13 - Blueprint for Success: Strengthening Teams to Optimize Surgical Efficiency

Description: Description of Team
Winchester Hospital's perioperative leadership—including the OR nurse manager, clinical nurses, nurse educator, AVP/ACNO of Surgical Services, and frontline perioperative team members—led a comprehensive and multidisciplinary effort to improve surgical efficiency, staff retention, and education. This collaborative team approach fostered an inclusive, engaged, and empowered staff culture that has improved both clinical and operational outcomes.
Preparation and Planning
In response to high turnover and inefficiencies identified through internal metrics and staff feedback, Winchester implemented a structured, data-informed action plan. The initiative aligned with AORN's Orientation, Education, and Competency Assessment guideline, and incorporated principles from the "5 Ways to Enhance Operating Room Efficiency" framework, which emphasizes:
1. Streamlining scheduling
2. Standardizing procedures and protocols
3. Enhancing communication
4. Optimizing inventory management
5. Investing in staff education and training
Planning focused on a shared governance-based interview and onboarding process, updated staff education initiatives, and workflow improvements driven by real-time data analysis.
Assessment
Initial assessments revealed a 6.9% RN turnover rate (July 2022), a 32% first case on-time start rate, and that only 29% of OR turnover times were under 30 minutes. Preference cards were outdated, and staff reported disengagement and limited involvement in hiring and improvement efforts. Data from EPIC, OneBILH, and Vizient highlighted key gaps in workflow, communication, and education.
Implementation
Key interventions included:

—A revised hiring model engaging clinical nurses in interviews and peer shadowing
—A free CNOR prep course, resulting in over 50% of staff becoming CNOR-certified, with an additional 19 actively preparing
—Staff engagement through mock codes, fire drills, scavenger hunts, and first case on-time start education
—Comprehensive preference card and case cart updates to standardize protocols and optimize inventory workflows
—Daily multidisciplinary huddles, implementation of "just do its" to align workflows with Epic and enhance real-time communication and scheduling

Outcome
Turnover rates significantly decreased following implementation of the shared governance hiring model. Certification rates rose, with a majority of nurses holding CNOR credentials, reflecting heightened professional engagement. First case on-time starts improved through clarified team responsibilities and standardized protocols. Updated preference cards enhanced procedural consistency and inventory accuracy, reducing delays and errors. Turnover times and overall OR efficiency are now trending positively toward BILH's 2025 performance targets.
Implications for Perioperative Nursing
This initiative demonstrates the impact of data-driven, team-based improvement aligned with AORN guidelines and industry best practices. Winchester's model highlights the importance of empowering perioperative nurses through inclusion in governance, investment in education, and shared responsibility for sustainable change and optimized patient outcomes.