Date of Conferral

2020

Degree

Doctor of Nursing Practice (DNP)

School

Nursing

Advisor

Mary T. Verklan

Abstract

The operating room (OR) is a complex system that must run efficiently to remain profitable and of value to its multiple stakeholders who include the patient, surgeon, OR staff member, and hospital administration. The OR at the practice site struggled with teamwork and efficiency in the areas of first-case on-time starts, turnover time, and last-case out times, resulting in a less than favorable impact on the organizational bottom line. The practice-focused question asked if a performance-based incentive bonus program can improve OR efficiency in the department’s three major problem areas. Using Gittell’s relational coordination theory as a framework, the practice site’s leadership group established goals and provided feedback and tools necessary for the OR team to meet productivity benchmarks. The project compared retrospective to prospective productivity performance data before and after the leadership intervention. The use of incentives was successful in improving teamwork and productivity. The OR team reduced turnover times by an average of 20 minutes per turnover, increased on-time first-case start percentages by 25%, and reduced average last-case out times by an average of 2 hours per day. Remarkably, as improved productivity reduced daily hours worked, surgical minutes increased by over 50,000 in a year. The project studied the use of incentives to improve teamwork and collaboration in a novel way. Project limitations included the absence of qualitative comparative data, unreliable retrospective data, and the lack of a true quality improvement framework such as Lean or Six-Sigma methodologies. Through dissemination, OR leaders will gain knowledge to impact social change through improved access to healthcare made possible by greater operational efficiency.

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