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Archive ORX Session Previews 2019

The Role of Organizational Culture in Turnaround Time

David Ninan

David Ninan, DO


Shaving a few minutes off your wheels-out to wheels-in time is the easy part. You target the inefficiencies and streamline the process. The challenge is sustaining faster room turnovers. To do that, you must do more than tweak who mops and who wipes. You must also address your organizational culture. This means investing in human factors such as the initial buy-in of key team members and soliciting frequent feedback with positive reinforcement, says David Ninan, DO, medical director and chairman of the anesthesia department of Riverside University Health System in Moreno Valley, Calif.

Riverside County Regional Medical Center was plagued by an average turnover time of 45 minutes for elective scheduled surgeries. As Dr. Ninan wrote in a 2017 report detailing how the OR leadership team at the 10-OR hospital sustained and achieved an average 22.7-minute turnover time, a change in culture was as important as a change in turnover technique.

"Change can be challenging for an organization, particularly one that has been operating in a stable environment for a significant period. In cases where change has been achieved, sustaining a new way of doing business can be challenging," wrote Dr. Ninan in Cureus. "Often, new initiatives are met with minimal staff acceptance ("buy-in"), little effort and even passive-aggressive sabotage."

Sound familiar? Dr. Ninan will detail the keys to what he calls a "culturally-focused change process." In this session, you'll learn new ways to organize your staff, rooms and culture to keep surgeons and staff happy and productive — now and over time. A few key points:

  • Communication. Turnaround time interfaces with different teams — housekeeping, nursing, anesthesia, surgery — and communication among them is key.
  • Realistic goals. You don't want your people to have to sprint from beginning to end. You want them to be able to work steadily and consistently in a safe manner. "There is a certain sustainable pace at which you can comfortably, safely and consistently do a good job," says Dr. Ninan.
    "And I don't think we want to push people past that, for the primary reason that's it's not a sustainable model and it will induce more errors."
  • Workflow fundamentals. Your workflows must be laid out efficiently. Reduce waste and introduce parallel processes when you can.
  • The human component. Organizational culture should be more of a reflection of what you have rather than being able to dial up a certain culture.

"A significant part of any operational change is looking at that human component and engaging the actual stakeholders in ways that make their jobs easier to do," says Dr. Ninan. "Engage them as generators of the solution and have them drive the details." OSM

Speaker Profile

  • Medical director and chairman of the anesthesia department at Riverside University Health System, Moreno Valley, Calif.
  • Board of Governors member and current treasurer of the American Osteopathic College of Anesthesiologists.
  • Winner of the 2016 Riverside University Health System's Bertram H. Eckmann, MD, Emerging Leadership Award.
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