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Groundhog Day in the OR: Revenue Challenges Interims Frequently Observe

August 9, 2022


Groundhog Day in the OR: Revenue Challenges Interims Frequently Observe

Last year, two studies presented at the American College of Surgeons Clinical Congress 2021 showed just how much pausing elective surgeries in 2020 impacted hospital revenues. Across the nation, researchers found that surgical services lost $1.5 billion in revenue from missed elective procedures between March and May of 2020.  

The repercussions can be felt today. In an environment where many hospitals are still playing catch-up and struggling to stay out of the red, addressing ongoing revenue challenges is more essential than ever for the Director of Surgical Services. The Whitman Partners Road Warrior Recognition Series celebrates the unique talent of the Interim Director of Surgical Services. Below, some of our 2022 Road Warriors discuss the issues they repeatedly see during their travels that deflate hospital revenue. 

Broken Processes and Vendor Management 
Gayle Fox, MHA, BS, RN 

“The statistic that most facilities use is OR minutes, not cases. So, when you don’t have a patient in the room and a surgeon operating, that is a loss of revenue and can be attributed to many broken processes. I see a lot of item misallocation into sub-accounts that don’t flow over and missing charges. That goes back to preference card build and how clean they are. Another issue is vendor management. When you have an absence of leadership, you have surgeons who don’t want to tell vendors no in their office, so they send them over to the OR without the vendor going through the appropriate channels.”

Turnover Times and Lack of Purpose 
Sheila Grumbach, MSN, BSN, BLS, CNOR, RN

“A lack of a sense of urgency; getting in the room, getting the cases started, turning the rooms over. Most of us know about the ‘witching hour.’ If we’re working 8-hour days, people start looking at the clock when it comes time to change shifts. They won’t rush too much to turn this case over because they’ll have to set up before the next patient comes. Surgeons will tell you that they’re pulling their hair out because they can tell when it’s time for a change of shift. The 12-hour shifts, which they’re doing here, slow that down. But you need to have a sense of purpose and urgency because your turnover time is wasted time that we could be adding on additional services that will add access to care.  

The other thing is this: do you have staff meetings? I have been to places where it’s once a month, and most people will tell you that once a month is not enough. We have so much new equipment and too many processes that we need to work on. We do staff meetings weekly here. We strategize on how we can make changes. I show the data, go over where we are, and then talk about how we can get where we need to be.”

A Culture of Safety and Managing Item Waste in the OR 
Anne Ertel, DNP, MSN, BSN, RN

“I was just looking at the losses hospitals have incurred over the last two years, and it’s astonishing. A key thing is human resources, having experienced perioperative staff being able to work. But the supply chain and the waste within the operating room have the biggest impact on revenue. Some of that is because of culture, whether it’s a nurse or surgical tech wanting to open everything up, and those items are not only expensive, but coming through the last couple of years, you might not be able to replace them for some time or not at all. 

One of the ways to be successful in perioperative is to address the waste that occurs and get a handle on that with the supply chain. That also relates to sterile processing and having what is needed to get through the day and keep your patient safe. That’s what it’s all about, right? A culture of safety.”