; ; ;
We thank all our correspondents for their comments and additions. To critically question processes in medicine often prompts a reflex reaction of resistance and the open accusation that doctors’ freedom is being sacrificed on the altar of economic considerations. Hahn in his comment stresses—rightly, in our opinion—that starting a surgical procedure on time is a manifestation of respect towards all colleagues, and he points out the important role that the doctors in charge have in terms of setting an example. This corresponds exactly with the intention of our article. The question he raises, whether frequent delays to morning operating lists are also associated with longer turnover times, cannot be answered on the basis of the currently available data. The processes during turnover are notably more complicated than in the morning start. However, there are indications in the literature that delays within turnover times and in the start of morning surgery are often due to the same causes (1, 2).
Braun mentions the problem of determining target times. The hospital colleagues who are involved ultimately have to reach a consensus about which time points in the process are desirable and acceptable to them and will have to adapt their process planning and working times accordingly. Every organization needs to measure itself against its own targets, otherwise the whole idea of process planning becomes pointless. Again, we would like to emphasize that saved minutes are not the ultimate goal since their economic effect is likely to be negligible. The goal is to ensure colleagues’ satisfaction with the processes they are exposed to and experience in the operating theater.
Dr Santamaria and colleagues mention the importance of operating room management in implementing planned processes. We completely agree that operating room management can be successful only if it holds appropriate competences and opportunities for decisions. Often, especially the hospital management expects that the operating room manager implements the necessary changes and ensures that all parties involved are “sworn in” to the collective process. At the same time, however, the hospital management may reach different agreements with various parties involved in the process, or it takes away the operating room manager’s ability to react to the refusal to engage in collective process planning. This cannot yield a satisfactory result for the organization as a whole. The way in which responsibilities and competences are shaped in individual hospitals is indeed always a local challenge. However, responsibilities and competences always have to be congruent: the operating room management can be responsible only for those issues that it is ultimately able to also make decisions on.
PD Dr. med. Martin Schuster, Prof. Dr. med. Martin Bauer
AG Prozess- und Kostenmanagement, Forum für Qualitätsmanagement und Ökonomie der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin und des Berufsverbandes Deutscher Anästhesisten
Marco Pezzella BA, Dr. med. Enno Bialas
digmed Datenmanagement im Gesundheitswesen GmbH, Hamburg
Dr. med. Christian Taube, Matthias Diemer MBA
Verband für OP-Management e.V., Hannover
Conflict of interest statement
PD Dr Schuster and Professor Bauer represent the Association of German Anaesthesiologists, Dr Taube and Mr Diemer represent the German Association for Operating Room Management. They are members of the scientific advisory board of the Benchmarking Program.
Mr Pezzella BA and Dr Bialas are employees of digmed.
|1.||Unger J, Schuster M, Bauer K, Krieg H, Müller R, Spies C. Zeitverzögerungen beim morgendlichen OP-Beginn. Anästhesist 2009; 58: 293–300. CrossRef MEDLINE|
|2.||Schuster M, Wicha LL, Fiege M, Goetz AE. Auslastung und Wechselzeit als Kennzahlen der OP-Effizienz. Anästhesist 2007; 56: 1058–66.|
|3.||Schuster M, Pezzella M, Taube C, Bialas E, Diemer M, Bauer M: Delays in starting morning operating lists—an analysis of more than 20 000 cases in 22 German hospitals. Dtsch Arztebl Int 2013; 110(14): 237−43. VOLLTEXT|