Operating Room improvements earn 'best practices' nod from VHA

Wayne, Mich. – When it comes to dramatically improving a work environment—including everything from morale to profitability—little things mean a lot.

That’s what Aaron Bontrager, business director of surgical services at Oakwood Annapolis Hospital in Wayne, found shortly after he was hired about two years ago. Bontrager was given three main goals: improve patient satisfaction, improve physician engagement and facilitate overall growth in business in the department—a pretty tall order for a person who didn’t have a background in the health care industry.

But Bontrager and the staff at the surgical services center quickly learned that by concentrating on the fundamentals and bringing a nuts and bolts philosophy to the operating room, they could improve overall efficiency of procedures, reduce the time between surgeries and make patients and physicians happier.

“Our physicians had grown increasingly frustrated because of the difficulty of performing cases,” said Bontrager. “By improving the OR throughput, we were able to regain the physician trust.”

Improving the process also improved patient satisfaction. Press Gainey patient satisfaction scores in the surgical services department increased to 98 percent in the Q3 of 2010 and were forecast to again be above the 90th percentile for Q4, said Bontrager. Physician satisfaction went up, too, while operating costs went down.

Those improvements were realized through better organization of the surgery case carts, more detailed physician preference cards and a centralized inventory system, and attracted the attention of the VHA, Inc. a cooperative that serves more than 1,400 not-for-profit hospitals and 24,000 non-acute care facilities in 47 states. The VHA recognized the process as a ‘best practice’ and featured it in its clinical education series in December.

Shirley Norton, a performance improvement consultant for Oakwood Healthcare, has 30 years of experience with Ford Motor Company in inventory and material management. She said sometimes, relatively simple changes in procedures can solve complex problems.

“We wanted to reduce the time it took for the case cart to get to the OR and we wanted to make sure the proper instruments were on the carts,” she said.

By ensuring the case carts are ready and accurate a day ahead of time, and by adhering to a physician preference card—which spells out the type of instrument a surgeon prefers, where they should be located on the operating tray, and how they like the patient to be positioned—surgical services staff found that patients would spend less time in the operating room waiting for their surgery and physicians spent less time waiting for the proper equipment. Assembly times for constructing OR case carts have been reduced from 13 minutes to seven minutes. Accuracy improved from 84 percent to 98 percent in 2010. It drastically reduces the time between surgical procedures, which has quite an impact at a hospital that had performed as many 9,000 procedures every year.

“We want (surgeons) focusing on the patient and the procedure, not worry in the back of their mind if their next case is going to be ready, if their next case going to be on time,” said Bontrager.

“From a patient’s perspective, the least amount of time they have to spend in the hospital, the happier they are,” he added. “From physician’s perspective, the more cases a surgeon can perform while they’re in the OR, the happier they are.”

The other part of the procedure was inventory control. Prior to the change, instruments were stashed in a number of places throughout the hospital, and there was no defined method of keeping track of it. Now, everything is located in one place and the hospital uses an automated bar-coded perpetual inventory system, which decreased financial loss and proved accurate tracking of our inventory.

Bontrager said that, alone, has saved the hospital about $1 million. In 2008-2009, the hospital spent $212,000 on lost/missing instruments. Last year, it was only $30,000.

“We have seen some significant savings,” said Stacy Bierkamp, manager of materials management at OAH.

Physicians have bought into the changes, too, and talked about them to their colleagues. The improved efficiency has had a positive impact on the atmosphere in the surgical services department, too. It has improved morale and allowed for increased communication between staff members. Bontrager said the goal is now to spread the ideas to other Oakwood operating rooms.

“We have a happy OR staff, we have happy physicians and that translates into happy patients,” said Bontrager.