Running head: Leadership Strategy 1

Leadership Strategy Analysis Quality Improvement Process

William G. Russell
NURS 440






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Running head: Leadership Strategy
Abstract
Efficient use of health care resources grows in importance every day in the United States.
Reimbursement rates are an every changing dynamic as well. Revenue and patient volumes are
the life blood of any hospital. Surgery is one of the most common forms of revenue. Efficiency
must be paramount in any hospital for it to survive. The following work will explore ways to
improve the efficiency of hospital surgical suites.

















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Running head: Leadership Strategy
Introduction
The Department of Surgery of any given hospital is most important sources of revenue for
that institution. Much like airlines needing to fly full airplanes at full capacity to be successful,
hospitals need to use their operating rooms in the most efficient way possible. Operating room
utilization comprises the number of hours each surgical suite is being used for operations, the
number of hours each suite is staffed and the number of minutes of non-billable time. Non-
billable time is any time a suite is not being used for operations. The most expensive revenue
wasting time is referred turn over time. Turn over time is the time after one patient leaves the
operating room until the next patient enters the operating room. During this time, all of the
members of the surgical team are being paid, but not operating. The hospital is also not making
revenue during this time. The focus of this paper will be to explore ways to improve the turnover
time of the surgical suite. Improving turnover time is defiantly a team sport and requires clear
leadership. While hospitals should have a keen interest in decreasing turnover time, quality and
safety must not be compromised in the process.
Clinical Need
The clinical need is to provide the cleanest, safest and most on-time operating rooms to every
surgical patient, every time. As mentioned above, hospitals must utilize their operating rooms in
the most efficient way to make revenue. Hospitals that dont make revenue, dont stay in
business, or hospitals that dont make enough revenue may not be able to afford the latest in
technology, ergo may not be able to provide the best care for its patient. The clinical need that
faster turnover time may create is not having adequate time for cleaning products to have
adequate kill time. Kill time refers to the amount of time a cleaning product needs kill a
specific bacteria and other organisms. Hospitals must also keep surgical site infection as part of
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Running head: Leadership Strategy
their financial equation as well. If a hospital has a high infection rate that hospital will need to
care for any patient who may acquire infections which will ultimately cost the institution more
than the lost revenue they may have lost while ensuring an effective turnover that has adequate
time to kill bacteria. Most third party payers (Medicare, Medicaid, private insurance plans) are
no longer reimbursing hospitals for hospital acquired infections. Infections are a very
unfortunate experience for patients and a very costly event for hospitals. Thus, the problem of
using operating rooms as safely as possible and as efficiently as possible is key to the success of
a hospital. This, as mentioned previously is a team effort that demands supervision.
Design
A team approach is necessary to tackle the first to consider is does a hospital have a problem.
Many hospitals aim for a 20 minute turnover time. Some smaller cases may take much less time
while other more extensive cases may take longer. The author is aware of some hospitals that
take an hour or more to bring the next patient in to the operating room after the last surgical case.
Most hospitals have struggled with this issue and come up with myriad solutions to lessening
turnover time. Its not a formula but relies on a teams experience and creativity. (Leone, G.,
Rahn, R.D. 2012). In the operating room staff comprises many separate, interdependent
disciplines. Anesthesia providers, surgeons, registered nurses, surgical technologists, unlicensed
assistive personal, sterile processing personnel, and environmental services technicians all play a
vital role in turnover time. The activities in turnover time must be distributed among all the
stakeholders in the efficient turnover of an operating room. Some of the personnel must stay with
the patient to unsure safe transfer of the patient to the post anesthesia care unit. In most
institutions these members are the anesthesia provider and the surgeon and or the surgical
resident. The rest of the staff members need to band together to complete the work necessary to
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Running head: Leadership Strategy
complete an efficient, timely and safe turn over. From a cost effective standpoint each person
should work at his or her full licensure. For instance, it does not make economic sense to have a
registered nurse mop the floor of the operating room. His or her time could be much better spent
retrieving medications for the next patient coming to the operating room. Good communication
and clear expectations must be established with each team member. A considerable amount of
evidence exists in nursing and health care literature documenting the disturbing pattern of
harmful nonproductive productive communication in the health care setting (Burgess, C., Patton-
Curry, M. 2014). To be successful in a rapid, safe and effective operating room turnover, each
staff member must know and follow his or her standard work. Standard work refers a specific
step-by-step instruction document that each team member is responsible to carry out the duties
described on the standard work document. Each team member must rely on his or her colleagues
to ensure a safe turnover. Each must see his or her role a vital and an expectation to ensure
patient safety.
Data Collection
The standard work of each team member must be monitored and inspected by members of the
management team. The management staff may develop a check list to chart a visual record of
the disinfect standards. The inspections may help assure the standard work is being completed
and emphasizes that members of management have a vested interest in the entire process. The
leadership of surgical services at any hospital must have patient safety in mind but also have
responsibility for the cost efficiency of the surgical services department. All private health care
organizations must make a profit to survive. If expenses are greater than revenues, the
organization experiences a loss. If revenues equal expenses, the organization breaks even. In
both cases, nothing is left over to replace equipment and facilities, pay for inflation or expand
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Running head: Leadership Strategy
services. (Yoder-Wise, 2011 p.234) All hospital staff should feel a sense of responsibility to
practice in a manner that is safe for patients and financially safe for the hospital.
Establishing Outcomes
As mentioned previously, the standard must be that each operating room be cleaned and
sanitized before and after every patient, every time. If a hospital is not allowing enough kill times
for the disinfectants to work, the operating room will not be safe for the next patient. Evidence
practice shows that many bacteria are able to live for long periods of time and pose significant
harm to future patients hours or days after an infected patient has left the operating room. If
hospitals are not providing a safe environment for patients in surgery, they must embark on an
improvement program (similar to the standard work and inspection listed above) to reach this
standard.
Implementation Strategies.
Communication is the key to any process improvement program. All stake holders must be
present at initial meetings designed to describe the focus of the process improvement program.
Identifying the problem is essential to planning an improvement program. Using a fishbone
diagram can be a very helpful to reach broad understanding of the problem that needs to be
improved. The issue must be outlined using evidence based practice and how each team member
plays a role in providing the safest care for the patients they all care for. In this case, the
operating rooms must be cleaned, and disinfected in a timely manner for each patient. The notion
that every patient is the responsibility of each care team member must be paramount. The idea
of My patient, or Your patient is contrary to the team. Each team member must think of
every patient as our a patient. Next, agreement must be reached that a problem exists and that
each member has a role in patient safety. In Its the staff who do the work, come up with the
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Running head: Leadership Strategy
solutions, and take the credit. (Leone & Rahn 2014). The evidence in one hospital system in
Michigan showed that allowing effective disinfectant time during turnover time allowed for a
safe environment for a patients and an efficient use of the operating rooms. Safety and
efficiency are the goals for a hospital to be effective on all levels.
Evaluation
With all the steps discussed earlier in this work on process improvement, one of the last and
most important steps is that of sustainment. If a well-planned improvement project is not
constantly inspected and sustained, the program will fail. Staff members must continue the
commitment they made in initial meetings to perform standard work responsibilities and
management staff must continue their commitment to inspect, round on improvements and praise
good work. Staff and management also must embrace the responsibility to identify ways that
standard work might need to change to be able to maintain sustainability. The nurse manager
who meets day-to-day management challenges must be able to balance three sources of demand:
upper management requests, consumer demands, and staff needs (Yoder-Wise, 2011. P. 58).
The best ways to monitor the success of process change is to use data. Ways to show trends
include Pareto charts, line graphs and histograms. No matter what tools are used, the only way to
measure success and sustainability are to use comparative data.
Conclusion
Process improvement is essential in todays health care environment. All health care
organizations are being asked to do more with less. Process improvement must be carefully
managed from the identification of an imperfect process to sustainment of the solution and new
process. A first and very important step in the process is to change the paradigm from us vs.
them to the environment of all stakeholders are in equally invested in the solution.
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Running head: Leadership Strategy























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References
Burgess, C., Curry, M.P. (April) Transforming the health care environment collaborative. AORN
Journal. 99 (4)
Leone, G., Rahn, R.D. Time busters: A lean team tackles OR turnover. OR Manager. 28 (7)
Yoder-Wise. P.S. (2011) Leading and managing in nursing. (5
th
ed.) St. Louis, MO: Elsevier