Business Process Redesign in the Perioperative Process: A Case Perspective for Digital Transformation

This case study investigates business process redesign within the perioperative process as a method to achieve digital transformation. Specific perioperative sub-processes are targeted for re-design and digitalization, which yield improvement. Based on a 184-month longitudinal study of a large 1,157 registered-bed academic medical center, the observed effects are viewed through a lens of information technology (IT) impact on core capabilities and core strategy to yield a digital transformation framework that supports patient-centric improvement across perioperative sub-processes. This research identifies existing limitations, potential capabilities, and subsequent contextual understanding to minimize perioperative process complexity, target opportunity for improvement, and ultimately yield improved capabilities. Dynamic technological activities of analysis, evaluation, and synthesis applied to specific perioperative patient-centric data collected within integrated hospital information systems yield the organizational resource for process management and control. Conclusions include theoretical and practical implications as well as study limitations

Targeting Perioperative Performance Aligned to Hospital Strategy via Digital Transformation

This study examines the digital transformation of a U.S. hospital’s perioperative process, which yields targeted performance alignment to strategy. Based on a 184-month longitudinal study of a large 1,157 registered-bed academic medical center, the observed effects are viewed through a lens of information technology (IT) impact on core capabilities and core strategy. The results offer a framework that supports patient-centric improvement and targets alignment of perioperative sub-process efforts to overall hospital strategy. This research identifies existing limitations, potential capabilities, and subsequent contextual understanding to minimize perioperative process complexity, target and measure improvement, and ultimately yield process management and hospital strategy alignment. Dynamic activities of analysis, evaluation, and synthesis applied to specific perioperative patient-centric data, collected within integrated hospital information systems, provide the organizational resource for management and control. Conclusions include theoretical and practical implications as well as study limitations

Impact of the WHO Surgical Safety Checklist implementation on perioperative work and risk perceptions : A process evaluation by use of quantitative and qualitative methods

Background: Human performance deficiencies account for a large proportion of adverse surgical events. The World Health Organization (WHO) Surgical Safety Checklist (SSC) was launched to improve teamwork and patient outcome. Its introduction in hospitals worldwide has been associated with beneficial impacts on a range of patient and team outcomes. However, both the implementation quality and the comprehensive inclusion of all parts of the checklist is reported to differ among hospitals, surgical specialties and surgical staff members. To understand and engage with these differences, studies were warranted to investigate both perioperative work processes and process indicators associated with positive SSC outcomes. Aims: To investigate the impact of WHO SSC implementation on perioperative care processes and patient outcome. To explore perioperative work processes in the provision of surgical antibiotic prophylaxis (SAP) following the SSC implementation. To explore how the WHO SSC fits with existing perioperative risk management strategies among the multidisciplinary team members. Methods: A combination of quantitative and qualitative methods was used in the studies for this thesis, including data from patients, healthcare personnel and perioperative teamwork observations. In Study 1, we performed a secondary analysis of a WHO SSC stepped wedge cluster randomised control trial. A total of 3,708 surgical procedures were analysed from three surgical units (neurosurgery, cardiothoracic, and orthopaedic) from Haukeland University Hospital. We examined how the SSC implementation quality affected perioperative work processes and patient outcome. In Study 2 and Study 3, we used a prospective ethnographic design, combining 40 hours of observations and 22 single face-to-face interviews of key informants, conducted at Haraldsplass Deaconess Hospital, Førde Central Hospital and Haukeland University Hospital. We explored perioperative work processes in relation to SSC utilisation. In Study 2, we outlined the provision of surgical antibiotic prophylaxis, and in Study 3, we analysed the integration of the SSC in local and professional perioperative risk management. Results: In Study 1, the results showed that high-quality SSC implementation, i.e., all 3 checklist parts used, was significantly associated with improved perioperative work processes (preoperative site marking, normothermia protection, and timely provision of SAP pre-incision) and reduction of complications (surgical infections, wound rupture, perioperative bleeding, and cardiac and respiratory complications). In Study 2, we identified that the provision of SAP was a complex process and outlined the linked perioperative work processes. This involved several interacting factors related to preparation and administration, prescription accuracy and systems, patient specific conditions and changes in the operating theatre schedules. The timeframe of 60 minutes described in the SSC was a prominent mechanism in facilitating administration of SAP before incision. In Study 3, we identified three dominant strategies: “assessing utility”, “customising SSC implementation”, and “interactive micro-team communication”. Each of these reflected on how the SSC was integrated into risk management strategies in daily surgical practice. Each strategy had corresponding categories describing how SSC utility assessment was carried out and how performance of SSC was customized, mainly according to actual presence of team members and barriers of performance. The strategy of “interactive micro-team communication” included formal and informal micro-team formations where detailed, and specific risk assessments unfolded. Conclusion: Utilisation of all 3 parts of the SSC was significantly associated with improved processes and outcomes of care. Overall improvement of SAP administration is likely to have been influenced by the SSC timeframe of “60 minutes prior to incision”, either as a cognitive “reminder” of timely administration and /or as an educational intervention. Although the SSC use has made significant impact on specific perioperative work processes, identified norms of behaviour and communication indicate that the SSC seemed not to be fully integrated into existing perioperative risk management strategies on a daily basis among the multidisciplinary team members

Improving Perioperative Data Integrity and Quality via Electronic Medical Record Reconciliation

This case study investigates data integrity and quality within the perioperative process via embedded quality control check (QCC) rules, used within a business process management framework to support patient care documentation, performance reporting, patient billing, data analysis, and regulatory agency audits. The study identifies specific perioperative nursing care documentation as electronic medical records and demonstrates how QCC rules, an embedded QCC process, and QCC rule violation reconciliation is applicable to ensuring data integrity and quality within integrated hospital information systems. Based on a 166-month longitudinal study of a large 1,157 registered-bed academic medical center, this study provides a priori business process management examples of data integrity and quality within the perioperative process. Recognizing existing limitations, potential capabilities, and the subsequent contextual understanding are contributing factors that yield measured improvement. Theoretical and practical implications and/or limitations of this study’s results are also discussed

Transactions of 2019 International Conference on Health Information Technology Advancement Vol. 4 No. 1

The Fourth International Conference on Health Information Technology Advancement Kalamazoo, Michigan, October 31 - Nov. 1, 2019. Conference Co-Chairs Bernard T. Han and Muhammad Razi, Department of Business Information Systems, Haworth College of Business, Western Michigan University Kalamazoo, MI 49008 Transaction Editor Dr. Huei Lee, Professor, Department of Computer Information Systems, Eastern Michigan University Ypsilanti, MI 48197 Volume 4, No. 1 Hosted by The Center for Health Information Technology Advancement, WM

A Case Study Perspective to the Digital Transformation of a Hospital’s Perioperative Process

Based on a 177-month longitudinal study of a large 1,157 registered-bed academic medical center, this research examines the observed effects associated with the digital transformation of a United States hospital’s perioperative process. The observed effects are viewed through a lens of information technology (IT) impact on core capabilities and core strategy to yield a digital transformation framework that supports patient-centric improvement across the perioperative sub-processes of pre-admissions, pre-operative, intra-operative, post-operative, and central sterile supply. This case study identifies existing perioperative sub-process limitations, potential capabilities, and subsequent sub-process contextual understanding to minimize perioperative process complexity. Specific perioperative nursing documentation as electronic medical records demonstrate the utility and value of patient-centric perioperative data collected within integrated hospital information systems as an organizational resource for process management and control. The case results are discussed, including theoretical and practical implications as well as study limitations

Transactions of 2015 International Conference on Health Information Technology Advancement Vol.3, No. 1

The Third International Conference on Health Information Technology Advancement Kalamazoo, Michigan, October 30-31, 2015 Conference Chair Bernard Han, Ph.D., HIT Pro Department of Business Information Systems Haworth College of Business Western Michigan University Kalamazoo, MI 49008 Transactions Editor Dr. Huei Lee, Professor Department of Computer Information Systems Eastern Michigan University Ypsilanti, MI 48197 Volume 3, No. 1 Hosted by The Center for Health Information Technology Advancement, WM

Reducing work pressure and IT problems and facilitating IT integration and audit & feedback help adherence to perioperative safety guidelines: a survey among 95 perioperative professionals

Background: To improve perioperative patient safety, guidelines for the preoperative, peroperative, andpostoperative phase were introduced in the Netherlands between 2010 and 2013. To help the implementation ofthese guidelines, we aimed to get a better understanding of the barriers and drivers of perioperative guidelineadherence and to explore what can be learned for future implementation projects in complex organizations.Methods: We developed a questionnaire survey based on the theoretical framework of Van Sluisveld et al. forclassifying barriers and facilitators. The questionnaire contained 57 statements derived from (a) an instrument formeasuring determinants of innovations by the Dutch Organization for Applied Scientific Research, (b) interviewswith quality and safety policy officers and perioperative professionals, and (c) a publication of Cabana et al. Thetarget group consisted of 232 perioperative professionals in nine hospitals. In addition to rating the statements on afive-point Likert scale (which were classified into the seven categories of the framework: factors relating to theintervention, society, implementation, organization, professional, patients, and social factors), respondents wereinvited to rank their three most important barriers in a separate, extra open-ended question.Results: Ninety-five professionals (41%) completed the questionnaire. Fifteen statements (26%) were considered tobe barriers, relating to social factors (N = 5), the organization (N = 4), the professional (N = 4), the patient (N = 1),and the intervention (N = 1). An integrated information system was considered an important facilitator (70.4%) aswell as audit and feedback (41.8%). The Barriers Top-3 question resulted in 75 different barriers in nearly allcategories. The most frequently reported barriers were as follows: time pressure (16% of the total number ofbarriers), emergency patients (8%), inefficient IT structure (4%), and workload (3%).Conclusions: We identified a wide range of barriers that are believed to hinder the use of the perioperative safetyguidelines, while an integrated information system and local data collection and feedback will also be necessary toengage perioperative teams. These barriers need to be locally prioritized and addressed by tailored implementationstrategies. These results may also be of relevance for guideline implementation in general in complex organizations.Trial registration: Dutch Trial Registry: NTR3568.Keywords: Guideline adherence, Implementation, Implementation barriers, Implementation facilitators, Patientsafety, Perioperative car

An Informatics Solution for Operating Room Efficiency

Problem: For most hospitals, a major cost is the operating room. Inefficiency increases costs and risks for adverse events. An efficient operating room can also be a major revenue generator. Context: This evidence-based performance improvement project was conducted in a small rural Veteran’s Hospital, which belongs to an integrated health network in Central California. The facility has four operating rooms and is expanding services provided to their patients. Intervention: The intervention was the use of analytics and evaluations to improve the operating room efficiency by five percent. The use of 3 separate queries which were combined to generate reports and then some data were entered separately into IBM SPSS 24 for descriptive analytics. The reports provided measures to gauge operating room efficiency. Measures: The analytic results were broken down into three reports. The first was titled Operating Room Times. The second was titled Operating Room Efficiency, and the third was titled Operating Room Utilization. The first was utilized to discern data errors and missing elements of data and to detect cancellations. The second to measure the difference between scheduled times and actual times. The third was for Operating Room utilization and overtime. Results: Data errors decreased by 60% whereas cancellations, surgery start, and surgery end variance fluctuated. On-time starts did show some improvement by over 5%. Operating room utilization and overtime did not improve Conclusion: The project did not achieve its objectives. There was not large buy-in for the project. There are other extenuating factors such as staffing shortages and no beds to admit patients to after surgery that further confounded the data. Data analytics alone cannot improve any area. There must be a desire from top-down for improvement. Plus, there must be a consensus and agreement on what needs to be improved

Optimizing Operating Room Throughput

Practice Problem: Throughput is an instrumental aspect for hospitals to maximize patient capacity; therefore, methods to improve patient flow should be consistently implemented. Surgical areas are a major contributor to inpatient admissions and the subsequent revenue; however, without the appropriate oversight, patient throughput can be negatively impacted. PICOT: The PICOT question that guided this project was: In operating room patients who require inpatient admission (P), how does the implementation of a standardized bed flow process (I), compared to the current methods for care transitions (C), reduce perioperative delays and improve hospital financial metrics (O), over a three-month period (T)? Evidence: A review of the evidence revealed that streamlining operating room throughput was essential to the quality of clinical care and patient safety as well as to improve efficiencies associated with patient volumes, lengths of stay and hospital census. Intervention: A dedicated bed flow manager was implemented in the project setting with the overall goal to enhance throughput measures within the operating room. Outcome: While the intervention did not achieve statistical significance as determined by the data analysis, the results did demonstrate clinical significance as the organization was able to maximize capacity and throughput during the Covid-19 pandemic. Conclusion: The addition of a dedicated surgical bed flow manager was beneficial to the optimization, standardization and systemization of the perioperative throughput process