Although they don’t serve pretzels, surgical departments can learn a lot about efficiency from Southwest Airlines, the no-frills company with the best airplane turnaround among airlines.
Engineering professors and students at the University of Southern California are applying Southwest’s quality improvement concepts to cut operating room turnover times in California hospitals. "It’s nothing very sophisticated," says David Belson, PhD, an adjunct professor of engineering USC’s department of industrial engineering. Like Toyota’s kaizen or Motorola’s Six Sigma philosophy, the Southwest quality improvement concept is based on looking at a process and figuring out which steps are necessary and which are not.
From January through July, Dr. Belson and his students helped the Children’s Hospital of Los Angeles, Riverside County Regional Medical Center and Ventura County Medical Center reduce their OR turnover times by an average of nine minutes, or 21 percent. (Children’s Hospital went from 34 to 28 minutes; Riverside went from 49 to 39 minutes; and Ventura went from 45 to 34 minutes.) The project was sponsored by a grant from the California HealthCare Foundation.
Some of the solutions were extremely simple and cost little, such as having patients arrive earlier for their procedure and moving the television from the patient waiting area to the pre-op area to put patients at ease while they waited to be moved into the OR.
While many of the situations were unique to each hospital, some common concepts were applied in each institution:
Improve communications so the charge nurse is aware of patient status in each OR. This can be done by walkie-talkie, whiteboard, video monitors or computerized patient tracking systems.
Develop a realistic and accurate schedule by communicating with physicians and the schedulers in their offices.
Identify bottlenecks caused by lack of equipment and create policies for the use of equipment.
Create checklists for the pre-op period to ensure that all paperwork has been completed before the procedure’s start time.
Create report cards so that staff can track their progress. These should be simple, visual reports that include benchmarking data.
Dr. Belson and his students are working with a handful of other hospitals and plan to publish a guidebook for managers who would like to apply quality improvement concepts in their healthcare facilities.
—Kent Steinriede
