A Picture’s Worth 1,000 Words

A Picture’s Worth 1,000 Words
Increasing OR Eficiency: A Case Study

By Jennifer Schraag

Ambulatory Surgery Center of Yuma
Yuma, Ariz.

EVERY CENTER HAS ITS ‘SECRET TO SUCCESS’— something a center makes all its own that leads that center to succeed. today’s surgicenter set out to find a few of those secrets.

When Kelly LaRocca took the helm as administrator of the Ambulatory Surgery Center of Yuma, the center was staggering due to facing its last four months of operation with no leader. The three operating room (OR), one treatment room, ambulatory surgery center (ASC) was struggling to keep afloat with a bare-bones staff. It struggled even harder to keep any physicians on board.

LaRocca says she realized she would have to become quite creative to avert failure. “We couldn’t afford the top dollar to get skilled people, but we couldn’t not have good people. It was a catch 22,” she recalls. “So, I had two techs, one of which was also a purchasing coordinator, and we sat down to discuss developing a way to train enough techs for our three ORs. We needed to be fully staffed.”

LaRocca searched for ideas on how to increase efficiency throughout the center; to try to turn it around and make it once again flourish. She then read a magazine article about a training program that relied heavily on the use of pictures and this gave her an idea. She would make experts out of the team she had on hand and together they would make the backbone of the facility — the OR — so efficient that when new people were brought in, they too would become instant experts.

It worked.

LaRocca and her staff decided to make a series of OR photo books. The books detail each and every case the center performs. It models each physician’s preference, down to the most minute detail, for each procedure the physician performs.

It has worked, “because it is a lot easier to look at something then it is to try to describe something without seeing it hands on,” LaRocca explains.

She continues, “It is kind of like a baby puzzle. Put the pieces of the puzzle where they go. Physicians like to see continuity. The reason this center wasn’t getting the doctors coming in was because they couldn’t guarantee that each time they did the case, it would be done the same way. No one here knew enough that they could anticipate what the physician wanted.”

With the books in place, LaRocca says this has changed. She pulled all the doctors together and asked not only for their preference cards, but for any special ideas and insights of what they like to go on in the room. She then attended several of the procedures and took pictures and video footage of varying aspects of each procedure.

Once she gathered all of the preliminary information, she held an in-service with all staff.

“This is what we are going to do, and I don’t care if it’s waste, but we are going to open trays and we are going to open packs, and we are going to do an in-service on every case,” she recalls explaining to them. “We did the whole mock procedure, with the anesthesiologist, the nurses — everybody. We had one staff member pretend to be a patient. We would set the room up, and bring the ‘patient’ in from pre-op to the OR and set them up in position, and we said ‘OK, this is the way Dr. So-and-So sets up his right shoulder.

“We snapped pictures of everything — of all the trays lined up, the way the beach chair was set up, of the way he likes the patient positioned in it. Does he like the light on the left or the right side? Is he right handed or left handed? Where does he like the tech? And we set everything up based on what we had seen from all of those surgeries.

“When the doctors came in, I said ‘You’re going to put us through the test,’” LaRocca recalls saying to the physicians. She asked the physician to pick a staff for the next procedure. “He said ‘OK, give me Rebecca, give me Anne Marie, and obviously the anesthesiologist.’ When he came out, I asked, ‘How did it go?’ He said, ‘Good.’ 

“I said ‘OK, now you’re going to do it with Ernie and Diane.’ And he kind of looked at me funny. This doctor does like four shoulders a day when he is here. So he went in for his second shoulder.

“When he came out I asked him, ‘How did it go?’ He said, ‘Perfect. What did you do?’ That was the first question every doctor has asked.”

She says she then asked the physician if he had noticed anything different in the room. “He said, ‘Other than it went very smooth. No.’ I said, ‘Good, you weren’t supposed to notice.’”

The book is set up at the end of the tray where the tech stands. The techs look at the book, the pictures and all of its notes, and they lay everything out for a particular procedure just as it is in the book. When the physician comes in, there is a picture in there that shows where the physician stands and where the tech should stand so that they can anticipate what the physician is going to expect.

The books include little notes from the senior techs. The notes give pointers such as, “On Dr. So-and-So’s shoulders he always starts endoscopically, but ends up opening. Be prepared to open.”

Or, for the ambidextrous physician with back problems, “Ask physician morning of case which side he prefers to use.”

“We can take any new tech and put them in the room and they can lay out the room and assist in a room as if they had done that case with that physician at least 10 times,” LaRocca says. She further explains that simply not having to wait for the physician to ask for everything he or she may need and have a tech fumble to look for it, has saved countless errors from occurring — not to mention the time that has been saved during each procedure.

“The case goes quicker, they (the physicians) are happier, and it seems to be working. We do it with all our cases — every tray, every set up, every case that is done.” 

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