OR Manager - July 2020 - 14

COVID-19
Agile, data-driven strategy for managing the OR after COVID-19
A
s state authorities begin to
ease restrictions imposed by
COVID-19, physicians, nurse
leaders, and administrators face a
momentous challenge: resuming elective
surgical procedures that have
been postponed for several weeks or
months. How will they accommodate
the looming glut of elective surgery
demand with limited infrastructure and
staff who are already highly utilized
under normal conditions?
Now is the time for organizations
nationwide to take action to construct
and revise recovery plans that address
the backlog of elective surgical procedures.
In the spirit of the cooperation
and camaraderie that characterize many
aspects of the COVID-19 response, this
article offers insights into one such plan
that can be adopted by other healthcare
facilities.
Through collaboration, ingenuity,
and a little math, dedicated healthcare
leaders will find ways to not only recover
from COVID-19, but also increase
the resiliency and performance of their
staffs as our nation returns to a " new
normal. "
How an agile approach works
Within hours of the Centers for Medicare
& Medicare Services (CMS) issuing its
recommendation to postpone elective
and non-essential surgical procedures,
perioperative leaders at Cincinnati Children's
Hospital Medical Center (CCHMC)
in Cincinnati took decisive action. While
physician and nurse leaders dealt with
immediate concerns such as cancelling
cases, taking inventory of personal protective
equipment (PPE), and addressing
staff concerns, others focused on the
future. How would a department that
routinely performs more than 100 cases
per day manage the backlog created by
performing only a handful of cases each
day for weeks on end? With many unknowns
looming, the team knew it must
use data to focus its effort.
Brooke Mullett, MBA, is no stranger
to evidence-based, data-driven decision14
OR
Manager | July 2020
making. An industrial engineer with
more than 10 years of experience in
healthcare operations, Mullett is senior
director of operations for perioperative
and surgical services at CCHMC. She
possesses the technical skill and operational
acumen required to provide
actionable, data-driven insight that
guides decision makers through turbulent
times.
Supported by engineers from St
Onge Company in York, Pennsylvania,
where I am senior manager of healthcare
operations strategy and analytics,
we developed a model that made best
use of available data (eg, case logs,
forecasts, etc). Adoption of an agile
methodology-a method in which a project
is broken into stages marked by
continuous improvement and iteration-
allowed our modelers to quickly bring
situational awareness to the leadership
team and remain in a near-constant
state of collaboration with clinical stakeholders.
In
the first stage, or " sprint " in
agile terms, our team constructed
a simplified model to test proposed
operating parameters (eg, number of
rooms, hours of operation, etc) and
forecast a timeline for full recovery. In
this iteration, constraints were relaxed
to streamline workflows and quickly
define a framework of key parameters.
For example, we treated all minutes
equally, distinguishing only between
add-on and elective minutes. This allowed
us to arrive at our first outputs
within 48 hours.
Though simplified, the utility of this
model was its ability to judge the relative
feasibility of proposed solutions,
and do so rapidly. In turn, outputs became
defining parameters of an operations
plan and modified schedule that
made best use of rooms and staff available.
For
example, in this first iteration, we
decided whether weekend hours were
needed to achieve an acceptable timeline
for recovery. In later iterations, we
prioritized use of total available block
time for divisions based on magnitude
of their backlog as well as demand
for future cases. After blocks were assigned,
each division decided which
cases to perform.
In subsequent sprints, modelers reintroduced
constraints and integrated
additional data for greater accuracy.
While doing so resulted in less efficient
use of resources within the perioperative
system, it highlighted opportunities
to think creatively about uses for underutilized
assets and for performance
improvement. The focus of such sprints
included:
* assignment based on room type and
capabilities (technology, room size,
etc)
* protecting access for emergent (addon)
and inpatient cases
* availability of beds and intensive
care capabilities for patients admitted
after surgery
* integration of staff scheduling (nursing,
anesthesia, surgical services,
etc).
Output from each iteration of the
" COVID Model " demonstrated value to
the leadership team. " Even in its earliest
iterations, the model helped us define
the problem at hand in a concrete
way. It started the conversation, " Mullett
says. " In turn, its output facilitates
meaningful dialogue among divisions
and has helped prioritize our work and
use of resources. "
As with any model, there is immense
value in the ability to test alternatives,
recognize key variables, and prioritize
solutions without the need for trial and
error. At CCHMC, the model has opened
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OR Manager - July 2020

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