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Operating Room Leadership and Perioperative Practice Management 2nd Edition

Operating Room Leadership and Perioperative Practice Management 2nd Edition PDF

Author: Alan David Kaye, Richard D. Urman

Publisher: Cambridge University Press


Publish Date: January 17, 2019

ISBN-10: 1107197368

Pages: 390

File Type: PDF

Language: English

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Book Preface

Evolution describes our past. Revolution defines our future. Surgical services are in a period of revo-lutionary change, and financial and operational effi-ciency will remain important. However, it is no longer sufficient to simply refine our current processes. We must reengineer our models, designing toward our future of bundled care, shared risk, and value- based payments to determine our success.

We must also look outside of our traditional tem-poral and geographic boundaries. The days when a sur-gical encounter is viewed as an event in isolation must be put behind us. To maximize the value provided to our patients, we will include preconditioning efforts prior to surgery, and examine the longer- term outcomes and effects of our actions during the perioperative and recovery periods. Through integrating multidiscip-linary teams into the entire care process, we will draw on the unique talents and knowledge of each group, maximizing safety, efficacy, and patient satisfaction.

Expanding our geography will ensure that our patients receive care in the most convenient and cost- effective location. Ambulatory, office- based, and nontraditional procedural locations such as radi-ology and gastroenterology suites are experiencing increasing demands for service. Applying the know-ledge held by experts in OR suite management will be critical for the success of these areas.

This textbook highlights processes, techniques, and expert knowledge to prepare today’s and tomorrow’s leaders for these challenges. Only through exemplary leadership will we be able to realize the success which is critical for our sustained vision of providing excel-lence to the patients we serve.

Paul St. Jacques, MD
President, Association of Anesthesia Clinical Directors (AACD)
Quality and Patient Safety Director, Department of Anesthesiology,
Vanderbilt University Medical Center, The Vanderbilt Clinic,
Nashville, TN

With the operating room (OR) and practice man-agement science constantly evolving, we undertook a laborious task of writing a second edition to this already popular textbook. We changed the title of the book to reflect the inclusion of topics related to peri-operative practice management, adding topics that are important for anesthesiologists, surgeons, nurses, and administrators. Thus this new edition is now entitled Operating Room Leadership and Perioperative Practice Management. We hope that you find the additional topics useful in your daily clinical practice or admin-istrative activities, especially given the constantly evolving regulatory and payer environments and published research. We have significantly updated and expanded each section of the book, with an emphasis on areas such as leadership training, teamwork, and OR culture change; perioperative surgical home; non- OR locations; efficiency, scheduling, and budgeting; anesthesia practice management and post- anesthesia care unit. Three chapters speak exclusively about nursing, education, and checklists.
We believe that our book currently represents the only up- to- date, evidence- based text that encompasses the “A to Z” of OR management: metrics, scheduling, human resource management, leadership principles, economics, quality assurance, recovery, information technology, ambulatory practice, and topics spe-cific to surgeons, anesthesiologists, and pain service providers.

Years ago, the OR stood alone, and little attention was given to the perioperative period. This is because until the 1980s the OR generated large profits, des-pite its inefficiencies. Thus, hospital administrators allowed it a great deal of autonomy. However, today’s administrators realize that, although the OR is typic-ally one of the biggest sources of revenue for a hos-pital, it is also one of the largest areas of expense. This, coupled with increasing requirements for cost containment in healthcare and a demand for account-ability to the federal and state governments, insurance companies, hospital administrators, surgeons, and patients, has magnified the need for an effective and efficient perioperative process. While there was little centralized leadership in the perioperative period of the past, perioperative management is now a critical feature of successful hospitals.

As mentioned above, today’s perioperative prac-tice of medicine has evolved significantly and is now influenced by a vast array of factors, both medical and administrative. Because of this, knowledge of hospital economics and administration, OR mechanics and metrics, preoperative patient optimization strategies, human resources, financial planning, governmental policy and procedures, and clinical perioperative management is necessary in order to succeed. A good management team must bring together these diverse components to maximize productivity. Today there are more regulations, quality measures, and outcome expectations, which push innovation and result in additional burdens and challenges for hospitals. The need for this expensive technology, to compete with other hospitals, forces reform and new thoughts for traditional ways of the past. Staffing ratios, pre-operative visits, and postoperative care will be highly scrutinized financially, while clinical and adminis-trative “multitasking” is now expected. Putting an emphasis on quality data definition and collection, leadership style, simulation, and OR design will lead to the creation of a more productive and efficient peri-operative process.

We should not lose sight of the fact that the OR is where miracles happen every single day through teamwork, natural talent, hard work, and empathy. From all of this, we create game- changing and life- altering experiences for patients. Without effective and efficient leadership from all areas  – nursing, administration, surgery, and anesthesia services – we are doomed to fail. Let us also remember that all of us will be patients one day, and so let us strive to make a first- class OR in the best interests of everyone.

As we have observed from our real- life experiences collectively accumulated over the past three decades, the science of perioperative patient care is constantly evolving. This speaks to the enormous complexities in all aspects of management and development of a winning OR. We applaud all the authors for their hard work and dedication. Their chapters give a practical insight into creating a successful perioperative program.

We all face challenges in the OR environment. We hope the ideas and practical solutions discussed in this expanded second edition will benefit any stakeholder in administration, surgery, anesthesia, or nursing services, as we all do our best to move forward into the future.

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