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Transforming operating room utilization at Rush, part 1: building trust and a data-driven team

  • Alena Shelton

    Director of Business Operations Perioperative & Interventional Services, RUSH University Medical Center

A 671-bed academic medical center located on the West Side of Chicago, Rush University Medical Center is driven by a culture of quality, patient-centered care. Rush truly promotes its ICARE values: Innovation, Collaboration, Accountability, Respect, and Excellence. It is not uncommon to meet an employee who has been with Rush for more than 20 years, and the culture is a reason I chose to return after working elsewhere for some time.

Rush has accumulated many recognitions for quality and safety, speaking to the power of clinical pathways and a culture of continuous improvement. We perform over 30,000 surgeries a year, a volume that carries inherent challenges. Effectively analyzing and sharing data of that magnitude over a traditional EMR, among all the surgical stakeholders who needed it, was a struggle, as was allocating operating room (OR) space and staffing efficiently. To continue upholding Rush’s delivery of quality care driven by patient needs, we needed to progress to a data-driven culture that utilized the latest developments in analytics and technology.

Rush needed stronger surgical data governance and OR allocation management to promote better operating room utilization

Prior to adopting a better solution, Rush’s OR space struggled mainly with data governance and OR allocation management.

The surgical data governance process consisted largely of monthly manual Excel reports, based on the KPIs of OR utilization and volume. Not only were these intensive and time consuming, they were stuck in the past. By the time they were completed, their information would be out of date, and our surgeons knew that. The Rush surgical team mistrusted the data, could not understand how their performances were measured, and believed the metrics were not comprehensive enough to capture their performance in any case.

This state of misunderstanding contributed to a scarcity mindset amid existing Rush surgeons, who were wary of releasing their assigned block time even when they did not need it, in case they could not get that time back when they did. In turn, new surgeons had trouble obtaining block time at all. None of us could clearly see how rooms were truly being utilized, as block or “flip rooms”, and there was no obvious process to allocate additional OR time when it was needed.

Building a data-driven surgical culture at Rush 

Underlying these issues was a lack of transparency and trust, which we could begin to build by standardizing our data and making it visible to all stakeholders. The process was not easy, and involved establishing a new aspect to our culture. Our team spent more than a year talking to surgeons, nurses, and administrators about our approach to structuring the data, and naturally those involved often disagreed. Deciding which surgical KPIs to measure going forward, and ensuring everyone was educated on them, was complicated. But this only proved how the effort to provide access to data across the board, and build trust among teams, was worthwhile.

We continued to build processes that would bring in stakeholder input on an ongoing basis. Our Perioperative Leadership team reframed our roles, to make clear that we are partners with our surgeons and are invested in their success – we don’t exist just to measure and judge their performance. Now we hold monthly check-ins with our surgical chairs, so we can work with them to improve OR access, utilization, and financial performance, according to agreed-on metrics, then share our learnings with the chair councils. Making small but visible gains, then discussing together why we made those gains and how we can grow them, strengthens our drive as a team and helps us achieve further results.

But we could not have continued achieving results without a better view of performance data, and better access to OR time. For these, collaboration within Rush was not enough. We needed a technology partner to join the effort as well.

Beyond people and culture: technology support for better operating room utilization 

Supporting the surgical team at Rush also involved offering further insights into data than we had ever had before, and giving our surgeons and staff the tools to take direct action to better use and distribute OR time. We chose LeanTaaS’ iQueue for Operating Rooms solution to deliver these, and the LeanTaaS team acted as a partner in implementing them.

A follow-up post will explore how the right technology matched Rush’s specific needs for driving better OR utilization.

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