“We need to create awareness of the overall process in the hospital”

Ms. Klein, you know the processes in the clinics all too well. What exactly do you do?

The main mission of DIOMEDES is to make hospitals more competitive and thereby more future-proof. For the past 20 years, we have advised hospitals of all sizes and types, in particular regarding ongoing development of OR management structures. This is a very complex business, as it affects core processes occurring before, during, and after surgeries, and together these take on a pivotal role in all hospitals. Critical factors such as costs and clinical outcomes, up to and including employee satisfaction, are linked to process management. As part of our analysis of the as-is situation and in order to get a comprehensive picture, we talk to employees from all professional stakeholder groups involved with the operating room. From our analysis we derive and recommend measures for implementation as well as offering support where it may be needed.

What stands out most in your work?

The biggest challenge is to make OR planning more engaging. This can be achieved by using better tools for planning and organising the entire OR-supply process. It is essential that there is access to an agile and reliable OR management system, one which supports flexible, digitally controlled sterile supply processes and enables interoperability among hospital information systems. To these ends, B. Braun Supply Solutions offers intelligent, interconnected systems that streamline the overall process and make it easier to plan. DIOMEDES also does a deep dive on underlying organisational structures, in particular on the institutional culture, so that ORs can be run more cost-efficiently, while at the same time focusing on employees and patients.

Can you give a good example of the challenges associated with OR planning?

Actually, OR schedules and the underlying processes, especially the provision of sterile goods as well as the reprocessing of instruments, are easy to plan. This applies to planning for emergencies as well, because there is enough retrospective data to work with. But in practice, it often comes down to individuals not seeing the big picture and lacking commitment to a common goal in the OR workflow.

In most hospitals, general surgeons, trauma surgeons, orthopaedic surgeons, and neurosurgeons must share common resources among themselves. These include among others the operating room, the cleaning staff or the sterile supplies. The OR process design therefore needs to reflect these cross-functional and interdepartmental factors.  However, this is often not the case – planning ends up being primarily driven by silo thinking.

What does that mean, exactly?

Here's a simple example. As an OR manager, one afternoon you make a plan for the following day, but when you come to work the next morning, the schedule no longer looks like the one you approved. Typically, the original schedule is thrown off by the addition of some unplanned, emergent surgical interventions. That's when bottlenecks occur: wherein in most cases, the necessary sterile products are either not available or they have been held up in the reprocessing stage. It may therefore result in there being only two trays prepared, when according to plan four patients were scheduled for surgeries. With proper planning and organisation, bottlenecks of this kind, which lead to cancelled surgeries and patients not being operated on as planned, aren’t allowed to happen in the first place.

Some surgeons argue that they are obligated to operate on emergency patients first, even while this disadvantages elective surgery patients.

That’s the way it is. The reality we have observed, however, is that many so-called emergency surgeries could be delayed a bit without sacrificing that patient's well-being. Seen from a different view, this has less to do with urgency and more to do with silo thinking: namely that individual surgeons often focus solely on those cases that are immediately relevant to themselves. In addition to causing considerably higher costs, postponed surgeries come with another consequence: they put a substantial burden on staffing, when surgeries that could have been performed during the day then have to be done on the night shift with on-call personnel. Hospitals are becoming more sensitive to this issue, because an increase in employee dissatisfaction can naturally lead to an increase in employee turnover, which is something that hospitals want to avoid. 

What concrete measures can help make processes work smoother?

First, the range of services and demand for resources are taken into account. One of the major challenges that many hospitals face is cost accounting. Few who work in the OR realise how much it costs for the entire process in which they are involved. Therefore, the approach should be to enlighten all employees on a basic understanding of health care economics and to make them aware that they are part of an overall process. All have to work together to shape this process, not only for the benefit of patients, but also for their own job security. So a fundamental culture change is needed, and to be sure it should include all aspects of the system. 

How can the products and services offered by B. Braun Supply Solutions help to ensure better planning?

For example, with a readily implementable OR management system that makes OR planning more engaging. With the help of appropriate IT systems, the management of resources and patient flows can be optimized to ensure smooth processes – whether it’s for scheduling the use of a bed, an operating table or an outpatient procedure. This involves integration of different departments in the hospital, including the operating room, the sterile reprocessing unit, as well as the warehouse and logistics. This is exactly what B. Braun Supply Solutions offers: networked, intelligent systems, with real-time communication mechanisms that create flexibility and transparency across departments and significantly improve safety in terms of time, costs, and planning.