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39 Executive Briefing Sponsored by: Surgical Directions LLC is a national consulting firm based in Chicago that assists hos- pitals in improving the operational, financial, and market performance of perioperative and anesthesia services. Our consulting team is led by nationally-recognized, practicing anesthesiologists, surgeons, and surgical service professionals experienced in organi- zational design, block time, surgical scheduling, patient throughput, materials, staffing, strategic planning, and physician relations. Team members have successfully helped over 500 hospitals nationally increase surgical volume, improve clinical outcomes, improve surgeon satisfaction, improve anesthesia satisfaction and enhance overall perioperative performance. and labor, case volumes, primetime utilization, block length and sched- uling. One other metric analyzed, which Ms. Hedman uses as an ex- ample, is the rate of on-time surgical starts. Delays in first case starts pres- ent problems for organizations and contribute to problems further down the line. When the first case does not start on time, the delay cascades throughout the day and can trigger overtime costs and dissatisfaction among patients and staff. What's more, the cause of a delayed first case can change from day to day. Surgical Directions' performance improvement team benchmarks the OR against the best practice metrics of comparable ORs. In a healthy and efficient OR, 90 percent or more of surgical cases begin within 5 to 7 minutes of the start time. In many hospitals, only 60 to 65 percent of cases start in that timeframe. Surgical Directions makes these metrics visible so the OR team can see just how far they are from the best practice met- ric. The disparity is especially powerful given the competitive nature of many physicians and medical professionals, who are wired to outperform and usually despise mediocrity. But as any medical professional will tell you, numbers without context are meaningless. To craft a comprehensive and meaningful improvement plan, members of the Surgical Directions team sit down with the OR team for a more detailed discussion. "We say, 'We're going to get that benchmark to 90 per- cent," says Ms. Hedman. "Then we open it up to the team to ask: 'But to do that, what must you change about your work? What will this change look like in your OR?'" This is where individualization comes in. When it comes to improving first case start times, numerous stakeholders must readjust their workflow. Perhaps the patient's history and physical needs to be completed earlier. Maybe the pre-opera- tive process needs to be standardized, with surgeons arriving and consulting with the patient earlier than 30 minutes be- fore the scheduled start. Perhaps the entire surgical team will huddle post-surgery for a debrief, allowing for an opportunity to address delayed first case starts and further analyze how to prevent them. Specific conversations force surgeons, anesthesiologists and nurses out of the abstract. Team members must vividly describe their roles in achieving the shared goal, and under- stand how their behaviors and decisions will help or hinder their team's progress. Such specificity calls for individuals to take responsibility for the outcome and own up to the "small" changes they must make in their daily lives to support the "big" organizational change at hand. These conversations also strengthen team members' un- derstanding about what the change means for them personally. This is the predominant concern of every member in an orga- nizational transformation. Some roles face a greater intensity of change than others, and people are more empowered when they have an upfront understanding of the degree to which their routines will change. "It's always easy to go back to the way it was rather than keep it the way it should be," says Ms. Hedman. "Detail is incredibly important when you are trying to distance yourself from the 'old way.' To do that successfully, you need a vivid picture of your new reality." n "When a member of your organization tells you how your work or attitude affects them, that's a wake-up call." — Lee Hedman, Senior Vice President of Surgical Directions