Organizations that are capital investment or service intensive have a special interest in resource utilization. Consider what happens to an airline every hour its planes sit on the ground. Consider what happens to a law firm when partners and associates are not billing.
Or, consider a hospitals surgical unit and what happens when the first procedure of the day is delayed and immediately backs up constrained facilities, high-paid personnel, heavy equipment and the sanitary turnover required to keep an operating room (OR) on a busy schedule. Multiply that by 27, the number of operating rooms run at Lahey Clinic, the Burlington, Massachusetts, medical facility affiliated with Tufts University School of Medicine, and you get an idea of the caseload and business process challenge at hand.
Laheys surgeons perform open-heart procedures, liver and kidney transplants and a variety of robotic-assisted cases on a daily basis. Like all perioperative units, Laheys deals with everything from the initial case for surgery, to scheduling the right people and equipment in the right place, to wheeling the patient off the floor post-anesthesia.
It requires a lot of administration and is not as orderly as the structure might indicate. What we plan is never what we end up doing, says Janet Burke, operating room systems manager at Lahey Clinic. We always have add-on cases, emergency cases and cancellations, so were constantly juggling our daily schedule for the best utilization, keeping to plan to shut down the OR at the times we want and plan for our staffing at the end of the day.
Utilization rates have a big impact on productivity, worker and patient satisfaction, and its estimated that perioperative units contribute as much as 60 percent of both costs and revenues in surgical hospitals. One key metric of success is first-case delay, or simply the success of launching the days first surgery in a given operating room on time. Lahey Clinic has recently seen this key metric improve by 35 percent. How did this happen?
From Tracking to Monitoring
Laheys answer to perioperative efficiency and activity monitoring came in the form of an advanced dashboard of indicators, which could be configured for surgeons, nurses, anesthesiologists and administrators. The solution came from a vendor called Picis, which has licensed systems for more than 1,300 hospitals in 19 countries.
Burke manages surgical scheduling at Lahey, acts as the Picis administrator and provides reporting and analytics for operating room and other units. Her job deals with performance management, compliance and process improvement.
We had a modern patient-tracking program and thought it was great because it could follow a patient walking into the building all the way through their post-op unit experience, says Burke. It gave us a lot of information, but you had to look in each of the rooms and look at colors on the tracking board to figure out first-case delays, what rooms were in turnover or what rooms are running late. With Picis you get real-time interactive status, and you see graphs and speedometers. Its a very quick, at-a-glance look.
This allows information to be distributed electronically rather than by word of mouth. At Lahey, youll see workers in scrubs and surgical masks glancing at monitors as they move about the facility. The on-duty charge nurse and the anesthesiologist running the floor mind the OR dashboard and immediately know which rooms are turning over. A display ticks off the minutes above the norm and flags them for extra staff. First-case delays show up immediately. Its really offering more that we can address in real time, Burke says. But were seeing the greater impact of particular issues and getting more people involved. All of a sudden someone is walking into the room to address why a case started 40 minutes late.
There is ability to drill down into metrics, but more important is the ability to hover over information for a summary that tells floor managers to adjust their schedules, mobilize staff to specific rooms and plan for end-of-day staff if rooms are going to be shutting down later than anticipated. Were not waiting at 2:45 in the afternoon to ask our 3:30 people to stay late because a room is starting, says Burke. Were looking at this at noon and adjusting our 3:30 and 5:30 staff. Not only do we adjust our staffing plan for today, the forecast shows the current week and next week. If we have 90 percent utilization on Friday and 68 percent on Wednesday, we forecast and move staff to different days.
The chief nursing officer uses the display to inform nurse managers in preoperative and post-anesthesia units of the ripple effect of delays or shutdowns, the staffing and overtime that will result and report whether past overtime staffing was necessary.
While the dashboard is not intended for strategic reporting, senior managers use it to manage process and productivity issues, safety and compliance programs and personnel certifications. Laheys chief surgical service officer is a super user of the dashboard who manages discrepancies and disputes among surgeons and anesthesiologists regarding case start times and other process issues. The division of surgery chairman uses the dashboard to monitor organizational resources with summary status views.
As for Burke, she remains a licensed physical therapist even though the last 20 years of her career - a temporary departure that became a career in systems management - took her to a different role. She is no less a part of a team effort that keeps her on the floor with her health care peers. We are all proud of our efficiency and being able to manage our daily operations and to forecast things we could never do before. We all gain by being able to look at something and know the answer.