An ASC won a national award for its quality improvement and efficiency project to reduce average operating room turnover time, which was 22.8 minutes.

  • One of the first challenges was building trust and a team mentality among the ASC’s employees.
  • The creative solution was to build team spirit through a NASCAR pit crew model. Then, the organization gave pit crew titles to operating room staff, including “kick starter” for the pre-op nurse, who starts the IVs for patients.
  • Reinforce changes through feedback and praising staff for successes.

When Surgery Center Fremont in Fremont, CA, opened a couple of years ago, the ASC faced multiple challenges, including building a team out of many people who didn’t know each other.

The ASC’s efficiency effort succeeded in reducing its average turnover time from 22.5 minutes to 17.6 minutes, a 22% reduction, within 30 days of implementing changes. It was reduced even more by June 2017 to 15.8 minutes. The program’s creativity and success resulted in Surgery Center Fremont winning the 2016-17 Bernard A. Kershner Innovations in Quality Improvement Award from the Accreditation Association for Ambulatory Health Care (AAAHC).

“After we spent the first couple of months acclimating to the building, there was a whole trust piece of learning how to work together,” says Robin Menefee, RN, BSN, MBA, nursing director at Surgery Center Fremont.

Employees had not yet learned to think like a team, and this deficit showed in the high turnover time, which was 22-25 minutes on basic cases, Menefee says.

“After our first huddle, we had to focus on that,” she says. “We had to work on engagement and helping people get to know each other.”

Menefee experienced a creative breakthrough one day while in her Mini Cooper waiting on a red light to change. A man in a racing BMW pulled up next to her, revving his engine and gesturing that he wanted to race. “I thought, ‘Of course not!’” Menefee says. “It made me think of a NASCAR pit crew and how they can do whatever they need to do to get a racer back out there quickly, and that’s what we’re looking for in the OR — fast and efficient,” she explains.

Menefee researched NASCAR pit crew work and turned that model into a model for her OR team. (See story in this issue on how ASC cuts turnover time.)

“We came up with titles for roles and talked about maintaining those same roles for people when they do a turnover,” she says.

For example, the “kick starter” became a pre-op nurse, who starts the IVs for patients. The lack of an IV can delay a procedure. Another role is the “pit boss,” which is the charge nurse. The pit boss/charge nurse manages the pit or core of the OR daily, directing staff and making sure cases are staged and prepared before the next case goes into the OR.

The “collector” is the surgical scrub tech, says Nathalie Waite, RN, MSN, CNL, registered nurse at Surgery Center Fremont.

“They collect all the dirty instruments and remove them from operating rooms to take to decontamination,” Waite says. “Then, they come back into the OR and should be ready to start opening a new sterile table for the next case.”

The “compressor” is the role fulfilled by the anesthesia technician, who handles turnover of anesthesia-related supplies and equipment. “They bring in any conditioning devices or airways needed for the next case,” Waite says.

The last role is the “sweeper,” which is a position assigned daily. The sweeper is the cleaner, the person who wipes down all surfaces, mops floors, takes out trash, and remakes the bed once everything has been cleaned, Waite says.

Each pit crew member had specific goals and tasks related to accelerating the turnover process.

Menefee presented the pit crew concept to the staff, and she hoped her enthusiasm for it would be contagious. But after she introduced the idea, she received pushback from employees.

“I gave them two months to say, ‘I don’t like this or that,’” she says, adding that she listened respectfully to complaints.

After a couple of months, Menefee told ASC staff that the new OR pit crew program would launch for a 30-day trial period. After trying the new process for a month, they could re-evaluate it and talk about improvements.

“After we started using that model, the comments were huge,” Menefee recalls. “Doctors noticed the change immediately, and they would comment to staff, saying, ‘Things are working so smooth — I love my turnover. What are you doing different?’”

Once the staff received the positive feedback from physicians, their perception of the change began to improve. Staff buy-in also improved when Waite began working at the ASC, soon after the beginning of the implementation, Menefee notes.

“Nathalie had a completely positive attitude and said, ‘Sure, I’ll do it,’” she says. “I’m not in the OR all the time, so when things are sliding back, I might not see it. But she was there, and she did daily huddles with the team to make sure they understood that this is what we were doing and will continue doing.”

Waite embraced her role as pit crew cheerleader. “I have a very loud personality, at times, and I can get people excited about things if I’m excited about it,” she says. “Quality improvement is very much about keeping people informed of their successes.”

Each day, they’d see a report on turnover times, per room and case. Then, during the daily huddles, the team would discuss the times, what worked, and what could improve.

“People got competitive about it and wanted to do better,” Menefee says.

“I have this deep-seated interest in quality improvement and efficiency, so I was excited about the idea,” Waite says. “The bottom line is if you are more efficient, you can schedule more cases, and physicians are happy, patients are happy, and staff is satisfied.”