News / Behind the red line

Peeling the Onion: How Directors of Surgical Services Approach Organizational and Policy Change

January 12, 2022


Peeling the Onion: How Directors of Surgical Services Approach Organizational and Policy Change


While innovation is the bedrock of our species’ survival, the irony is that most people bristle at the idea of change. Many find comfort in familiar approaches even when something different can improve outcomes. It’s no different in the operating room (OR). The mere suggestion of implementing organizational change can be like walking on eggshells for Directors of Surgical Services.  

But a 2019 study, “Organizational change in hospitals: a qualitive case-study of staff perspectives,” showed that it was not so much the proposal of a new thing that made staff skittish. It was the failure of leadership to address concerns and engage stakeholders.  

So how does one navigate these delicate lines? It could be as simple as getting the latest AORN guidelines on the shelf or as complicated as making the business case for new technology. A handful of our 40 Fast and Future Leaders of Surgical Services 2021 share how they approach implementing organizational change at their facilities. 


Shawn Craddock: Administrative Director for Perioperative/Surgical Services, Augusta Health

The way I’ve had success is that you need to bring everyone up to speed. There are reasons why practice has evolved in the last 15 years and why the guidelines we follow change annually. It’s because we’re constantly learning and growing, and we know more every year to refine what we do and to do it better. So, you help them understand, get them on board, and then you just drive the change.


Charles Kaczmarek: Director of Perioperative Services, Centura Health 

One of the challenges for me as a director has always been having clean data available. If you have that data, it will help you make a business case to update to a new system. Many of these new systems coming to the market can pull data at one click where you know the FCOT, turnover times, etc., and you use that to manage the business side in the OR and improve operational efficiencies.


Christopher Hunt: Interim Director of Perioperative Services, Children’s Hospital of Colorado   

The OR committee has become a relic of the past, especially when multiple systems are under one umbrella. Having a group of 30 or 40 people trying to reach a consensus is becoming less the norm. What is more impactful is having a smaller group of key decision-makers in the room so you can come to a faster agreement.


Christina HollowayCorporate Clinical Specialist, ASC Bala Cynwyd, Pennsylvania

My response is to take ownership of it. It’s easy to say this process is old and not functional anymorebut I’m a huge proponent of coming to an issue with a solution instead of just reiterating the problemSo, I think the easiest thing to do is to say, I can take this project and let me move it forward for you. 


Courtney Kleeb, Director of Surgical Services, Louisiana

It’s like an onion where you peel off one layer, and it reveals more and more layers of a system or process that is old and not necessarily up to date. 

You must quantify the process. How is it affecting your efficiencies in the OR? How is it affecting your monthly and yearly budget? Once you pull that data, you can present that to the executive in your C-Suite to go in the direction you need. One of the most underrated options is having an electronic medical record (EMR). It creates efficiency across the board from the time the patient comes into the hospital, during the procedure, after the procedure, to when the patient leaves the hospital. 


Dillon HofelingVP of Surgical Services, St. Mark’s Hospital, Utah

There are so many policies at every facility that will change every five to seven years because the recommendations will change every five to seven years. Having governing bodies like AORN, AAMI, and IAHCSMM, helps us because they can change our policies and even get rid of some outdated policies that shouldn’t be there in the first place (because they’re too onerous with no room for flexibility)I’ve been able to change or help institute different procedures or pathways for our patients and employees.


Emina Arcan: Director of Operations/Nursing, Central Arizona Endoscopy 

I changed a lot of policies and systems during COVID to ensure the safety of my employees, patients, and their loved ones. The healthcare IT space has expanded rapidly over the past decade. It’s essential to invest in supporting applications and remove duplicative technologies, particularly when it comes to data and analytics. Streamlining those would provide consistent data and lead to a more efficient and better business and better clinical decisions.


Keeli Stith: Assistant Director of Perioperative Services, The Ohio State University Wexner Medical Center 

The Ohio State University Wexner Medical Center has an integrated system. I’m at the University Hospital. We have the Ross Heart Hospital, which is right next door. We have the James Cancer Hospital, and then we have same-day surgery. And on top of that, we’re building two ambulatory centers. 

There are so many policies that intersect and contradict. Anytime you want to move something forward, it just takes a while. It’s not necessarily always a bad thing because you want everyone to be engaged. But how I try to get things moving forward is to build relationships with people outside of my domain. I’m going to find you, and we’re going to have a great conversation. That’s how I try to dissolve some of those barriers to moving initiatives forward. 

The other thing is that it is crucial to identify the stakeholders anytime we are rolling something out or creating an initiative. Get those folks to the table to have that buy-in. 

It can eat you up and swallow you and make you so exhausted. But it doesn’t have to be that way if you have relationships and understand who you need to go after to talk to and politic with them.