Top 3 Highlights From the Operating Room Manager Conference
The OR Manager conference took place in Nashville last week, bringing together operating room leadership from academic hospitals, community hospitals, and ambulatory centers from all corners of the United States for two and a half days of sessions and conversations. Here are the highlights.
1. “We can’t keep doing things that don’t work”
Dr. Marcus Schabacker, the CEO of ECRI, wrapped up his afternoon keynote with a thought-provoking question for the audience: How is it that when we require a simple medical procedure, we rush to research physicians, fueled by our worry that something might go wrong? Yet, simultaneously, we don’t think twice about stepping onto a metal tube, piloted by a stranger we’ve never even looked up online, sitting on tons of explosives, with the full expectation of soaring into the sky and returning safely to the ground?
The keynote focused on the state of quality and safety, emphasizing the urgent need for a change in approach. Despite constant efforts to improve patient safety since the Institute of Medicine’s “to Err is human” report in 1999, the industry has failed to make a significant impact. Healthcare status quo must change, and one of the critical areas to address is the operating room. Surgical adverse events are the second most common (30.4%) and are most likely to be life-threatening, according to a recent study published in the New England Journal of Medicine .
Now may finally be the time: Dr. Schabacker shared a major milestone in healthcare safety in the United States with the release of the President’s Council of Advisors on Science and Technology (PCAST) report to President Joe Biden on September 7th 2023. The report, titled “A Transformational Effort on Patient Safety,” includes bold recommendations for improving patient safety and the safety of the healthcare workforce :
- Create a nationwide transformational initiative to support every hospital and practitioner in implementing known safety solutions for both patients and the workforce.
- Create and maintain a robust national enterprise aimed at accelerating research, development, and deployment of technology and policies aimed at improving patient safety.
The bottom line: we can’t keep doing things that don’t work.
What does NOT work? Rules and policies. Educational programs.
What does work? Standardization. Redundancies. Checklists. Forcing functions.
Dr. Schabacker’s keynote, which called for the “re-engineering of healthcare” and advocated for a total system approach while borrowing methodologies and technologies from other fields, echoed throughout the conference sessions.
2. ‘Lean’ and ‘Continuous Improvement’ in the Operating Room
Dr. Matthew Miller and Carrie Steiner from the University of Rochester delivered an impressive talk about establishing an environment of continuous improvement in their institution. Their work to improve first-case-on-time-start (FCOTS) leveraged Lean Six Sigma methodology. They emphasized the importance of creating a trusted process for improvement. Rather than setting a one-time goal and trying to hit a number, they focused on creating a process that supports iterative efforts of improvement.
In their session about navigating a Quality Improvement project in the dynamic world of the OR, Ann Marie Morris and Christina Garbarino from the Hospital of University of Pennsylvania shared their structured framework for high reliability healthcare. They provided practical tools for approaching Quality Improvement projects in the operating room, aimed at assisting with three fundamental questions that should precede any project:
- What are we trying to accomplish?
- What change can we make that will result in improvement?
- How will we know a change is an improvement?
3. Addressing the staffing shortage while increasing OR capacity
Quite a few sessions touched the challenge of staffing and the effort to increase staff satisfaction. Dr. Mark Clemens and Elizabeth Priya Ninan from MD Anderson Cancer Center talked about creative staffing models to increase surgical case volume. They painted a grim picture of the current state of staffing in the operating room [3,4]:
- 25% of hospitals reporting being understaffed.
- Nurse-to-patient ratio decreased by 12% in the past five years.
- Agency staffing increased by 30% over the past two years.
- 68% report that recruiting experienced OR nurses is more difficult than 12 months ago.
They quoted Albert Einstein (and were not the last to do so in the conference): “we cannot solve our problem with the same thinking we used when we created them”.
The MD Anderson team created a comprehensive framework that integrates best practices and focuses on team happiness and productivity, providing a holistic approach to increasing OR capacity.
One of the most powerful moments in the talk was when Dr. Clemens shared his ChatGPT experiment, showing a sample prompt that asked to organize a given OR schedule based on a list of constraints and assumptions (e.g. same surgeon shouldn’t follow themselves in the same room), with a goal to end all rooms as early as possible. The ChatGPT output was a complete plan for 3 ORs, meeting all constraints. It took 3 seconds.
Healthcare is at a critical crossroads, presenting a unique opportunity to accelerate research and the deployment of technologies and methodologies for preventing harm. These advancements need to reduce the system’s sensitivity to human errors while simultaneously relieving the burden on the workforce and ensuring improved performance. The operating room is a perfect place to start a transformation.
Maya Ber Lerner is the co-founder and CEO of Chiefy, a digital huddle cloud software.
- The Safety of Inpatient Health Care N Engl J Med 2023; 388:142–153 https://www.nejm.org/doi/full/10.1056/NEJMsa2206117
- Report to the President: A Transformational Effort on Patient Safety, President’s Council of Advisors on Science and Technology. September 7, 2023.
- Saver C. Survey: ASC volumes continue to rise amid staffing challenges. August 21, 2023.
- NSI national healthcare retention & RN staffing report. NSI Nursing Solutions. 2023.