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Virginia Chard, RN, BSN, CNOR
Pen Bay Medical Center
Rockport, ME
Today’s Healthcare Challenges
It’s a new day in how we deliver and how we are
paid for delivering patient care.
Healthcare reform has brought new strategies,
processes, and innovations to the table.
• Affordable Care Act
• Accountable Care organizations
• Meaningful Use
• Value Based Purchasing
New emphasis going into the future:
• Quality
• Performance
• Accountability
• Efficiency
What this means for the Us
• New strategies for efficiency, cost
containment, revenue enhancement
• New funding- pay for performance, bundling
• Improved utilization of space, time, human
Strategic Plan
Our overall mission:
• Offer safe, highest quality patient care and
customer service to our community
• Increase patient, surgeon, staff, and
anesthesia engagement and satisfaction
• Create potential for new business
The Journey
• Engaging the executive Team in our plans and expected
• Defining the key stakeholders and their roles in the
• Identifying needed resources (i.e. IT) to support the
data gathering
• Developing a format to present the data in a
consistent, concise package
• Building communication channels to share our data
and move our goals forward as a team
Who owns this journey?
Identify Stakeholders:
• Executive team members
• Medical Director
• Chief of Surgery
• Chief of Anesthesia
• Surgical Director
• Department Managers-OR/SPD, PREP, Surgical
• Front line staff
Facts of data management
• Most health care facilities and operating rooms
maintain databases and generate dashboards
that help the management evaluate its
performance; Multiple genre of data has been
collected in perioperative service:
– Clinical outcome: e.g. Surgical Care Improvement
Project (SCIP) measures
– Institutional initiatives: e.g. patient satisfaction rate
– Risk management data: e.g. medication errors
– Operational efficiency: e.g. first case on-time start
– Financial performance: e.g. supply cost/ case
The Game Plan
Assessment of where we are
Team Collaboration across all disciplines
Education and Communication
Stakeholder ownership and involvement
Development of key performance indicators
Process changes identified
Implementation of identified changes
Where We are
Stakeholder Participation
Key Performance Indicators
• Monitor and improve turn around times
• Monitor and improve first case start times
• Monitor and improve/right size block
• Monitor and improve booking accuracy
The Surgical Dashboard
– To report surgeons’ operational and financial performance
– To maximize block utilization
– Retrieve data from ORIS, preference card, supply chain master item file to generate
the comprehensive report
– Surgeon scorecards satisfy the needs of block management and present the
complete picture of surgeon performance related to OR operations
– Key Performance Indicators are in line with OR performance dashboard, e.g. case
volume, first case on time start
– Block utilization, out-of-block surgery minutes
– Monthly report for review and report
– Quarterly report for OR leadership’s decision on block reallocation
Data Management Challenges in OR:
Data accuracy
– Many ORIS do not provide data-cleansing functionality - “Garbage in garbage out”
– Accurate, complete data is essential to an effective performance dashboard
Analytical skills and experiences in OR data management
– DRIP – Data Rich Information Poor
– Let the numbers speak, “gut-feeling” is not always right
Buy-in of surgeons and clinicians
– Data and information needs to be presented in an intuitive and informative manner
– Increase data transparency and data sharing with clinicians
Culture change
– It takes time for data-driven decision making to Gain Ground in hospital and perioperative
The Tools
PBMC Surgeon Utilization Report
PBMC Surgeon Utilization Report
Reserved Block Minutes Use
PBMC Surgeon Utilization Report
•Minutes in Regular Hours
•Estimated vs. Actual Minutes
•First Come, First Served Minutes
PBMC Surgeon Utilization Report
•Day Surgery
•Emergency Minutes In/Not In Regular Hrs
Dashboard detail –specialty group
block time
First Case Start Time
First case start is defined as the time the first
scheduled patient of the day enters the OR
On time is defined as patient in the room by
0735 or within 5 minutes of scheduled start
First Case Starts
>30 min
21-30 min
11-20 min
6-10 min
on time
Turn Around Times
Definition of Turn Around Time:
Patient out of the room time to patient into the
room time
Turn Around Times
45 min
60 min
120 min
– A centralized standard report depicting a
complete picture of OR operational performance
– A continuous measurement mechanism
demonstrating performance trend
– An effective tool helping identify performance
improvement opportunities
– An intuitive communication venue facilitating
decision making process
The rest of the story
Turn Around Time –
• Initial average 27 minutes
• Current Average 22 minutes
First Case Starts• Initial performance average- 62%
• Current performance average- 81%
Results achieved by collaborative changes in
processes by surgeons, surgical staff and
Block Utilization
Work is ongoing as we develop communication
mechanisms to keep surgeons informed of OR
utilization and their individual performance
within their blocks
Several successful changes have already been
implemented to support block utilization and