Operational Improvement Projects — Terrina McKinnon, CST · CRCST · CLSSBB

OR Performance · DMAIC Analysis

Root-Cause Analysis of Surgical Case Delays at a Multi-Specialty OR

Conducted a structured DMAIC analysis of case delay patterns at a hospital performing 65–70 surgical cases daily across 8 service lines. Extracted and categorized delay data by root cause — surgeon late arrival, consent issues, pre-op readiness, instrument and supply failures, and anesthesia. Built a delay frequency matrix and identified the top 3 contributing factors driving 78% of all delayed cases. The analysis was structured to distinguish chronic system failures from isolated incidents, giving leadership a defensible evidence base for targeted intervention — rather than reactive policy responses to individual events.

Tools Used

EPIC data extraction Delay categorization matrix Frequency analysis Pareto chart

Outcome

Identified actionable top-tier causes; recommendations briefed to OR leadership with a structured improvement roadmap prioritizing the three drivers responsible for the majority of delay volume.

Data Analysis · Visual Management

Pareto Analysis: Identifying the Vital Few Delay Drivers

Using case-level delay data, constructed Pareto charts to distinguish the vital few causes from the trivial many. Surgeon-related delays — late arrivals and consent gaps — combined with pre-op readiness failures accounted for over 70% of all first-case and add-on delays. Rather than presenting raw data, the analysis was translated into an executive-ready visual report that communicated relative impact, resource implication, and prioritization logic in language appropriate for OR leadership, service chiefs, and medical staff committees. The Pareto framing reframed the conversation from "everyone has a problem" to a focused, rank-ordered improvement agenda.

Tools Used

Pareto chart construction 80/20 principle applied to OR delays Executive visual reporting

Outcome

Delivered visual summary used to prioritize improvement targets and allocate resources — providing OR leadership with a clear, data-grounded case for where to act first.

OR Throughput · Systems Redesign

Throughput Improvement Recommendations for a 12-OR Surgical Department

Developed a comprehensive set of throughput improvement recommendations based on systematic analysis of turnover times, room utilization rates, block schedule efficiency, and add-on case management practices. Recommendations addressed parallel processing opportunities during room turnover — coordinating anesthesia, environmental services, and surgical tech teams to compress the dead time between cases — as well as first-case start standardization and a governance model for block utilization accountability. All recommendations were designed to increase case volume capacity without adding OR rooms or extending scheduled hours, making the return on investment immediate and operationally durable.

Tools Used

Turnover time analysis Block utilization assessment Parallel processing design Change package development

Outcome

Recommendations presented to surgical services leadership; projected 8–12% improvement in daily case capacity through operational restructuring alone, with no capital investment required.

Culture Change · Standard Work

Building a Readiness Culture — From Overnight Prep to First-Case Launch

Designed and implemented a readiness culture initiative targeting the overnight-to-first-case handoff — the highest-risk window for FCOTS performance. The initiative recognized that first-case outcomes are determined hours before the surgeon walks in, and that sustainable improvement requires cultural ownership at the frontline level, not just policy compliance. Developed overnight readiness checklists, T-15 pre-case huddle protocols, and accountability huddle structures that made the morning launch routine repeatable and self-sustaining. Trained staff at supervisor and charge nurse levels to own the readiness standard — shifting accountability from passive observation to proactive stewardship. Created visual management tools, including whiteboard templates, to make readiness status visible at a glance by 6:30 AM each morning.

Tools Used

Standard work design Overnight checklist deployment T-15 huddle protocol Visual management boards Staff training and competency assessment

Outcome

Measurable improvement in first-case readiness scores; reduced last-minute scramble incidents and established a repeatable morning launch standard owned by frontline charge nurses — not dependent on manager presence to execute.

Sterile Processing · Cross-Department Integration

OR–SPD Collaboration Strategy: Closing the Handoff Gap

Developed a structured collaboration strategy to close the communication and reliability gap between the OR and Sterile Processing Department — one of the most persistent and costly friction points in perioperative operations. The initiative began with structured observation of the handoff process to identify where breakdowns were occurring, then moved to tool design: a case-signout defect capture form, a tray defect escalation protocol, and a priority case cart tracking process. Worked across departmental boundaries to establish shared definitions of readiness and mutual accountability, reducing the finger-pointing dynamic that typically characterizes OR–SPD tension during tray failures. Created a feedback loop that allowed SPD to understand downstream impact — and gave the OR a structured way to report defects without triggering defensiveness.

Tools Used

Defect capture form design Cross-departmental protocol development Escalation pathway design Feedback loop structures

Outcome

Reduced tray-related OR delays; improved inter-departmental communication and accountability through a closed-loop defect system that replaced informal blame cycles with structured, documented escalation and resolution.

Visual Management · Lean Tools

Visual Management Board Design for Perioperative Services

Designed a suite of visual management boards for use across OR huddles, the Sterile Processing Department, and the pre-op area. Each board was built around a core principle: the right information, visible at the right time, maintained by the right person without requiring a manager in the room. Boards surfaced OR schedule readiness, case cart status, tray defect tracking, and FCOTS performance trends — all updated on a standardized daily cycle by frontline staff. Color-coded status indicators replaced verbal status checks, reducing the cognitive load on charge nurses during the highest-pressure windows of the day. The design process included shadowing staff through daily routines to ensure the boards reflected how the unit actually worked — not how it was assumed to work.

Tools Used

Visual management design principles Daily management system design Color-coded status indicators Standardized update routines

Outcome

Visual tools adopted into daily huddle routine; improved transparency and team accountability — with boards maintained consistently by frontline staff long after the initial implementation period concluded.