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Process Improvement Teams: A Collaborative Approach to Meet the Challenges of Today’s Operating Rooms

By David L. Taylor III

The most relevant resource an organization has is its people. To stay nimble in today’s health care market, organizations need to develop and empower employees with greater responsibilities to develop sustainable solutions for complex situations health care organizations face. Perioperative leaders cannot be everywhere, and they don’t need to be. Employees should be trusted to make decisions. The OR is too complex of a department for this not to happen. Allowing employees to implement ideas will produce lasting effects. While he was the CEO of General Electric, Jack Welch spent half of his time developing people with special emphasis on developing future leaders.1 Teamwork and interdisciplinary collaboration can increase employee awareness leading to better communication and decision-making. This shared and participatory governance model gives employees a voice helping them to feel vested in the company which maximizes their efforts, having an immediate effect on patient outcomes.

Fostering and Empowering Your Teams

Leaders have an obligation to bring their employees together and strive for one goal. That is to work harmoniously to support safe patient care. Effective leaders recognize that organizational collaboration is an important part of being a transformational leader who encourages team participation as part of the problem solving process.2 By relinquishing control and advocating for decision making to come from those responsible for doing the work, a collaborative environment is created where employee opinions matter. This can have a lasting impact on the organization’s culture.

Process Improvement Teams

Creating process improvement (PI) teams creates an environment that promotes the ideas of the employees; leaders who use PI teams will gain a greater share of employee’s expertise, opening new opportunities to improved quality, safety and financial performance. By recognizing the skills and expertise of employees and the willingness to share information not only helps generate ideas but develops skills within the service line as well. This supports quality and improved practice standards, which in turn reduces operating costs. Leaders who make the effort to bring the right people together create pockets of excellence that allow employees to take on greater responsibility for organizational performance.

The concept of using frontline employees, in a semi-formal setting such as PI teams can produced some amazing results. Leaders who partner with their employees can address numerous difficulties within their service line, removing the silo mentality and creating a culture of empowerment. Employees’ ideas help provide focus. Delegating authority will unite the PI teams toward a common goal. In turn these teams will push boundaries to improve performance and reduce the risks patients face when entering the health care environment. Employees who participate in a professional forum deliver results.

Building Your Team from Within

When developing an effective PI teams leaders should consider including frontline employees at all levels from inside and outside of their service line. Front-line employees provide insights to everyday situations and act as live sounding boards for new process recommendations that can have an impact on the care environment. By including staff from various departments, the PI teams gain insight to the issues faced by all, bringing new perspectives to everyone. Leaders who create an environment that promote safety, accountability and collaboration will optimize the working relationship between the people of various departments. Supporting one another throughout the collaborative process helps inspire innovations that improve the delivery of safe and effective care.

Exposing PI members to each other’s departments and work processes can have a positive effect as well. Observing how decisions are made and the impact those decisions will have on workload will help employees understand the importance of working together. It can also underscore the importance of their roles in the entire process. These experiences provide both parties with an in-depth understanding and allow members a chance to ask specific questions about points they may not fully understand, which in turn develops a more robust process.

Overall transformation and cultural changes can be accomplished by implementing a series of PI teams that can be used to lead change in areas such as efficiency, staff education and safety, technology and value analysis. Leaders who utilize this type of method should know how important it is to listen to the input of the PI teams and take action. This prevents the team from becoming dissatisfied and feeling as if their efforts are being wasted. Leaders who build confidence among their employees helps them to realize their ideas will be valued.3 Examples of PI teams and their responsibilities could include

Efficiency and Safety

  • Includes parallel processing,
  • Review of key performance indicators and benchmarks, such as,
    • First case on time starts
    • Turnover times
    • Block time and OR capacity
  • Creating a safer surgery culture.


  • Develop dashboards, scorecards and reports
  • Updating IT and communication technologies throughout service line
  • Develop cross training initiatives that incorporate best practices

Value Analysis

  • Evaluate new equipment and review high cost supply spend
  • Review outsourced functions,
  • Improve supply chain management.

Financial Implications

Organizations who are quality minded and focused on initiatives that put the ideas of their employees as a top priority have created high reliability services lines. Leaders who have incorporated direct engagement and embraced collaboration have not only aligned priorities that lessen the risks associated with health care, they have created tremendous financial opportunities for their organization as well. As a result of using PI teams several organizations have

  • Rebuilt their staffing models around new block schedules that resulted in a $1.7M savings
  • Redesigned a perpetual inventory system resulted in $1.2M in savings
  • Through a multipronged approach, the organization decreased its cancelation rate to less than 2%, grew surgical volume 22% in a higher acuity platform, and gained a net income improvement of $7M
  • Developed a comprehensive capital equipment campaign to create competitive differentiation and first to market strategy resulted in a 31% increase in surgical volume
  • Restructured a perioperative education, orientation and competency training program, resulted in a 50% reduction in staff orientation, reduced overtime by 33% and improved employee engagement 39%

Although the financial considerations of a PI project are important, process improvement teams can also improve the quality of patient care by incorporating best practices and following the recommended guidelines of AORN, APIC, AAMI, TJC, CMS, creating an overall safer surgery culture.

As a result of these management practices leaders who effectively empower their employees can deliver long-term results associated with real benefits for health care organizations and can

  • Inspire creative thinking,
  • Improve quality of work
  • Develop mutual respect and understanding
  • Increase employee and job satisfaction
  • Increase productivity while reducing costs
  • Reduce employee turnover
  • Better communication
  • Learn to be flexible
  • Shows appreciation for a job well done


Embracing the challenges and discovering opportunities in the unpredictable business of health care will create new approaches and help health care organizations uncover opportunities when employees have the autonomy and flexibility to question and connect with one another. Leaders who cultivate their employees allowing them to discover themselves, their passions and their commitment to the organization. Producing a passionate workforce that is more committed to finding solutions and welcome opportunities to try something new.


  1. Hymowitz C, Murray M. General Electric’s Welch discusses his ideal on motivating employees. Wall Street Journal. June 21, 1999. Accessed Feb 3, 2018.
  2. Schwartz DB, Spencer T, Wilson B, Wood K. Transformational leadership: implications for nursing leaders in facilities seeking magnet designation. AORN J. 2011; 93(6):737-748.
  3. Taylor, DL. Surgical Services Leadership: Insights, Priorities and Tools for Managing Change in the OR, AORN Journal July 2014, VOL 100, NO 1.

– David L. Taylor, MSN, RN, CNOR, is an independent hospital and ambulatory surgery center consultant and the principal of Resolute Advisory Group LLC, in San Antonio, Texas. He has no declared affiliation that could be perceived as posing a potential conflict of interest in the publication of this article.



1 Comment

  1. Very well written and important aspect to building sustainable improvements. I often see organizations make the mistake of not gaining employee buy-in and struggle at the implementation phase.


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