Restructuring the surgical process after regional reform in Emilia-Romagna: an action-research project at Rizzoli Orthopedic Institute.
BACKGROUND
Hospitals performing surgery in Italy underwent important transformations in recent years, with decreasing economic resources and higher expected standards of care. Regional authorities acted differently across the country to adapt to the new scenario, generating heterogeneous outcomes. The Rizzoli Orthopedic Institute (ROI) in the Emilia-Romagna region started its reorganization in 2017, after the issue of new regional regulations about surgical activity. Aim of this paper is to describe the actions taken at ROI and discuss their outcomes.


STUDY DESIGN
Action-research.


METHODS
From 2017 to 2019 an action-research project was developed to introduce organizational changes within ROI and close the existing gaps between regional requirements and actual features of the Institute. Four areas of intervention were identified: surgical scheduling, appropriateness of surgical setting, monitoring and management of the surgical path and accountability. Progress was monitored through the collection of performance indicators and qualitative investigation of the organizational culture.


RESULTS
Changes were implemented in all areas of intervention. Key features were the introduction of Operating Room Management (ORM) skills and the establishment of multiprofessional teams to drive the changes. Performance indicators showed a positive trend in the comparison between 2017 and 2018. Improvements were observed in terms of productivity, scheduling, and respect of standard waiting time, while case-mix did not significantly change.


CONCLUSIONS
Effective ORM and collaborative practices can successfully drive the change towards a more efficient surgical process without increasing resources consumption.
['Ubiali|A|A|', 'Rochira|A|A|', 'Buccioli|M|M|', 'Perger|P|P|', 'Bonarelli|S|S|', 'Campagna|A|A|', 'Rolli|M|M|', 'Cavalli|M|M|']
D000328:Adult D000368:Aged D001071:Appointments and Schedules D017598:Efficiency, Organizational D005260:Female D018166:Health Care Reform D006302:Health Services Research D006761:Hospitals D006801:Humans D007558:Italy D008297:Male D008875:Middle Aged D009873:Operating Rooms D019637:Orthopedic Procedures D009985:Orthopedics D010348:Patient Care Team D014850:Waiting Lists D055815:Young Adult
Action-research Surgery Operating Room Management