IHP 640 Module 3 Milestone One Example

Milestone One: Late Starts, Long Turnovers and Overtime in Highland Valley's Operating Rooms

[Student Name]

Southern New Hampshire University

IHP 640: Measurement, Analysis, & Models for Performance Improvement

Module Three Milestone One

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Milestone One: Late Starts, Long Turnovers and Overtime in Highland Valley's Operating Rooms

IHP 640's final project is a performance improvement report on an operational problem. This milestone frames that problem for Highland Valley Medical Center's surgical suite, using the metric definitions set in Module Two, a year of baseline data and published analysis of what operating room delays actually cost.

The Setting

Highland Valley's main suite runs 14 operating rooms on an eight-and-a-half-hour weekday staffing plan, handling about 11,200 cases a year across general, orthopedic, gynecologic, urologic and vascular surgery. First incisions are planned for half past seven. Surgeons hold block time by service, and unused blocks are released 72 hours in advance.

Baseline Performance

Over the past twelve months, 54% of first cases started on time, with mean tardiness of 9.4 minutes per first case. Mean turnover was 44 minutes, with 13% of turnovers exceeding 60 minutes. Rooms averaged 1.9 hours of underused staffed time and 0.8 hours of overtime per day. Same-day case cancellations ran at 4.2%. Monthly values were stable across the year, with no seasonal pattern, suggesting a persistent system problem rather than a temporary one.

Table 1. Baseline Surgical Suite Performance, Twelve Months

Note. Composite data; peer medians from a regional perioperative benchmarking group.

Where the Money Goes

Childers and Maggard-Gibbons (2018) estimated that operating room time in California hospitals averages in the mid-thirties of dollars per minute, and most of that is fixed cost. For Highland Valley, the direct financial effect of delays shows up mainly in overtime: 0.8 hours per room per day across 14 rooms and about 250 weekdays is about 2,800 hours a year, costing roughly $2.1 million in premium pay for nurses, technicians and anesthesia staff.

What Reducing Tardiness Is Worth

It is tempting to multiply every minute of late start by an average cost. Dexter and Epstein (2009) analyzed operating room data to estimate the savings from reducing first-case tardiness and showed that the value depends on whether rooms finish after their scheduled hours; earlier starts save money mainly by reducing overtime at the end of the day. Because Highland Valley's rooms frequently run late, reducing tardiness is likely to have real value here, though less than a naive calculation suggests.

What Faster Turnovers Are Worth

Dexter (2007) cautioned that reducing turnover times improves efficiency mainly when it reduces overtime or allows an additional case to fit into the day, which small average reductions seldom achieve. This argues for targeting prolonged turnovers, the 13% exceeding an hour, which consume far more time than a few minutes shaved from routine ones.

How Delays Travel Through the Day

Delays compound. A first case that starts fifteen minutes late pushes every later case in that room back unless a later case finishes early, which is rare. When a prolonged turnover follows, the final case may start after 2:30 p.m. and run past the end of staffed hours. Room-level data show that rooms with a late first start ran overtime on 61% of days, compared with 34% for rooms that started on time. The same pattern appears for days with at least one prolonged turnover. Late starts and long turnovers are therefore not separate problems but links in the same chain that ends in overtime.

Effects Beyond Cost

Delays affect people as well as budgets. Patients fasting since midnight wait longer, a survey found only 41% of surgeons satisfied with operating room efficiency and two orthopedic surgeons have moved some cases to a competing surgery center. Nurses cite unpredictable end times as a reason for leaving, which increases reliance on agency staff.

What Staff Say Causes Delays

Preliminary interviews with twenty staff members produced a long list of suspected causes: patients arriving late for preoperative preparation, incomplete consent forms, missing history and physical documents, surgeons arriving after the scheduled start, anesthesia evaluations completed at the last minute, instrument trays arriving incomplete from sterile processing and too few environmental services staff to clean rooms promptly. Each group named causes outside its own control. These claims have not yet been tested against data, which is the task of Milestone Two.

Stakeholders

Surgeons, anesthesiologists, operating room and preoperative nurses, sterile processing, environmental services, scheduling and patient transport all touch first starts and turnovers. Each sees part of the problem, and early interviews show each group tends to attribute delays to another. A performance improvement effort will need representatives of all of them.

Problem Statement

In Highland Valley's 14-room surgical suite, 46% of first cases start late and 13% of turnovers exceed an hour, contributing to about 0.8 hours of overtime per room per day, $2.1 million in annual premium pay, patient waiting and surgeon and staff dissatisfaction. Performance has been stable for a year and lags peer medians on every measure.

Aim

Within twelve months, the suite will raise the first-case on-time rate from 54% to 80%, reduce first-case tardiness from 9.4 to 4 minutes, cut prolonged turnovers from 13% to 6% and reduce overtime by 30%, saving about $630,000 a year, without increasing same-day cancellations.

Scope

The project covers weekday elective cases in the main suite. It excludes the obstetric rooms, the ambulatory surgery unit and emergency cases, and it does not address block allocation among surgical services, which the perioperative committee is reviewing separately.

Questions for the Analysis

Milestone Two will ask which causes account for most first-case delays and prolonged turnovers, and which case and room characteristics predict long turnovers. The capacity modeling paper will ask whether recovery room congestion contributes to delays. Milestone Three will design improvements and a control plan.

Conclusion

Highland Valley's surgical suite has a stable, measurable efficiency problem whose main financial effect is overtime and whose human effects reach patients, surgeons and staff. Framing it through precise metrics and evidence on what delays actually cost points the project toward late starts and prolonged turnovers rather than small average gains.

References

Childers, C. P., & Maggard-Gibbons, M. (2018). Understanding costs of care in the operating room. JAMA Surgery, 153(4), Article e176233. https://doi.org/10.1001/jamasurg.2017.6233

Dexter, F. (2007). Impact on operating room efficiency of reducing turnover times and anesthesia-controlled times. Annals of Surgery, 245(2), 336-337. https://doi.org/10.1097/01.sla.0000253097.64557.7a

Dexter, F., & Epstein, R. H. (2009). Typical savings from each minute reduction in tardy first case of the day starts. Anesthesia & Analgesia, 108(4), 1262-1267. https://doi.org/10.1213/ane.0b013e31819775cd