Creating a Perioperative Environment for Sustainable Change

Healthcare Reform has forced hospitals to take a hard look at the way they do business.  The shift from fee-for-service to value based purchasing (pay-for-performance) has resulted in a shift in focus from quantity of services provided to quality of services provided.  No longer is it enough to just perform services for payment; hospitals and healthcare providers must now ensure quality patient outcomes and satisfaction for those provided services in order to receive payment.

“Sustainable change requires a transformational change, an internal cultural change.”

Sustainable Change

Executive leadership is sounding the call to action: Provide superior patient care in the most cost-effective manner with the highest patient approval. Perioperative Services is not exempt from this call to action and in fact has a significant role in a hospital’s ability to sustain itself during these changing times.  As a result, operating rooms all over the country are engaging in lean six-sigma initiatives; projects to improve efficiency, quality and to streamline costs.  These projects have increased OR utilization, improved block scheduling, decreased turn-over times, increased percentage of on-time first case starts, and decreased supply costs. But how sustainable are the improvements six (6) months out… a year out?  Many of these initiatives, although successful in the short term, are not able to endure the test of time. Why?  Because sustainability appropriate for the surgical environment was not factored into the projects.

Sustainable change requires a transformational change, an internal cultural change.  It is not enough to fix the processes, procedures and/or technologies. The “fixes” require continuous evaluation and adoption as well as ownership for sustaining these changes.

Executive Support

Sustainable change starts with solid executive support led by transformational leaders; leaders who inspire and empower the entire perioperative team.  These transformational leaders are the “Executive Champions”; administrators as well as physician leaders who are committed to the initiative(s) and who will embrace and strive to sustain the change.  The Surgical Services Executive Council (SSEC) is a great place to recruit the Executive Champions. 

Collective Ownership

Sustainable change also must have commitment from and a working partnership with the entire perioperative team.  This collective ownership does not automatically happen once the lean initiative is shared, the ownership requires significant effort on the part of leadership to address the cultural environment where the change will occur and prepare and gain buy-in from the perioperative team.  Collective ownership is achieved through:

  • An understanding of the mission and vision- to deliver quality patient care with positive patient outcomes and increased patient satisfaction.
  • A breaking-down of silos and independent thinking; abandoning the self-serving attitude “what’s best for me” and a realization that what is best for the patient is a win not only for me but the organization as well.
  • A feeling of empowerment and confidence that all members of the team have contributions and ideas of equal value.

Open Communication

Sustainable change is only achievable through total transparency, open communication and sharing of information with the perioperative team.  When the team has a clear understanding of the WHY behind the change and the expectations from the change, they become more receptive to assisting in the process. When the team is kept informed of the progress and the outcomes, they are better able to understand and believe in the purpose. When belief in the change is achieved, they will embrace accountability for that change.

Open communication must be bidirectional; leadership must not only share information and expectations but must also listen to the team’s ideas.  Sustainable change happens when the leadership team functions as a coaching staff to move the perioperative team to create effective processes and procedures to drive the change; working across boundaries- physician and clinical staff- to develop collective ownership.

Strategies to Overcome Resistance

Executive support, a culture of collective ownership and transparent, open communication are all effective strategies to overcome resistance.  Change adoption does not happen overnight and resistance is a normal response.  The perioperative team must be given time to adjust, express concerns and frustrations and share suggestions for modifications to the changes.

When resistance is encountered, take a head-on approach to identify the reason for the resistance:  is the change  perceived as a bad idea, are there feelings of being left out of the decision making, is there a misunderstanding of the WHY, or are they just uncomfortable or unhappy with the impact the change will have to their process?

An effective way to overcome resistance is to identify those who are resistant and actively engage with them. Remember, some of the strongest resisters can become your biggest champions if they understand the WHY for the change and when they feel empowered to drive that change.

Working toward a common goal - Patient-Centered Care

When clinical staff and physicians work as a team to develop processes and procedures that streamline the perioperative process and drive efficiencies, the organization thrives and the patient reaps the benefits- streamlined patient throughput, better communication and evidence-based practices for optimal outcomes. It is a win for all!

These changes do not happen overnight.  Unlike the lean six-sigma initiatives that have project starts and ends, transformational change is an ongoing process; it is a cultural development, an attitude that must be nurtured and fed so that it can grow.   Because of the significance and long-term nature of transformational change, organizations often seek outside expertise for an unbiased and candid assessment of their perioperative environment and facilitation of the transformation.  Change thrives when there is executive commitment, ownership by those responsible for implementing and sustaining the change, measureable achievements and an open and transparent process for continuous evaluation and adoption.