Implementing Change in Surgical Culture

Abstract

This management project sought to understand the source of poor team dynamics in the operating room (OR) and develop an intervention to address key pain points.

We diagnosed the pain points in our hospital culture using qualitative interviews. We structured themes pulled from these interviews using the theory of Relational Coordination, which allowed us to develop a map that showed the quality of relationships and communication between key stakeholders. We then performed an organizational structures analysis that allowed us to determine a current and desired state for the organization. Findings from these methods informed the development and rollout of the intervention; a physician of the day (POD) role designed to implement and enforce policy changes. We determined the effects of this intervention using two efficiency measures of on-time start to surgical procedures and operating room turnover which were pulled from administrative records. These measures were observed for 6 months prior to the intervention and 1 year after the intervention.

Interviews reflected that nurses were put in the position of enforcing surgeon compliance to hospital policy. This proved challenging considering the traditional hierarchy of operating theaters which put surgeons in charge. In addition to creating a toxic work environment for nurses, this structure negatively impacted the relationships between administration and surgeons, as well as between administration and nurses. The implementation of the POD role was associated with increased efficiency. On-time starts increased from 78.7% to 82.5%. The turnover time improved substantially from 29.2 min to 20.5 min.

The operating room culture at our organization reflected a traditional top-down hierarchy that disincentivizes collaboration and physician adherence to policy. We found that develo** a third-party POD role helped to alleviate some of the power vacuum that surgeons were using to circumvent hospital policy, which created a more cohesive environment that facilitated increased OR efficiency.