The Healthcare Executive's Guide to Navigating the Surgical Suite : A Roadmap to the OR and Perioperative Services

The Healthcare Executive’s Guide to Navigating the Surgical Suite: A Roadmap to the OR and Perioperative Services


Chapter 1:  

“Unique Challenges from Surgical Services”

Part I


by Gerald E. Biala, MSN, RN, CNOR, CSSM, Senior VP of Sullivan Healthcare Consulting
and Therese A. Fitzpatrick, PhD, RN, FAAN

Published by Sigma 

This book provides experienced and novice healthcare leaders with the information, leadership structures, and practical strategies needed to successfully oversee both patient outcomes and balance sheets.

Unique Challenges from Surgical Services


Serving as the leader of surgical services within an organization can be a daunting endeavor for a new executive.  Unless they have actually worked at an operating room (OR) table as a surgeon or surgical nurse or managed a surgical product line, most new executive leaders lack an operational frame of reference for the unique concerns and challenges present in the contemporary OR’s dynamic environment.  The dress is different, the language unique and the management nuanced. Operating rooms have their own supply chain, scheduling and billing systems, and procedure codes. What can be touched or where one can safely tread is closely monitored.

Once referred to as “the workshop” of the hospital, with all of its tools and gadgets, the OR has rapidly evolved into a high-tech robotic center.  Staying current with the ever-evolving clinical evidence on everything from safe patient positioning to the use of sophisticated technologies requires constant practitioner vigilance.  Thousands of pages of federal and state regulations, along with various professional association practice guidelines, govern everything from cleaning protocols to physician preceptorships.  Well-educated physician and nurse practitioners, emerging from the finest sites of higher learning, require thousands of additional hours of training to be judged proficient in the surgical arts.  The fact that operating theatres are by necessity isolated from the rest of hospital operations makes it increasingly difficult for an executive to understand and experience this very different world.

In the past, it was not uncommon for surgical service operations to be the bastion of an elite group of physicians who operated behind closed doors, controlled the granting of practice privileges to colleagues and determined everything from professional standards of behavior to who would receive preferential time on the OR schedule.

However, the importance of the operating room to the overall success of a healthcare organization has cast a new light – a very bright spotlight — on operating rooms.  It is of critical importance for the new executive to gain an immediate understanding of complex OR operations. While simultaneously providing the greatest contribution of total revenue for the average hospital, the OR represents the location of greatest legal and patient-safety risk and the largest investment in physical assets and materials.

Additionally, the rapidly evolving payment landscape now includes innovative provider models affecting ORs and once unthought-of partnerships. Surgeons can now be competitors and collaborators simultaneously as they develop their own surgical centers.  Revolutionary technology is blurring the traditional boundaries of radiology, cardiology and surgery. The new executive may be rapidly immersed in conversations about building or buying ambulatory centers, recruiting a new surgeon in a technology-intense specialty or mediating block scheduling conflicts. Such topics rarely, if ever, emerge in other areas of hospital operations

A Systems Approach


The “operating room” was once the label for actual operating suites and all departmental activities related to the management of ORs, including finance, supply chain, materials management, scheduling and more.  Organizations now recognize that effective management of this complex operation requires a systems approach, both to improve the way a patient experiences a surgical procedure and to align practitioners in the creation of effective and efficient processes.  Increased payer interest in this most-costly aspect of healthcare also has fueled the new approach.

Industry process improvement efforts have confirmed the benefit of subsystem alignment as a precursor to system optimization.  Once separate silos of care must now function in complete synchronicity for care to be safe, cost-effective and efficient. Navigating a patient through a surgical event requires the systemic efficiency of the following processes: scheduling in the physician’s office, preoperative testing and anesthesia assessment, the arrival and check-in processes, pre-procedure holding, the surgical procedure itself, post-anesthesia recovery and discharge and post-procedure follow-up.  Optimizing any one of these processes does not necessarily improve the entire experience for either the patient or the provider.

As a result, formerly disparate departments or functions typically are now referred to as perioperative services or surgical services.  This name change suggests more than a simple refresh of signage. Driven by contemporary payment structures, optimization of processes and labor across the entire surgical event is required.  Additionally, competition is playing a major role. Hospitals are now competing with a growing number of alternate sites for delivery of surgical services, including surgeon offices, ambulatory surgery centers and even clinics in the local mall.  Each of these sites advertises the fact that procedures can be performed cheaper, quicker and with great convenience. Customers are responding.

The term “surgical services” is used in this text to refer to the surgical product line and the fully integrated system of surgical care, including sites of care (inpatient and outpatient) and their strategic, operational, management and business processes.  When referring to the actual suite where the procedure is performed, the term “operating room” is used.

Stay tuned for part II or sign up for our email list to receive a notification directly to your inbox.

Gerry and Karen have teamed up to assist preoperative teams.

About Kirby Bates Associates

Kirby Bates Associates, LLC, drives healthcare organizations to achieve high quality, cost-effective patient care through a comprehensive portfolio of proven leadership services, including Executive Search, Interim Leadership, Leadership Coaching and Operations Consulting. As former CEOs, COOs and CNOs, our effective approaches achieve sustainable outcomes for our clients’ greatest leadership challenges.

About Sullivan Healthcare Consulting
Sullivan Healthcare Consulting (SHC) helps maximize the return on investment in the perioperative suites of hospitals and ambulatory surgery centers. The firm’s consulting practice serves clients across the United States and Canada. Toll free number: 866-303-8968.



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