• John A Girotto, Peter F Koltz, and George Drugas.
• University of Rochester Medical Center, Plastic Surgery, Rochester, NY 14642, USA.
• Int J Surg. 2010 Jan 1; 8 (5): 359-67.

IntroductionCaring for patients in traditionally designed, large teaching hospitals is often frustrating. Attempts at decreasing internal costs and inpatient length of stay are universally undertaken in order to address dwindling reimbursement, and patient care becomes more specialized and fractionated. These attempts have proven to be myopic, at best, and injurious to patient care and professional job satisfaction, at worst. This manuscript attempts to characterize the operational processes of our university operating room facility as well as make suggestions for operational improvements that can be applied to all hospitals.MethodsThrough a step-by-step approach, we analyze the patient's journey from the surgeon's office through the day of surgery to discharge. Using this approach, a series of studies designed to identify operational shortcomings and inefficiencies are undertaken, and the results of these shortcomings are elucidated.ResultsIn our operating room, the peri-operative services are composed of multiple departments, each accountable to their own administrative silo. We found this to result in fragmented goals and objectives confounded by individualized and conflicting incentives. Consequently, we conclude with a recommendation that veers from process modification to a disruptive innovation of the hierarchical organization.ConclusionNowhere in the hospital is this drive for cost containment and increased patient volume more evident than in the operating theatre. Long-term improvements must embrace radical reduction of OR costs and increased operative patient through-put, (i.e. per 8 h day; per fiscal year) by re-engineering the processes of operative patient care. In the end, the ultimate goal of safe and high-quality patient care must not be compromised.Copyright 2010 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

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