Aligning the Perioperative Process to Hospital Strategy

Introduction

In the United States, the 2009 American Recovery and Reinvestment Act, the 2010 Affordable Care Act, the Joint Commission on Accreditation of Healthcare Organizations (TJC), and Centers for Medicare & Medicaid Services (CMS) require performance and clinical outcome reporting as evidence of healthcare provider quality, efficiency, and effectiveness (Blumenthal, 2012). Consequently, the resulting widespread information systems (IS) and information technology (IT) adoption across United States’ hospitals further necessitates the need for value realization (CMS, 2014; Jones, Rudin, Perry, & Shekelle, 2014). Furthermore, hospital administration could benefit by considering the strategic IS and business alignment challenges experienced in other industries over the past decades (Kappelman, Nuygen, McLain, Mauer, Johnson, Snyder, & Torres, 2017) as well as within the healthcare industry (Bush Lederer, Li, Palmisano, & Rao, 2009). This study investigates the research question of how business process management (BPM) is an applicable approach to align perioperative stakeholder activities to execute and achieve hospital strategic goals.

A hospital’s perioperative process provides surgical care for inpatients and outpatients during pre-assessment, pre-operative, intra-operative, and immediate post-operative periods. Accordingly, the perioperative sub-processes (e.g. pre-assessment, pre-operative, intra-operative, and post-operative activities) are sequential where each activity sequence paces the efficiency and effectiveness of subsequent activities. Furthermore, perioperative sub-processes require continuous parallel replenishment of centralized sterile supplies along with the removal and sanitation of soiled materials, instruments, and devices. As a result, a hospital’s perioperative process is tightly coupled to patient flow, patient safety, patient quality of care, and stakeholders’ satisfaction (i.e. patient, physician/surgeon, nurse, perioperative staff, and hospital administration).

Implementing improvements that will result in timely patient flow through the perioperative process is both a challenge and an opportunity for hospital stakeholders, who often have a variety of opinions and perceptions as to where improvement is needed. The challenge of delivering quality, efficient, and cost-effective services affects all healthcare stakeholders. Perioperative improvements ultimately affect not only patient quality of care, but also the operational and financial performance of the hospital itself. From an operational perspective, a hospital’s perioperative process requires multidisciplinary, cross-functional teams to maneuver within complex, fast-paced, and critical situations—the hospital environment (McClusker, Dendukuri, Cardinal, Katofsky, & Riccardi, 2005).

Similarly from a hospital’s financial perspective, the perioperative process is typically the primary source of hospital admissions, averaging between 55 to 65 percent of overall hospital margins (Peters & Blasco, 2004). Macario, Vitez, Dunn, & McDonald (1995) identified 49 percent of total hospital costs as variable with the largest cost category being the perioperative process (e.g. 33 percent). Given the rising cost of healthcare, the public demand for healthcare transparency and accountability, and the current economic environment—managing and optimizing a quality, efficient, flexible, and cost-effective perioperative process are critical success factors (CSFs), both operationally and financially, for any hospital.