Intelligent Design: Getting Better Through OR Integration
This article will appear in the upcoming May print issue of Surgical Products.
Cassandra Whitney had a significant problem on her hands.
Having arrived at Florida-based Memorial Hospital Pembroke in 2007 as its Director of Surgical Services, she immediately realized her entire department – from pre-admission to the operating room – was quite out of date. Everything looked old. The functionality of the equipment was less than ideal. Whitney recognized she had her work cut out for her.
“I had a mess in the OR in the sense that my OR suites were very old and antiquated,” she says, recalling her early days at Memorial Pembroke, a communiy-based hospital with 301 beds and eight ORs. “As time goes by, you keep adding more and more equipment to the OR, more different individual pieces of equipment (it). It got to the point where it was just so cluttered.”
There were other problems. No one was going to offer Whitney and Memorial Pembroke the millions of dollars necessary to construct new ORs outfitted with the latest equipment and cutting-edge technology, and the facility’s capacity – from an expansion standpoint – was already maxed out.
“It was at that point that I started to look at other options, and that meant integration,” she says.
“Integration” means something different to every hospital, because no two facilities have the same needs, goals, opportunities, and challenges. For Memorial Pembroke, a key facet of its integration effort involved installing surgical booms into the ceilings of six of the facility’s eight OR suites. The next step in the project called for key decision-makers to clearly identify what OR integration technology was necessary to acquire for Memorial Pembroke to maximize its return on investment. That meant asking a number of questions about how the integration equipment’s functionality fit in the hospital.
“Every single piece of that costs additional dollars,” says Whitney. “At one point I was debating what to cut.”
The process of deciding what technology fit best within the walls of Memorial Pembroke was by no means easy, but Whitney and others determined they were best served to never lose sight of what was right for their hospital. They also began asking themselves tougher questions: Is the return on investment going to be there? If the project moves forward, will it bring additional surgeons to Memorial Pembroke to perform surgery? Is it really going to benefit the patients in the long run?
“You have to ask yourself, ‘Well, this is where I am today, but where do I want to be tomorrow as a community-based hospital?’” says Whitney.
The answer to that question eventually became abundantly clear to Whitney and others. They wanted Memorial Pembroke to increase the volume of surgical procedures in its OR suites and see a marked improvement in overall efficiency throughout the surgical department. To accomplish those goals, the hospital invested in a wealth of communication technology (interdepartmental, OR-to-OR, OR-to-physician office, videoconferencing, videotaping, communication with pathology and radiology,) and more.
“As we reviewed the documentation and what all of it could do, we thought it was best for our patients and our surgeons to acquire this technology,” says Joseph Stuczynski, Associate Administrator and Chief Financial Officer, Memorial Hospital Pembroke. “It just seemed like this is where medicine was going in the future, and this is where we needed to be.”
Whitney organized a group of individuals -- the hospital’s chief strategy office, its chief executive officer, a system architect, a facilities representative, and others -- to go room by room with the surgical department staff and determine exactly where equipment needed to go based on personnel’s needs and wants.
“Because the staff work in the room day in and day out, and they are the ones that have to navigate around the room when things are in the way and so forth, I brought the staff together and we had several meetings,” says Whitney. “We literally went one room at a time deciding where things need to go.”
For example, initial plans called for all of the booms to be installed to where the right shoulder of the patient would be in the OR. But once that decision was re-evaluated, everyone realized they had to come up with something else, says Whitney.
“If we would have made that choice, we would have limited ourselves to only being able to do certain procedures in certain rooms, which is what we didn’t want to do,” she says. “That takes away your ability to add on cases and do what you’ve got to do.”
The hospital then closed down one OR suite at a time to remodel the rooms and set up the necessary infrastructure. The project took about a year. It involved installing TRUMPF booms in the ceilings of the OR suites, reconfiguring other equipment around the rooms, removing items from the walls, repainting, and more.
“The construction and installation went very smoothly,” says Whitney.
In order to ensure the surgical department could still function effectively, Whitney took great pains to monitor how OR time was being used during the renovation project. She honored block time and took away open time. If a surgeon wasn’t filling a block, Whitney contacted them a week prior and informed him or her the space would be released if no one was going to fill it. That way, she says, the hospital wasn’t losing business while its OR suites were being redone.
Once the project was completed, the Memorial Pembroke surgical staff immediately enjoyed the benefits of Olympus two-dimensional video systems. According to Whitney, they greatly appreciated the improved image quality. They were able to utilize flexible tip scopes and all-in-one scopes, allowing for both better and easier viewing capabilities.
“The surgeons loved it,” said Whitney. “It gave them the opportunity to have new technology they hadn’t used before, even with a 2D system.”
Whitney says hospital facilities looking at OR integration technology and considering a renovation project similar to the one that occurred at Memorial Pembroke need to properly evaluate their needs, wants, and goals before moving ahead. There will be a desire to purchase and implement top-of-the-line equipment technology, but it’s vital for decision-makers to recognize the best investment is one that acquires technology that fits well within that particular hospital’s OR environment in the immediate future and several years down the road.
The decision-makers also require the support and input of the hospitals surgeons and staff or they run the risk of botching the project before it ever really begins.
“If they aren’t involved in the process, they are going to fight you,” says Whitney.
According to Stuczynski, the success of such projects hinges on the ability for decision-makers to ask themselves tough questions and be realistic about the corresponding answers. These questions include the following:
- How are my operating rooms running right now?
- Will the surgeons use the technology?
- What types of procedures is my hospital doing?
- What types of procedures do I want my hospital to do in the future?
Lastly, those tasked with making OR equipment purchases of any kind need to remind themselves of one fact:
“If you add new technology, it doesn’t mean your operating room is suddenly going to become efficient,” says Stuczynski. “It has to be an enhancement to an already good process,” he adds.
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