• Periop Proceedings

    This blog is intended to encourage open dialogue and learning amongst members and interested parties of the perioperative and periprocedural communities for the purpose of envisioning and encouraging higher performing systems.

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Building Capabilities for a High-Performing Perioperative System

Posted at 3:16 pm on Nov 29, 2010 by

What would it be like to be inside a high-performing perioperative system? We may hold different opinions; I certainly have mine.

Recently that opinion was reinforced during a visit to a hospital that has been participating in NSQIP for several years, and which has steadily improved its performance on a number of categories.

How did this perioperative system get to where it is today?  I believe that, several years ago, the chief of surgery began to worry that surgical quality was not what it needed to be, but could not prove it. When NSQIP came along, he recognized that it would provide the credible yardstick for comparing his hospital’s complication rates to other hospitals’.  The results confirmed his fears.  Let’s just say they weren’t pretty…

The good news was that the results fired up the surgeons, who, like surgeons everywhere, crave reliable data.  But simply getting the surgeons to commit to an improvement program wasn’t going to be enough: He also needed to win the hearts, the minds and the enthusiastic participation of the nurses.  To accomplish that, he decided to improve the quality of dialogue between the physicians and the nurses through a dose of Team Resource Management delivered by a former airline pilot.

These steps alone would not have been sufficient.  After all, many hospitals – though not enough, in my opinion –are following a similar path.  What’s really different about this perioperative system is its internally generated commitment to grow its capabilities and, in doing so, to further transform its culture and thus to further improve outcomes.  It’s a virtuous cycle.

So, what’s it like inside the perioperative system at this hospital? Here’s what I learned from several people with whom I spoke: Read more about this article »

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Why “First-Case On Time Percentage” Is Not An Ideal Metric

Posted at 7:22 pm on Nov 16, 2010 by

A few months ago, I was discussing OR metrics with a prospective client, an anesthesiologist.  “Of course, I know that working hard to reduce the first-case, on-time percentage doesn’t make sense,” he observed.  “We’ve known that for some time.”  Unfortunately, he’s in the minority.  Many still behave as though it’s one of the most important metrics to improve.

Here’s why it’s not.

Let’s start with the perspective of a patient who is lucky enough to be the first case of the day.  Although it would be great to be wheeled into the OR right on schedule, being 10 to 15 minutes late would not be too disturbing – “par for the course” when it comes to interactions with medical profession.  I grant you that I would be unhappy if I were delayed for an hour, particularly if I was in for a minor, outpatient procedure.  But we’ll come to that.

Read more about this article »

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