Job satisfaction or production? How staff and leadership understand operating room efficiency: a qualitative study

Contribution of Coordination Theories to the Determination of Human Factors Associated With Operating Room Perceived Performance

BACKGROUND

The efficient and fluid organization of surgical interventions in an operating room (OR) and operating suite (OS) is important as these are among the most expensive units to run in medical-surgical facilities. The complexity of OS organization requires careful coordination, defined here as the directing of individuals' efforts toward achieving common and explicitly recognized goals. There is currently sparse literature on OS coordination, especially in the French context. This study aimed to respond to this gap by reporting on the coordination mechanisms associated with the perceived performance of OS across 4 facilities in an urban setting in France.

METHODS

We used a qualitative comparative case study based on ethnographic methodology to explore 4 facilities (2 teaching, 1 general, and 1 private). Several investigation techniques were used for data collection (semistructured interviews, participant and nonparticipant observations, and informal interviews) in the OR, the OS, the regulation council (dedicated to adapting the necessary resources to specific procedures and patients' health status), and the OS council (dedicated to strategic and operational OS transformations and adaptations, and responsible for finding solutions to organizational problems). Analysis was guided by Okhuysen and Bachky's theoretical framework on coordination and multi-team systems theory. Data were compared across the 4 facilities and triangulated using the different techniques to ensure coherence and accuracy.

RESULTS

Overall, 48 interviews with health care providers and hospital managers and 200 hours of direct observations were performed. The OR exhibited a high degree of coordination, whereas improved perception of performance in the OS depended on managerial competency, trust, and authority. Perceived performance in the regulation council and OS council, on the other hand, depended on the identification of formal objectives by all stakeholders and the development of common understanding (developing agreement, direct information sharing, creating common perspective, substitution, bringing groups together, and storing of knowledge).

CONCLUSIONS

Based on existing literature on multi-team systems (as represented in the OS organization), this study identifies success factors influencing OS coordination. These include the OS manager's leadership skills; the identification of formal system objectives; and professional differentiation between stakeholders (absence/decrease of a sense of belonging to a multi-team system). This differentiation was related to the high degree of specialization within OS teams, each bringing different norms, cultures, and contingencies that induce dissonance in organization and task performance. Interventions targeting these success factors might improve coordination, and thus performance, in the OS.

Operating Room Performance Optimization Metrics: a Systematic Review

Literature proposes numerous initiatives for optimization of the Operating Room (OR). Despite multiple suggested strategies for the optimization of workflow on the OR, its patients and (medical) staff, no uniform description of 'optimization' has been adopted. This makes it difficult to evaluate the proposed optimization strategies. In particular, the metrics used to quantify OR performance are diverse so that assessing the impact of suggested approaches is complex or even impossible. To secure a higher implementation success rate of optimisation strategies in practice we believe OR optimisation and its quantification should be further investigated. We aim to provide an inventory of the metrics and methods used to optimise the OR by the means of a structured literature study. We observe that several aspects of OR performance are unaddressed in literature, and no studies account for possible interactions between metrics of quality and efficiency. We conclude that a systems approach is needed to align metrics across different elements of OR performance, and that the wellbeing of healthcare professionals is underrepresented in current optimisation approaches.

International Operating Room Nurses' Challenges in Providing Person-Centered Care During Organ Procurement Surgery

PURPOSE

International operating room (OR) nurses assisting in organ procurement surgery believe that it is their responsibility to provide continued and comprehensive person-centered care to donors through their surgical journeys. This study explored the challenges these nurses encountered in providing person-centered care during surgical care stages of organ procurement surgery in Australia.

DESIGN

The phenomenological approach by van Manen was used to portray 18 OR nurses' organ procurement experiences.

METHODS

Semistructured interview data were transcribed verbatim.

FINDINGS

International OR nurses encountered challenges in providing person-centered care during organ procurement surgery, which were described in different surgical care stages. They faced emotional challenges in handling family grief and clinical challenges in interacting with other health professionals. These challenges could cause personal distress and affect their professional practice.

CONCLUSIONS

Recognizing and managing these challenges is essential for supporting staff and providing quality person-centered care to deceased donors and their families during the organ procurement process.

ED healthcare professionals and their notions of productivity

OBJECTIVE

The combination of constrained resources, patient complexity and rapidly increasing demand has meant that healthcare productivity constitutes a significant problem for emergency medicine. However, healthcare productivity remains a contentious issue, with some criticising the level of professional engagement. This paper will propose that productivity improvements in healthcare could occur (and be sustained) if professionals' perceptions and views of productivity were better understood.

METHODS

An 8-month ethnographic study was conducted in a large UK ED, using semistructured interviews with healthcare professionals (HCPs) (n=26), a focus group and observation. Thematic analysis of the data was undertaken based on an interpretivist philosophy.

RESULTS

The data demonstrate that HCPs accept productivity improvement as part of their contemporary professional role. In particular, their understanding of productivity is focused around five key domains: the patient; the professional; the culture; the process of work and the economic.

CONCLUSIONS

By exploring how these HCPs experienced and made sense of productivity improvement and productive healthcare, the data reveals how HCPs may reconcile a culture of caring with one of efficiency. Understanding healthcare productivity from this perspective has potential implications for service improvement design and performance measurement.

Does effective designing of operation theaters contribute towards staff satisfaction

Purpose

– This study aims to measure the staff satisfaction achieved with regard to the recently furnished modular operation theaters (MOTs).

Design/methodology/approach

– A cross-sectional study through questionnaire-based interviews was done. Desired sample size for ANOVA design came out to be 25 per level at a level of significance of 5 per cent and a power of 85 per cent.

Findings

– Overall, mean rating of the satisfaction of the staff was 7.52 with a standard deviation (SD) of 2.35. Mean ratings (with standard deviations) of surgeons, nurses and anesthetists were 7.14 (1.26), 7.21 (0.95) and 8.21 (0.48), respectively. One sample t-test showed that all the three categories of staff were satisfied. Post-hoc test revealed that the anesthetists were significantly more satisfied than the surgeons (p = 0) and the nurses (p = 0.001). Maximum satisfier was aseptic environment provided by the MOTs. Hatch box with ultraviolet technology also attracted high ratings from all the three categories. Staff considered all the probable advantages of MOTs, except air showers, significant with regard to its satisfaction and morale.

Originality/value

– Findings suggest that initiatives such as effectively designed MOTs may contribute toward the satisfaction of all categories of staff working in operation theaters (OTs), which, in turn, may probably lead to better overall performance of these facilities. It is desirable that hospital planners in modern health-care systems give adequate importance to finer aspects of OT designing.

Efficiency as a domain of health care systems: a phenomenographic approach

PURPOSE

This paper focuses on efficiency as a central theme of the Italian health care reforms, combining macrolevel policies with microlevel (i.e., operating room) perceptions of the concept.

DESIGN/METHODOLOGY/APPROACH

According to the phenomenographic approach, this analysis investigates how the components of a surgical team (22 semistructured interviews) experience efficiency in their daily workflows.

FINDINGS

The main findings show that the concept of efficiency is multidimensional. According to participants' perspective, several categories of efficiency collected in an outcome space emphasize an holistic view of efficiency driving health policies and strategies.

SOCIAL IMPLICATIONS

The suggestion of further relationships between perspectives and other constructs (i.e., quality, safety, patient focus, process) at micro and macro level could enhance the impact of health reforms.

ORIGINALITY/VALUE

A qualitative approach conducted at microlevel help to recognize the phenomenon (of efficiency), engaging the individual conception that practitioners have of the health efficiency.

Managing quality in an anesthesia department

PURPOSE OF REVIEW

To provide a practical approach to measure and then improve the quality of an academic anesthesia department.

RECENT FINDINGS

The quality of any entity is defined by the user. Anesthesia departments should adopt practices that meet their specific operational needs. The relative importance of each of the user groups will be determined by the purpose of an individual department. Four categories of users will be considered: patients, surgeons (and other proceduralists), the hospital organization and the department itself (i.e. faculty and trainees). Patients value avoiding nausea and vomiting and pain after surgery, surgeons want cases to start on time with low turnover times, and the hospital desires high throughput of surgical cases, all facilitated by department faculty who value professional development. Quality improvement efforts in anesthesia should be aligned with broad healthcare quality improvement initiatives and avoid distortions in perceptions of quality by over-emphasizing what is easily measurable at the expense of what is important.

SUMMARY

Departments of anesthesia should develop performance criteria in multiple domains and recognize the importance of human relationships (between staff and between staff and patients) in quality and safety. To improve the value of anesthesia services, departments should identify their user groups, survey them to determine what attributes are important to the user, then deliver, measure, monitor and improve them on an ongoing basis.