The case for a physician director of the surgical suite.

Traditionally, the surgeon performs surgery and leaves the surgical suite to make rounds or go to the office. The anesthesiologist is involved primarily in the anesthetic management; the nurse is focused on the nursing perspective. No one person is responsible for overall functioning or for resolution of the many issues that arise everyday in the surgical suite. Many O.R. consultants feel strongly that the most common issues are among physicians. Problems with block time, differentiating emergency from routine cases, late surgeons, etc. are "physician problems" and can only be handled effectively by a physician. The physician director often plays the role of referee in resolution of problems.

Leadership in Surgical Suite

Lack of leadership is a common finding in the surgical suite. No one may have authority for operational decisions. Strong personalities, long hours, critically ill patients, and interpersonal conflicts make the surgical suite a difficult area to manage. Three major players are surgeons, anesthesiologists, and nurses. When there is unsatisfactory performance in the surgical suite, i.e., delay in starting cases, long turnover time, cancellations, etc., there is the familiar habit of players blaming each other.

The physician director must play a leadership role in the surgical suite. He or she must identify with the overall mission of the health care facility. It is essential that he or she is a visionary and has the ability to see what the surgical suite should be, not what it is. He or she should create a system to wire the people together for a common commitment and vision. A generic version of the job description of a physician director of the surgical suite is shown in figure 1, page 29. This covers all the functions performed in the surgical suite, the recovery area, and same-day surgery.

  Figure 1. Genetic Job Description. Physician Director of Surgical Suite
Member: Medical Executive Committee and O.R. Committee
Chair: O.R. Executive Committee
Jurisdiction: Surgical Suite (space), PACU (budget), SDC (personnel)
Responsibilities:
* Strategic planning for surgical suite services
Physical plant
Short-term goals
Long-term goals
Priorities, resource requirements, implementation
  * Creative view of desired future
  * Comparison of future with present
  * Strategies and action
* Surgical suite information management
Transaction information
Decision-support information
Communication system (patient care information)
  * Flow of information
  * Data analysis
  * Opportunities for improvement
* Efficiency/utilization of O.R.s
By surgeon
By service
By procedure
* Surgical case scheduling
Facilitate scheduling process
Block booking
Urgent/emergency cases
* O.R. budget
Capital
Operational
Materials management
* Customer orientation
Surgeon satisfaction survey
Patient satisfaction survey
O.R. staff satisfaction survey
* O.R. operational management
Incentives/motivation
Teamwork
Recognition/rewards
Cross-training
* Conflict resolution in surgical suite
* Marketing surgical suite services
* Benchmarking for perioperative services
Cost containment in the surgical suite
Patient-focused care

The job of physician director of the surgical suite is undergoing delineation and maturity. Ultimately, this position will become part of senior management of the health care facility. Because this alignment may not be easily acceptable to the medical staff, full support from the CEO and executive staff is crucial to the success of the position. Gaining respect and trust of the surgical suite staff and of surgeons will enhance the position, which must be sensitive to the needs of the surgical suite and effectively meet the needs of administration.

Administrative Structure

It is becoming apparent that increases in efficiency and decreases in the cost of services provided in the surgical suite are crucial to the profitability and even survival of a health care facility. This has led to direct reporting of the physician director of the surgical suite to the executive vice president (EVP) or the chief operating officer (COO). A typical administrative structure is shown in Figure 2, page 30.

Committee Activities

To be effective, the physician director of the surgical suite must be on the following hospital committees: * O.R. Committee. This committee has the usual representation by the chief of surgery, the chief of anesthesiology, the nursing director of O.R., and some surgical specialties. In addition, either the EVP or the COO is on this committee. To maintain the balance of power, the chairman should alternate between the chief of surgery and the chief of anesthesiology. O.R. committee meetings usually take place once a month. For this committee to be effective, objectives and scope must be clearly defined. The committee should focus primarily on developing and approving policies and procedures related to functioning of O.R. * O.R. Management Team/ Committee. Many problems that develop in the surgical suite, e.g., urgent/emergency surgery, need quick resolution. The O.R. management committee provides such a forum. It consists of the chief surgery, the chief of anesthesiology, the O.R. nursing director, the physician director of the surgical suite, and the EVP or COO. The physician director serves as chair of this committee. The committee meetings are more frequent, e.g. every week or two weeks. * Medical Executive Committee. In order for the physician director to have the perspective of strategic planning and operational management of the hospital, he or she should be a member of the medical executive committee.

Funding for the Position

In a smaller community hospital, the position of physician director need not be full-time. In larger hospitals, with 8,000-10,000 or more surgical procedures annually, this should be a full-time position. Compensation will vary with local factors and with the percentage of time spent in the work of the position. Funding for the position should logically come from the administration of the hospital. An incentive program based on cost containment in the surgical suite may be a consideration.

In the final analysis, the physician director of the surgical suite must be a leader and a change agent, with the ability to solve key issues; a skilled negotiator; and a team builder. He or she will also need to transform tons of data generated in the surgical suite into useful information. It is possible that with experience gained in this high-profile position, the physician director of surgical services may be the CEO of tomorrow.