Re-organising an operating theatre

The hospital administrators' viewpoint

In September 2006, Dr Albrecht Bornscheuer (right) changed roles within the Hannover Medical School (MHH): the anaesthetist became a manager responsible for the coordination and capacity utilisation of the school's 41 operating theatres.

Dr Albrecht Bornscheuer
Dr Albrecht Bornscheuer

‘Re-organisation is not an embarrassment,’ he reflects, ‘but a necessity brought about by changing times – and the same applies to hospital administrators. Thus, over the last two years, the MHH has managed to achieve an increase of up to 30% in the capacity utilisation of its operating theatres.

 What the administrator wants

‘The most important issue for me in the daily work of an operating theatre co-ordinator is to promote dialogue between the theatres and other hospital departments.’ To recognise and utilise potentials within a theatre you need to “open the doors of the operating theatre”. For the hospital administrator one particular communication is the loss of information moving between management, administration and wards. Performing those tasks oneself provides an understanding of the atmosphere in the operating theatre and the importance of seemingly insignificant tasks. ‘The experiences of those who carry out these tasks every day must be acknowledged,’ Dr Bornscheuer points out. ‘However, the biggest impact on theatre performance always comes from the surgeons, and this means that they carry special responsibility beyond the purely medical issues.’

Changes for theatre staff
Initially, it should be understood that the staff must not be viewed as ‘main cost factors’, but that they actually facilitate hospital services. If a staff member is to perform well and shoulder a lot of personal responsibility they should be given attractive working conditions. However, a surgeon’s individual competence is just as important, yet often underestimated. ‘We have to prepare for the fact that, in future, we will probably have a kind of transfer market between the best staff members and hospitals. It is a fact that shorter operating times, with constant quality, account for the highest increase in the number of cases treated, and that not all colleagues can deliver this in the same way,’ Dr Bornscheuer explains.
The use of functional services across the theatres is another important aspect that has enabled the MHH to perform 40-45 more operations monthly during core working hours. Over-qualification is a hindrance to processes in the theatre: ‘If more than half the staff in certain groups have managerial qualities, then at some point you will be short of those who are actually happy to touch a patient,’ he points out. ‘I also think it’s necessary not to turn down overtime in general. An extra hour is often the one utilised in the best way.’

Tips for a theatre manager
Albrecht Bornscheuer recommends careful analysis of the causes of target and performance discrepancies. The re-organisation process should take place in small, concrete steps to make it truly feasible. Objectives should be achieved without stress, because stress is the main cause of mistakes. He warns against losing the grasp of the basics, i.e. the basic relationship between doctor, patient and care, by obscuring it with secondary processes, such as accounting, purchasing and personnel management. Optimising patient care in the theatre, on a qualitative, ethical and financial level, is the main objective – in precisely that order, he concludes.
‘You can set an example for colleagues by taking the initiative and actually carrying out necessary changes. This particularly applies to the adjustment and synchronisation of work schedules. This tangible implementation of changes then makes it easier to tackle further necessary adjustments because the reorganisation process has begun.’

29.10.2008

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