title: Successful strategies for the reduction of operating room turnover times in a tertiary care academic medical center.
abstract: BACKGROUND
  Turnover time (TOT) is one of the classic measures of operating room (OR) efficiency. There have been numerous efforts to reduce TOTs, sometimes through the employment of a process improvement framework. However, most examples of process improvement in the TOT focus primarily on operational changes to workflows and statistical significance. These examples of process improvement do not detail the complex organizational challenges associated with implementing, expanding, and sustaining change.
  
  
  METHODS
  TOT data for general and gastrointestinal surgery were collected retrospectively over a 26-mo period at a large multispecialty academic institution. We calculated mean and median TOTs. TOTs were excluded if the sequence of cases was changed or cases were canceled. Data were retrieved from the perioperative nursing data entry system.
  
  
  RESULTS
  Using performance improvement strategies, we determined how various events and organizational factors created an environment that was receptive to change. This ultimately led to a sustained decrease in the OR TOT both in the general and gastrointestinal surgery ORs that were the focus of the study (44.8 min versus 48.6 min; P < 0.0001) and other subspecialties (49.3 min versus 53.0 min; P < 0.0001), demonstrating that the effect traveled outside the study area.
  
  
  CONCLUSIONS
  There are obstacles, such as organizational culture and institutional inertia, that OR leaders, managers, and change agents commonly face. Awareness of the numerous variables that may support or impede a particular change effort can inform effective change implementation strategies that are "organizationally compatible."
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Bhavani S
authors.initials: BS
authors.lastname: Kodali
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Dennie
authors.initials: D
authors.lastname: Kim
authors.affiliation: Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Ronald
authors.initials: R
authors.lastname: Bleday
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Hugh
authors.initials: H
authors.lastname: Flanagan
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: rurman@partners.org.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Urman
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration*; D019985:Benchmarking / Q000458:organization & administration; D017598:Efficiency, Organizational; D005160:Facility Design and Construction; D006801:Humans; D009873:Operating Rooms / Q000458:organization & administration*; D012189:Retrospective Studies; D013503:Surgery Department, Hospital / Q000458:organization & administration*; D062606:Tertiary Care Centers / Q000458:organization & administration*; D013997:Time Factors; D013996:Time and Motion Studies
keywords: OR benchmarks; OR efficiency; OR management; Turnover time