Modeling and management of variation in the operating rooms helps to improve patient outcome.

Operating rooms (OR) are relatively costly for a hospital nevertheless the health care system. Increases in the efficiency of use of the ORs results in more production. As more cases are performed within the maximum margins of the available OR time without overstepping those boundaries frequently, efficiency will eventually increase and therefore also the contribution margin for the hospital. When looking at an operating room (OR) both in an era in which both cost-containment and quality of health care are considered of prime importance, hospitals simply have to utilize ORs effectively and efficiently. Often we see the opposite in ORs. Next examples will illustrate this. Due to poor case scheduling, OR staff is forced to stand around idly, and expensive nursing, anesthesia and support staff are wasted on some of the days. On other days, the OR staff works beyond regular working hours to finish the workload on that day. Surgeons/ anesthesiologists arrive too early or too late in the OR and teams are not always ready at the scheduled time. Capacity in the OR is sometimes insufficient for patients who arrive in the emergency department, which causes scheduled patients to be denied surgery that day, or for staff to work late. Such situations frequently result in nurses, doctors, management and patients becoming extremely frustrated. As this paper will demonstrate, a fundamental understanding of the variation and proper control in the OR makes it possible to improve its efficiency and effectiveness, and therefore also improve the quality of care provided to the patients. In its influential ‘Crossing the quality chasm’, the Institute of Medicine (IoM) identifies six quality dimensions of health care, among which are efficiency and timeliness (1). The IoM described many problems in the quality of the United States health care delivery system. The report suggests that: “Health care should be: – safe: avoiding injuries to patients from the care that is intended to help them; – effective: providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit (avoiding underuse and overuse, respectively); – patient-centered: providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions; – timely: reducing waits and sometimes harmful delays for both those who receive and those who give care; – efficient: avoiding waste, including waste of equipment, supplies, ideas, and energy; – equitable: providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status”. The view the IoM has on quality is has some similarities to the view expressed in the 1991