in place to be revenue neutral, but in the end, we were able to benefit from the increased acuity. A secondary gain was that we had developed a measurement of acuity based on how we developed these levels. We could more accurately describe the increase in resource intensity of cases over time, both how it relates to direct staffing and supply usage as well as preoperative planning and assessments that are necessary with increased case intensity.
Take-home tool: A step-by-step guide on the financial opportunity to updating your billing structure and monitor the implemented changes to quantify the results.
Surgical errors resulting in adverse events are significant causes of morbidity and mortality in the US. The majority of surgical adverse events occur in the OR, and as reported in literature, nearly 50% of the adverse events are preventable. The OR is a complex environment, and creating a culture of safety is contingent upon the ability to not only learn from adverse events, but to celebrate behaviors that are congruent with best practices. To actively drive a robust culture of safety, it is imperative for perioperative teams to promote transparency and facilitate learning by incorporating innovative technology.
Consistent with lessons learned in the aviation industry, the implementation of the Surgical Safety Technologies "Black Box" captures continuous, comprehensive intraoperative data and monitoring for targeted interventions to discover effective ways to identify errors and prevent them from recurring. The implementation of the Black Box quality improvement project in a large, tertiary academic medical center has created transparency among surgical teams and facilitated open dialogue to enhance teamwork. The data obtained from this initiative has shown an increase in OR efficiency for first case on time starts; reduction of turnaround times; and increased the quality, engagement, and compliance of the surgical timeout checklist. Supporting an environment of transparency, all members of the OR team are empowered to request a surgical case review using the Black Box technology to learn from defects and identify possible safety concerns, incorporating findings into action items as a proactive approach to promoting a culture of safety in the OR.
Take-home tool: A tutorial describing the benefits of implementing Black Box technology in the OR as an innovative solution to enhance OR efficiencies and promote patient safety.
The way we manage OR blocks and capacity is broken. Traditional tools require significant manual effort and lack real-time connection to automate provider schedules and PTO, as well as up-to-date patient case information. The use of disparate systems to manage these operations restricts hospitals and health systems from truly optimizing capacity.
QGenda Capacity helps healthcare organizations manage all provider operations in one place and optimize capacity. With this new operational tool, for the first time, hospitals and health systems can easily view and manage real-time provider schedules, OR blocks, and patient case information in a centralized location—increasing efficiency and giving visibility into schedule and patient densities.
With provider schedules, OR blocks, and patient case information in one location, perioperative leaders can improve OR block allocation and utilization, accurately align provider time and resources to patient demand, and ensure more patients receive the care that they need faster. Ultimately, this enables hospitals and health systems to increase patient access, improve revenue capture, and positively impact provider performance and satisfaction.
Unannounced CMS surveys are a reality for centers providing surgical services to Medicare and/or Medicaid beneficiaries. Even centers who choose the route of deemed status through accreditation from entities such as JCAHO or AAAHC are not exempt from this anxiety provoking experience, as one could encounter a CMS validation survey following their deemed status survey or a focused complaint survey. Knowledge and understanding of the CMS conditions for participation and corresponding interpretative guidelines provide an awareness as well as a roadmap for overall compliance. Proactive efforts aligned with ongoing preparation and staff awareness of what to expect during the survey process can foster a more positive experience and a successful survey outcome. Attendees will be able to discuss the types of unannounced CMS surveys a facility could expect to undergo; identify proactive activities that can be taken to foster a state of ongoing preparedness; and discuss what to expect during the actual survey process.
Take-home tool: A tutorial on processes that can be taken to proactively prepare your center for a CMS survey.
The purpose of this session is to present our experience with tackling the complex challenges related with vendor tray management. Limited storage space coupled with high volumes of vendor trays and implants have made this process improvement work essential to the successful operations of our busy surgical suite. We will provide you with ideas for implementational change in your own surgical suites.
Take-home tool: A worksheet to take the traditional 5S tool and altering it to fit your needs. Step-by-step directions on breaking down your current process into a flowsheet and 50 ways to engage with your vendors.
Join us for this exciting wrap-up panel discussion as we close out this year’s conference! Hear directly from members of the OR Business Management Program Committee and their perspective on the business of managing the surgical suite. Ask your burning questions and get advice on overcoming challenges with staffing, scheduling and operating on razor thin margins.