An internet search of “increasing surgical efficiency” produces a plethora of articles and scholarly publications all recommending different ways to achieve this simple goal.
Some recommend applying existing efficiency methodologies, like lean six sigma methodology, to increase productivity[1]. Others recommend redesigning the processes that occur between procedures[2]. Some research recommends constructing new or specialized areas in the hospital, like dedicated minimally invasive surgery suites[3]. Others still point to issues in training, scheduling and personnel management as sources of inefficiency. There’s an overwhelming amount of advice available for those hospitals looking to increase productivity and decrease wasted time and effort.
All of these various methods have their own merits and drawbacks. Used alone or in combination, every hospital has to assess its own strengths and weaknesses to identify areas of improvement. This article will therefore focus on what we believe is the greatest promoter of efficiency in the operating room based on our experiences: The incorporation of technology designed specifically to increase efficiency. But it’s not just us: The European Commission also recognizes in its fund guidelines that cost effective technologies that enable access to better care are important cornerstones of their funding strategy for 2014-2020[4]. The shift from volume-based healthcare (using fee-for-service reimbursement models) to value-based healthcare (best possible outcome at the least possible cost) is also fostering the use of information technology for information sharing within the hospital[5].
In our experience as a player in medical technology for almost 30 years, turning time consuming human interaction into automatic digital processes is the best way to decrease surgical time and thereby increase productivity. After integrating thousands of operating rooms across the globe for the last twenty years, here are four of the ways that we’ve identified for hospitals to digitalize processes to enhance their efficiency.
1. Consolidating data influx into a single control platform
During active surgery, operating rooms are full of equipment and people, which in itself can create quite a chaotic environment. In addition to the staff, surgical table and surgeon’s instruments, the room can be packed with microscopes, displays, endoscopes, anesthesia machines, image guided navigation systems, imaging devices, surgical robots, and more. Many of these systems generate patient data, contributing to this influx of information created intraoperatively. To tackle this, hospitals are consolidating their IT systems to create an environment that is conducive to processing these large amounts of data. NYU Langone Hospital in New York, one of the 10 top-ranked hospitals in the US, for example already began an initiative back in 2007 to consolidate their various information systems into one interconnected data warehouse. This allowed the hospital to streamline processes so much that it helped them double their patient revenue from 2007 to 2015[6].
2. Streamlining documentation flow
The days of printed patient scans are not far behind us. Even hospitals that use digital images nowadays often have cumbersome ways of dealing with data storage and transfer. In fact, surgery is one area that involves significant time spent on documentation and review with some surgeons spending upwards of 3.5 hours a day on these tasks. This translates to significant expense for the hospital, as well — 21% of physician and nurse personnel costs[7]. We’ve seen this happen especially in institutions that slowly digitalized processes over time: They end up with patched together Frankenstein-like IT systems that don’t work smoothly as a whole (for more on this, read Saving Time, Money and the Sanity of your Healthcare IT Team with Virtualization). The best solution here is to implement cohesive systems that are suited to the organized storage and efficient transfer of patient data.
3. Improving communication inside and outside the O.R.
Good communication is essential during surgery not only for patient safety but also surgical efficiency. Part of good communication is ensuring that all members of the team are on the same page. Here, this idea intersects with point 1: If all O.R. team members are able to view the same information from a consolidated system, everyone is working from the same data. Sometimes communication outside of the O.R. is also necessary. During surgery it’s not uncommon for the team to seek expert opinions from surgeons, radiologists or other professionals who may not be in the immediate area. With a good network supported by the right IT systems, these experts can even be consulted remotely, which saves time and effort and works toward giving the patient the best care possible.
4. Facilitating planning from anywhere
Planning is a crucial aspect in many fields and surgery is of course no exception. A well thought out and executed surgical plan can save minutes in the operating room. But what about the time it takes to make the plan itself? Using advanced software that supports quick and effective planning with algorithms and automation can expedite the planning process. Through secure collaboration platforms, planning can even be done from anywhere. A surgeon recently told us about the time he saves being able to review and approve a surgical plan from home instead of having to drive to the hospital to review a case.
Ultimately, choosing one or more methods to increase efficiency depends on the needs of the hospital and O.R. staff. Each way has its own associated cost and effort to implement. In our experience, building efficiency from the ground up very much depends on having a strong technological base that itself is focused of efficiency. With that strong foundation, other processes and methodologies can be used to further increase productivity thereby improving profitability and patient care.
[1] Use of lean and six sigma methodology to improve operating room efficiency in a high-volume tertiary-care academic medical center. Cima R.R., Brown M.J., Hebl J.R., Moore R., Rogers J.C., Kollengode A., Amstutz G.J., (…), Deschamps C. (2011) Journal of the American College of Surgeons, 213 (1), pp. 83-92.
[2] Improving operating room efficiency in academic children’s hospital using Lean Six Sigma methodology Tagge E.P., Thirumoorthi A.S., Lenart J., Garberoglio C., Mitchell K.W. (2017) Journal of Pediatric Surgery, 52 (6), pp. 1040-1044.
[3] Dedicated minimally invasive surgery suites increase operating room efficiency. T. A. Kenyon, D. R. Urbach, J. B. Speer, B. Waterman-Hukari, G. F. Foraker, P. D. Hansen, L. L. Swanström Surg Endosc. 2001 Oct; 15(10): 1140–1143. Published online 2001 Jul 5. doi: 10.1007/s004640080092
[4] European Commission, 2014. Investments in Health – Policy Guide for the European Structural and Investment Funds (ESIF) 2014 – 2020.
[5] Deloitte, 2018. 2018 Global health care outlook.
[6] Harvard Business Review, 2017. The IT Transformation Healthcare Needs.
[7] HIMSS Europe, 2015. Auf den Spuren der Zeitdiebe im Krankenhaus: Die wahre Belastung durch Dokumentation an deutschen Akutkrankenhäusern wird unterschätzt