Creating the Ultimate Surgical EnvironmentThe word ultimate gets thrown around a lot these days. Whether it’s the ultimate sub sandwich, the ultimate sports car, the ultimate big-screen TV or ultimate Frisbee, it seems like everybody wants to call their favorite whatever-it-is “the Ultimate.”

So we thought we’d focus our cover feature article in this issue on creating “the ultimate surgical environment.” To find out how, we spoke with several perioperative veterans to get their thoughts on what it takes to create the ideal surgery center.

It Starts With Leadership

Everyone we spoke with said the same thing when first asked what it takes to create the ultimate surgical environment: great perioperative leadership.

“It starts at the leadership level,” says Virginia Chard, the director of surgical services at Pen Bay Medical Center in Rockport, Maine. “Perioperative leadership needs to clearly define a commitment to excellence. OR staff needs a leader they can trust who is engaged in the daily challenges of the unit.”

Jan Davidson, MSN, RN, CNOR, CASC | Director of Ambulatory Surgery Division for the Association of periOperative Registered Nurses (AORN)

Jan Davidson

“Having a smooth-running OR has a lot to do with the leadership capabilities at the top of the organization,” adds James X. Stobinski, Ph.D., RN, CNOR, the director of credentialing and education at the Competency & Credentialing Institute.

“Leaders need to balance the needs of OR staff with the increasing demands for efficiency in health care delivery,” says Stobinski. “There are a lot of balls that have to be kept up in the air.”

Jan Davidson, MSN, RN, CNOR, CASC, the director of the Ambulatory Surgery Division for the Association of periOperative Registered Nurses (AORN), notes that there are many different leadership styles.

“However, great leaders are able to adapt their leadership style to the demands of the situation or challenges that the organization may face,” Davidson says.

There are pros and cons to all leadership styles, says Davidson.

“Unfortunately, the classic model of military-like leadership is the model most often used in the OR — and this is probably the least effective leadership style,” she explains.

“If employees are rarely praised for their good work, this will eventually lead to low job satisfaction and low employee morale,” Davidson adds. “And this, in turn, leads to low physician satisfaction, poor teamwork and poor communication. It can even impact surgical outcomes.”

Stobinsky points to the ability of OR leadership to help staff navigate all of massive changes health care organizations are facing today as critical to creating the ultimatesurgical environment.

If employees are rarely praised for their good work, this will eventually lead to low job satisfaction and low employee morale.“Invest in ongoing education and training for your staff, including your managers,” he says. “By taking good care of your people, you’ll create a better OR environment and get better results.”

“Having clearly defined goals and practicing constant communication with your front-line staff will drive both the morale and efficiency of your team,” adds Chard.

Quality Over Quantity

Another change OR leadership and management has to deal with today that they didn’t in the past is the increased focus on quality over quantity.

“The old saying that volume cures a lot of ills no longer holds true,” Stobinsky says.

“Managing the OR today is about much more than just maintaining a high-utilization rate,” he adds. “With the shift to accountable care organizations and changes in health care reimbursement, quality outcomes are more important than ever in creating the ultimate surgical environment.”

Having a patient-centered focus is critical.

Virginia Chard - Director of Surgical Services | Pen Bay Medical Center

Virginia Chard

“Everyone on the OR team should share one common goal: to support patients with safe, high-quality care in a cost-effective and efficient model of practice. This requires a commitment to cost awareness and finding safe ways to improve efficiency,” Chard says.

Stobinsky echoes her sentiment about being patient centered.

“For example, what are patients’ expectations for how long they should have to wait for surgery?” he asks. “Many ORs need to change the way they do things so the focus is on the patient and not the surgeon. Otherwise patients will go somewhere else — they have choices today.”

Addressing Key Concerns

In the 2015 OR Today Reader Survey, issues listed among perioperative nurses’ biggest concerns include dealing with difficult personalities and creating accountability in the OR. All of the perioperative veterans we spoke with agreed that addressing these concerns is one of the keys to creating the ultimate surgical environment.

“Difficult personalities and a lack of accountability in the OR can be demoralizing and lead to low morale among staff,” says Davidson. “But while staff members need to be held accountable for their actions, this doesn’t mean mistakes have to be punitive.”

“Instead, mistakes should be viewed as a learning opportunity for everyone and a chance to make improvements,” Davidson adds. “In fact, statistics show that the majority of medical errors occur due to a flaw in the system rather than human error.”

Stobinski notes that in the past, many hospitals tolerated abusive behavior on the part of surgeons because they brought in volume and revenue.

“But not anymore,” he says. “Creating the ultimate surgical environment requires dealing head-on with difficult personalities in the OR, including difficult surgeons.”

One simple step that Davidson recommends to help create a more relaxed and productive OR environment is to allow everyone on the team to be called by their first name.

“This tends to put everyone on an equal playing field, removing the hierarchy and making each team member feel valued,” she says.

“In front of patients and family members, it should still be the expectation that physicians be called ‘doctor,’ ” Davidson adds. “But otherwise, allowing everyone in the OR to be on a first-name basis will do a great deal to raise the morale and improve teamwork.”

A Few Best Practices

Chard lists a few best practices followed at her facility that help as they strive to create the ultimate surgical environment.

“For one thing, we have a review of our operating room dashboard data every month at our staff meetings,” she says. “In addition, we have clearly defined performance goals and benchmarks. And, we utilize data driven key performance indictors in our Lean Daily Management within the unit.”

Davidson acknowledges the challenges staff face in room turnover between cases, especially in ambulatory surgery centers.

“A consistent surgical volume equals a profitable surgery center,” she says.

She recommends ensuring that there’s adequate help with room turnover.

“Having an extra person to ‘float’ can be invaluable,” she says. “This extra person can not only help with room turnover, but also with covering during lunch and other breaks. Also, staff is less likely to cut corners if they have adequate help and don’t feel
so rushed.”

“With enough help, you might even be able to add an extra case or two, which will more than pay for the extra staff person,” she adds.

"It's the people who make a great OR." - Virginia ChardCelebrate Success!

Finally, Davidson strongly recommends that OR leadership and staff celebrate success every month.

“Whether this be that you exceeded your volume from the previous month, you had no surgical site infections, or your patient satisfaction scores continue to rise, it’s important that everyone on the team be included in the recognition,” Davidson says.

“Creating the ultimate surgical environment is all about communication, shared goals and shared purpose,” Chard stresses in summing everything up. “It’s the people who make a great OR.”