Take off in the operating theatre

Engineer Stefan Wollschläger, a partner in Visality Consulting GmbH, Berlin, and Dr Gregor Zehle MBA, a senior consultant at GÖK Consulting AG, Berlin, discuss the benefits of a strategy transfer from the aviation sector to operating theatre management.

Aviation, a sector that for decades has been characterised by continual growth, but also extreme competition and pressure to reduce costs, exhibits structural parallels with hospitals.

Airlines, airports and aviation service providers have developed strategies for survival in this politically influenced and fought over environment. Strategies that are successfully employed in aviation can be modified and transferred to hospital management. The example used here is the operating theatre, one of the central proponents for costs and profits, as well as often a hospital bottle neck.

Infrastructural bottlenecks
Aviation capacities are structurally narrowly limited. Runways for take off and landing, air space and parking spaces are scant resources that must be used optimally. European airspace is centrally co-ordinated from Brussels, from where slots are allocated, time windows for take off that must be adhered to. Each airport is simultaneously targeting optimum use of its capacities. Not all aeroplanes can land and take off in accordance with the airlines’ wishes; landing sequences, holding patterns and slots must be observed. Parking spaces close to buildings are also rare and comprehensive planning for their allocation is required.
The tool for optimum use of these bottlenecks is flexible planning and coordination, as well as a value-oriented prioritisation of the flight events. Planned runway capacities and parking spaces are continually adapted to the current requirements: changes due to delays, cancellations and weather conditions are the norm in the aviation business. Flight security and the airport management adopt a sovereign role, such that the airlines’ interests need to be considered comprehensively in the planning for bottle neck capacities. If an airline wishes to prioritise flights within its fleet, then the value of the flights will be compared. The criteria for this decision-making process are the number and status of the passengers, the relevance of transit passengers for connecting flights and the importance of those flights for competition.
What does all this mean for the management of operating theatres? Available surfaces and pathways are infrastructural bottle necks in the operating theatre area. Comprehensive advance planning relating to capacities is also required in this case. Deviation from the rule is the norm: complications, cancelled operations, emergencies. Therefore, there must an operating theatre management in place that co-ordinates special cases in accordance with agreed rules and ensures that the interests of different specialist units are equally served. To this end, medical or economic determination of priorities can be consulted. Assessment of these measures from an ethical standpoint is the hospital management’s job. Prerequisite to this is the presence of a comprehensive medical strategy within the hospital and a moderated synchronisation process between all participants.

High value production factors
Another characteristic of the airline business is the use of high value production factors, in particular the personnel and the aircraft. High costs result in the optimisation target of operating at full capacity whenever possible, in order to reduce individual costs to the minimum – always ensuring that all security requirements are fulfilled.
An aeroplane only earns money when it is in the air. Time on the ground must be kept to a minimum and the passenger, luggage and freight flows must be geared towards ensuring this is the case. Airlines have detailed knowledge on the procedures, costs and duration of the ground processes and have alternative strategies to deal with any deviations from this pattern. In all cases, reaction is immediate. Ground traffic service providers work towards minimising unproductive empty slots and maximising the use of employees and equipment. Flexible employee deployment models and the evaluation of the service performance are essential factors. Furthermore, airlines operate comprehensive, cost-oriented fleet and crew management. For example, should an aeroplane be grounded, then alternative actions are prioritised in accordance with measures of value and dispositive decisions are rapidly taken.
Similar questions are posed for operating theatre management. Equipment and personnel are high value production factors that constitute the added value of the operating theatre. Empty slots endanger cost effectiveness. The primary and secondary processes must therefore be synchronised and standardised in reference models, under consideration of deviations from standard procedure. Flexibility is required in the deployment of personnel and this must be reflected in working times and deployment models, as well as in task profiles. The aim must be to have the capacity to react in the short-term and in a cost effective manner to delays, curtailments and cancellations to operations. Furthermore, a comprehensive disposition for deployment is required, thus optimally using the high value personnel resources. In doing this, employment law and ergonomic restrictions as well as quality assurance must be adhered to.

High competitive pressure
Competition is a defining element in aviation and exists between airlines and, in the interim, now also between airports. The battle for passengers and freight leads some airlines into ruinous competition, in order to use their own capacities to the full. The airlines are gaining less than expected from the creation of added value in aviation.
A large proportion of the earnings are made by the airports that are in a position to use their monopolies for profit.
In the battle for each Euro, the airlines have perfected the optimisation of their profits. Prices and capacities are planned strategically: graduated ticket prices, enticing offers and customer loyalty programmes guarantee reservations. The range is differentiated by varying types of service to such an extent that business or first class customers are prepared to pay more than twice the price of an economy ticket.
Another strategy is integration within the aviation sector. Airlines take a share in airports or service providers enter into joint ventures with airports in so-called vertical integration. Horizontal integration is accomplished by airlines joining in alliances and airports taking shares in other airports. The intention of such moves is to minimise risks and increase growth in market force and increase competitiveness.
The parallels with the healthcare market are obvious. The big players are also arming themselves for competition through vertical or horizontal integration. We can make derivations that apply to operating theatre management. Optimisation of the use of resources and financial gains is possible, obviously under due consideration of all medical and ethical standards. One step is the creation of medical focal points, in which operating with high productivity, quality and cost effectiveness is targeted. In order to guarantee the safety of the hospital’s location, an edge must be provided and the medical performance protocol developed further, in accordance with the hospital’s medical strategy. Finally, why should there not be any differentiation between services and prices based on the nature of the service?
Learning from the mistakes and successes made by others – this is an option for the healthcare sector. The first step in the reorganisation process for a hospital is to work out an individual development strategy, and to derive from this individual targets and measures. The operating theatre should be a special focus of this, as a ‘production plant’ in the creation of added value within the clinic. An analysis of personal strengths and weaknesses will indicate the path towards change that can be of existential significance.