Edited by Jaideep J. Pandit, Oxford, UK
Cambridge University Press 2019, 206 pages
Because they work in operating rooms, anaesthesiologists are automatically involved at some level with managing the process of patient flow through surgery. Some anaesthesiologists have specific managerial responsibilities, but all are responsible for the smooth flow of their patients from the ward to the recovery area and then back to the ward or home. Moreover, hospitals in Europe and the world over are challenged to deliver healthcare cost-effectively, which means maximising efficiency in the face of ever-increasing demands. Some countries, or insurance companies who contract for services, set specific time targets by which surgery must be performed, if the hospital is to be paid. Therefore, even if anaesthesiologists do not feel they are managing the service, it is in their interests to understand the system in which they work.
All this raises a need to comprehend the decision-making and metrics that constitute the daily schedule in surgical theatres. Yet, few if any courses on operating room management are offered by national associations to provide training on how to calculate productivity or efficiency. In his new book Practical Operating Theatre Management: Measuring and Improving Performance and Patient Experience, Pandit fills this void and provides detailed materials and metrics relating to operating room efficiency, utilisation and scheduling. Pandit presents the material in a practical manner so that it can be readily adopted by the reader. There are also downloadable tools (Excel files) that the reader can use to work through given examples or apply to their own data.
Broadly, the book is divided into two parts. The introduction and first eight chapters introduce the key terms and main content. A core concept is that of defining efficiency as an easily calculated metric that can serve as a goal to the flow of patients within the operating theatre suite. A second key concept is that of using the known data on mean (or median) and variance of operating times for procedures to schedule the operating list. Combining these two principles in a data-driven way can yield positive outcomes very powerfully. To put it succinctly, if we use the times we already know the surgeon takes to perform the single operations he intends to plan, then we can schedule the surgical operations to a degree that makes it highly probable that the operating list will finish on time. If that happens, the hospital will have maximised its efficiency and therefore its income.
In getting across this simple message – albeit in a very data-driven way – Pandit debunks several current theories. One is that ‘utilisation’ of the list is the main goal, where utilisation is intended as the aim of using as much available time as possible. Pandit explains how trying to achieve this goal only serves to generate over-runs which are expensive and demoralising to staff. A second myth debunked is that all that is needed is to ‘start on time’. Pandit explains that there is no common agreement on ‘start time’. If the reference point is ‘surgical start’ then the anaesthesiologist needs to guess how much earlier to start. If the reference is ‘anaesthesia start’ then the surgeon needs to guess when anaesthesia will be complete before he arrives.
The second section of five chapters examines operating room management in many different countries, including Japan, Europe (represented by The Netherlands and Switzerland), Australasia and the United States. These chapters – with international contributors – show the commonalities across countries, as well as highlighting differences and nuances that are important in adapting the core principles more widely.
Notably, the book does not deal with leadership or teamwork, or other ‘intangible’ but important aspects of management. This aspect could be treated in future editions, even if already well covered in other texts. Readers who dislike mathematics may find this book difficult but, as Pandit says, ‘such readers should best avoid any role in operating room management’. Some may find the book focused on the United Kingdom, but the author makes great effort to generalise the principle to any system that employs block-scheduling of lists – and he also shows how the optimisation methods apply to different ways of scheduling lists (e.g. where multiple teams occupy a single operating room through the day). The international chapters also make the book highly relevant to a wide range of healthcare systems. In addition, Pandit lists several areas for future research and one that would be particularly important is the optimal flow of emergency cases; it appears there is very little literature on this subject and hopefully this book might stimulate studies in that direction.
Overall, the book ends with a discussion of operating room safety. This book is a useful resource to anyone involved in operating room management: managers, anaesthesiologists, surgeons, nurses, business analysts, etc. I highly recommend it to departments as a basis for understanding the processes underpinning the surgical patient pathway.
Manikandan Raju, PhD