A methodological approach to improve the performance in operating room management

Abstract

This research seeks to improve the service quality provided in Operating Rooms through a Key Performance Indicators (KPI) system based on the analysis of processes and resources used in three surgical units in Chile. This methodology integrates two frameworks: Lean Healthcare and Activity Based Costing. We analyzed these Operating Rooms to establish standard procedures and surgical costs. The proposed methodology includes the following four stages: (i) Identifying macro-processes in the Health Care Unit; (ii) Describing the macro-processes and their healthcare objectives; (iii) Analyzing and standardizing the described processes; and (iv) Generating indicators aimed at cost-control and indicators aimed at reducing activity-duration variability. The KPIs support the reduction of surgery variability, maintain low overhead costs, and set appropriate goals for the: (i) pre-operative; (ii) intraoperative; and (iii) postoperative stages. The implementation of Activity Based Costing, Ishikawa Diagram, and Value Stream Map allowed to identify the resources used in each activity performed, the costs of the activities, and the processes required to provide each surgery. Sample results, of the methodology and proposed application, include the identification of the three most expensive activities, which are: Provide total intravenous anesthesia, Perform postoperative nursing care and Monitor vital signs. These activities represent 29% of the total cost of an operating room. In addition, twelve process indicators were defined, such as Patient transfer time to OR and Extended use of OR. All of these indicators, processes and cost indicators, will likely improve the management of the operating rooms.