At a Glance
Renoir Consulting was engaged to lead a collaborative initiative to improve the performance & utilization of the Operating Rooms, and improve the effectiveness of the supply chain and inventory management.
The results of the project yielded the following:
- Increased OR throughput valued at $3.8 million annually
- Improved first case on-time performance from 74% to 98%
- Reduced OR procedure average variance by 40%
- Reduced pharmacy inventory $3.1 million and improved accuracy of inventory on hand
Background
The client is a top regional academic hospital in the United States, which was facing many challenges of similar healthcare providers, including increased demand for services, facilities that were no longer adequate and supply costs that were excessive.
The Challenge
Typically, clinical and patient care performance are at a much higher standard than operational performance at academic healthcare institutions. For example, operating room (OR) arrival patterns of both Physicians and Patients are often inconsistent, with little correlation to the scheduled procedure time. This affects OR utilisation levels, reducing them to levels that do not support financial viability. In addition, scheduling inaccuracies lead to frustrating procedure delays.
Although past change initiatives at the hospital had yielded significant improvements, performance was still below their high standards, in part due to a lack of a systematic approach and the siloed nature of the organisation.
Central materials management performed well, however, the numerous support organisations, such as Pharmacy and Radiology, demonstrated significant opportunities for improving their supplies and inventory management.
What We Did
Renoir carried out an analysis within the hospital, evaluating process flows, management control systems and behaviors in relation to the efficiency of the OR, sterilisation department and supply chain activities. A number of issues were identified:
- A lack of coordination between departments caused duplication of paperwork, inconsistent prioritisation and scheduling inaccuracies.
- Lack of ownership and active management of the process to manage the OR schedule and room turnover.
- While there was extensive performance tracking and reporting, the results reporting did not link directly to key performance objectives, and reporting was not done in a timely manner or to all key participants.
- Ineffective planning for equipment, material and resource needs, masked by staff’s ability to react to emergencies.
- OR supplies were stocked based on intuition rather than historic usage.
- Case cart fulfilment performance was limited by preference card inaccuracies and lack of a quality management process in the central sterile supply department.
- The materials management function in Pharmacy and support areas was typically a low priority with inconsistent application of the hospital’s standards.
- There was no accurate count of actual inventory on hand
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The Renoir Focus Process® was used as a collaborative process to systematically evaluate current performance, identify opportunities for improvement, and to develop improvements in processes, management systems and behaviors. Collaboration is the key word, which ensured a common understanding of the issues present and the impact it was having on the hospital.
This understanding led to solutions and improvements that were developed with and owned by the participants and managers in the area. The shared ownership developed in the Focus Process® led to realization of the project objectives and results that were sustainable beyond the length of the project.
Results
The direct results from these activities included a significant improvement in OR performance.
- Average OR utilization increased from 68% in the base period to an average of 84%.
While increasing the OR utilization, significant improvements in the following key performance indicators were also realised:
- First case on-time performance was improved from 74% to 98%.
- Room turnover was reduced from 47 minutes to 34 minutes.
- The average procedure booking variance was reduced by 40%.
- OR Case cart fulfilment increased from 60% to 95%.
- OR Physician Preference Card accuracy improved from 55% to 85%.
“I found Renoir to be a highly insightful and effective consulting company, unlike any other that I have interacted with in the past. Renoir not only implements the changes that are needed but trains your staff to obtain the tools necessary to further analyse and implement changes on an ongoing basis. They initiate the important cultural change that is needed and the tools to sustain those changes to provide the institution with long term improvement in both process and culture.”
Professor and Chairman, Department of Anesthesiology
An OR Leadership Model was also developed and implemented. This model helped to shift the focus of the management team from reactive to proactive management and results focused problem solving.
An inventory management process and system was implemented in the Pharmacy. The results were:
- Development and implementation of inventory levels that reflected historic usage, resulting in a reduction of inventory on hand of $3.1 million.
- Eliminated stock outs due to inventory levels.
Perhaps the most striking aspect of the Renoir engagement was improved communication and collaboration between departments in the operating room and on supply chain issues. Multi-disciplined active problem-solving teams were firmly established to ensure a culture of continuous improvement.
Address supply chain issues with a Management Control System.
