“I have worked with many consultants for many years. They come, we spend a lot of money, they tell us what is wrong that we already know and then they leave. We have never had a consultancy like Renoir where the problems are reviewed, studied, a plan is organised and then you stay with us and provide the on-going ideas and logical solutions.”
MD Co-Medical Director
Key Results
Annual Revenue
$13million
1st case room ready in the Main OR
↑ 60%
Turnaround times
↓ 75%
Patient throughput time
↓ 25%
1st case start time delays in the Main Operating Rooms
↓ 75%
Materials returns in the Main Operating Rooms
↓ 56%
Background
The client is a large academic medical centre, known worldwide for advanced patient care provided by its physicians and staff, particularly for the treatment of rare, complex disorders in areas such as cancer treatment and organ transplants. It is internationally recognised for translating medical breakthroughs into the care of patients. Their desire to improve the efficiency and throughput of their multiple sites, high volume operating room suites came as a result of pressure from increasing volume and complexity of cases.
The Challenge
Renoir’s initial analysis identified the following:
Performance management issues
There was a lack of short interval control rounding by management, insufficient operational key performance indicators, systematic performance reviews, root cause analyses and resolution processes.
Inefficient processes
Processes were not yet as efficient and robust as possible. A limited understanding of key patient throughput bottlenecks, detailed turnover activities not mapped nor clearly assigned to staff, 1st case start process not fully understood or managed were contributing to delays and unnecessary resources.
Planning issues
Scheduling inaccuracies and an incorrect utilisation methodology were being used which impeded productivity. In the Support Department, materials management was not optimised and lacked control of main OR inventory storage areas. Meanwhile, no lean techniques were being utilised to manage inventory, leading to a high rate of material returns from Main OR Patient Throughput.
A lack of clarity over OR throughput responsibilities was also evident. However, the root causes of issues such as this were not fully known or addressed yet. This was also impacting patient and employee satisfaction.
Data management issues
There was a lack of operational data the client actively managed such as turnarounds, utilisation rates, inventory and room readiness. Existing available data was either unreliable or difficult for the Renoir team to obtain.
What We Did
Renoir’s Focus Process™ provided the required framework and with guidance and coaching from full time Renoir consultants, a client ‘taskforce’ team was created to jointly lead multifunctional Management Action Teams (MATs). The MATs consisted of stakeholders from key areas, headed by administrators or clinicians. They were charged with achieving higher efficiencies, with a focus on improved processes, systems and performance management.
The Teams mapped all key processes to identify opportunities through studies which exposed root causes of delays and inefficiencies. They then examined, agreed and prioritised the issues, developed action plans to implement permanent fixes and installed ways to measure progress and success.
Less than 3 months into the Project, each MAT presented to senior leaders, their understanding of the issues, plans and timelines to address the issues and the operational and financial results. Critically, each Team made a public commitment to achieving specific results, a clear message that a significant change in the organisation’s culture had occurred – from one of blame and disinterest to ownership of the problems and involvement in solution implementation.
Main Operating Room, Pre-Op/Post-Op and Cath/Angio MATs
The key focus for these MATs was to improve the amount of ‘value added time’ in every room. Data was extracted from EPIC (software) into a custom-built performance management tool to understand where the main delays occurred. As a result, daily rounding and huddles were implemented to manage patient flow to the ORs, logging the main reasons for every delay. This contributed to the culture change, resulting in major efficiency improvements.
For example, room turnaround times were dramatically reduced through detailed understanding of activity flows using “lean” techniques such as SMED (single minute exchange of die). This provided a platform to effect process changes, review and revise roles and responsibilities, implement effective management rounding and set targets by service/procedure.
How a hospital optimized length of stay and communication
How a hospital optimized length of stay and communication
Planning & Scheduling MAT:
This MAT was assembled to ensure the accuracy and stability of daily scheduling. Among other basic and more complex reasons for the plan’s instability, this MAT found that:
- Procedure times in EPIC were not accurate. An OR analytics tool was used to define and obtain service specific turnover times and set-up/tear down times. EPIC was then adjusted accordingly.
- An incorrect methodology was used to measure surgeon/block utilisation, hiding the true opportunities for increasing utilisation. The methodology was improved and the analytics tool deployed to report performance trends for each block allowed effective adjustment and block changes.
OR Supply Chain & Support Services MAT:
Agreement was reached on a future-state preference card change/update process along with a schedule to change cards based on highest volume. Inventory stock usage was analysed and par levels were redefined along with new reorder points. Inventory champions were identified within the Main OR to manage housekeeping changes, control returns and maintain accuracy of case carts.
This was done in conjunction with materials management by opening up communications and partnering between the two departments.
Data Mining & Query Reports MAT:
The focus was to identify key metrics and develop ways to extract accurate data from EPIC into a performance management tool. Working with other teams, they assisted in developing better procedure accuracy and block utilisation.
Results
The engagement exceeded expectations, realising an additional capacity equivalent to over $13M in net revenue in just 6 months. Getting buy-in from physicians and clinical staff was critical to the success of the engagement and it was through this that the project was able to achieve the dramatic improvements in operational indicators, including:
75%
reduction in Turnaround time
25%
reduction in Patient throughput time
90%
Case cart accuracy
56%
improvement in Materials returns
The improved efficiency and predictability, along with the culture change, dramatically impacted staff and patient satisfaction. The improved transparency of operations and results, improvements to management systems, and techniques passed on through coaching and training, ensured that communication throughout the organisation improved.
This changed the organisation’s culture to be more performance-improvement focused. The processes, systems and behaviors continue to improve because of this change in culture and the establishment of an internal, performance improvement team.
“I had the honor and opportunity to participate in this project through a committee that has helped us improve efficiency in the operating rooms with start times and turnovers. It has been such an educational process for me to work with the Renoir consulting group”.
– MD, Anesthesiologist
Improve the patient experience with streamlined process management.
