Operating Room Efficiency

Dear Colleagues:

I’d like to share with you a recent article published online in the Journal of Orthopedic Experience and Innovation. If you are not familiar with this journal, take a look, as it is a fast-track for critical reviews and insightful studies that might otherwise languish before publication in the usual peer review journals.

In their publication, “12 by 12: Obtaining True OR Efficiency with Radical Time Transparency and Operational Excellence” the authors shine a spotlight on the reality we all share in the operating room environment of our large hospitals. This is a cultural mindset of barriers to efficiency. Their analysis considers many of the principles of Time Determined Activity Based Cost (TDABC) accounting, which Professor Robert Kaplan has applied to a variety of industries including healthcare. The concept of time management, efficiency and profitability is thus, not new.

All of us understand that ASC's are always more efficient than AMC's and large institutions, and part of this has to do with the culture and structure which differ in each of these. That said, the healthcare systems in which we work have, so far, been incapable of lean management. In defense of their historical structure, AMC's have a complex mission inclusive of education and treatment of complex and revision cases which may be neither profitable nor acceptable to smaller hospitals and ASC's.

When I studied our own hospital system, I found that a big part of our problem was the siloed structure of our OR’s and the lack of clear communication and coordinated care not only between our anesthesia, nursing, administration and surgical teams, but also between middle management and the end users, us.

This article packages all of this and offers insight into how we can do better.

Kind Regards,

“JP” Warner MD

Founder, The CSS

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