Latest / The Operator's Manual with Fexingo: Daily Decisions, Tactical Wins, and Business Execution / How One Hospital Cut OR Turnover Time by 38 Percent
Transcript
- Lucas: Forty-two minutes. That was the average turnover time between surgeries at the Cleveland Clinic's main OR. For a hospital doing roughly 30 cases a day, that adds up to about 21 hours of idle time. Every week. Luna: Twenty-one hours of prime operating room time doing nothing. That's a lot of cases that could have been scheduled. Lucas: Exactly. And they weren't waiting for surgeons or patients. They weren't waiting for supplies. The bottleneck was something far more mundane: the way the cleaning crew and the nursing team handed off the room. Luna: So a handoff protocol issue. I've seen that in factory settings — the changeover between product runs eats up hours because nobody standardized who does what when. Lucas: Right. And you know, this is exactly the kind of show we do — one specific fix that generates outsized impact. Before we go deeper, I want to mention something. We keep these conversations ad-free by design. No sponsors, no mid-roll interruptions. If you find that valuable, and if these episodes have helped you think differently about your own work, there's a simple way to support it. Luna: Yeah, it's buy me a coffee dot com slash fexingo. Just a small way to keep the lights on without selling your attention. Lucas: Exactly. No pressure, no perks, just a direct line if you want to keep it independent. Back to the OR. The Cleveland Clinic brought in a process engineer named Kristen Wang to do a time study. She set up stationary cameras and recorded every turnover for two weeks. What she found surprised everyone. Luna: What was the actual breakdown? I'm guessing the cleaning crew finished faster than people thought. Lucas: Spot on. The cleaning crew — the environmental services team — averaged seven minutes to fully clean a room. But turnover time was still averaging 42 minutes. So the hold-up was happening after the room was clean. The bottleneck was in the notification step. Luna: Notification? As in, who tells whom that the room is ready? Lucas: Yes. The cleaning crew would finish, then they'd have to find a charge nurse to verify the room. The charge nurse was often in another OR, so they'd page. The page might not be answered for five minutes. Then the nurse would walk over, do a visual inspection, and then go find the next surgical team. That whole chain averaged 23 minutes of pure waiting. Luna: So most of the delay wasn't cleaning — it was coordination. Classic process waste. Lucas: Classic. And the fix was surprisingly simple. They eliminated the verification step. The cleaning crew was trained to self-inspect using a checklist, and then they'd flip a physical sign on the door from red to green. The next surgical team could walk in the moment the sign changed. Luna: No charge nurse involved. That must have made some people nervous. What if a room wasn't actually clean? Lucas: That was the biggest pushback. The veteran nurses said, 'We need eyes on the room. We can't trust a checklist.' So Wang ran a pilot. For two weeks, every room that was signed off by the cleaning crew was also inspected by a charge nurse — but the nurse's findings were recorded without telling the crew. The result? The cleaning crew's self-inspection matched the nurse's inspection 99.3 percent of the time. Luna: Wow. So the data completely defused the objection. They could prove the checklists were reliable. Lucas: Exactly. And that's the value of a proper pilot — you don't have to argue with people's intuition. You just run the experiment and let the numbers speak. After the pilot, they rolled out the green-red sign system across all 28 ORs. Luna: What was the impact on average turnover time? Lucas: It dropped from 42 minutes to 26 minutes. That's a 38 percent reduction. In time saved, it freed up about 14,000 minutes per year — roughly 240 extra hours of OR capacity. That translates to roughly 60 additional surgeries annually, depending on case length. Luna: And that's without hiring anyone, without buying new equipment, without changing the surgical schedule. Just a sign and a checklist. Lucas: Right. But the key detail is that the checklist wasn't just a piece of paper. It was co-designed with the cleaning crew. Wang held three feedback sessions where the environmental services team listed the ten things they always checked. That list became the checklist. So it was their own knowledge, formalized. Luna: That's a smart approach. If you hand a crew a checklist written by someone else, they might follow it but they won't own it. Co-creation builds buy-in and accuracy. Lucas: Exactly. And the sign itself was also designed with input. They tested three colors — red-green, red-blue, and a simple magnetic slider. The crew preferred the red-green because it was intuitive and low-tech. No batteries, no screens, no training required. Luna: So the whole intervention cost basically the price of a few pieces of colored plastic and some lamination. I'm guessing the ROI was massive. Lucas: Wang estimated the project cost under $2,000 — mostly staff time for the pilot and the feedback sessions. The incremental revenue from 60 extra surgeries per year, even at conservative reimbursement rates, runs into the millions. And that doesn't even account for the reduction in overtime for the nursing staff, who were no longer spending 23 minutes per turnover just waiting. Luna: That's the hidden cost — the waiting time. Nurses standing around during turnovers is expensive. And they probably hated it. Lucas: Right. The surveys afterward showed that nurse satisfaction with the turnover process went up significantly. They felt less rushed and more in control. The cleaning crew also reported higher job satisfaction because their work was trusted rather than double-checked. Luna: So it's a rare triple win: lower costs, more capacity, and happier staff. Did they apply the same logic to other areas? Lucas: They did. After the OR success, the same approach was adapted for the emergency department bay turnover and for the cath lab. In the ED, the average bay turnover dropped from 18 minutes to 11 minutes. Same principle: self-inspection by the cleaning crew, a visual signal, and elimination of a redundant verification step. Luna: It's almost too simple. But I think that's the point — a lot of process waste is invisible because we've been doing it the same way for years. Nobody questions the handoff because it's always been there. Lucas: That's the core operational insight. Every handoff is a potential queue. And queues are where time disappears. The Cleveland Clinic case is a perfect example of how a small change in who does what can unlock massive capacity without adding any resources. Luna: I wonder what other industries have similar hidden handoff bottlenecks. I'm thinking about restaurants, hotels, maybe even software deployments. Lucas: Absolutely. Any environment where one team finishes and then another team needs a signal to start. The question is: can you make that signal automatic, or can you eliminate the verification step entirely by trusting the first team? That's the playbook. Luna: And it starts with a time study and a willingness to let people design their own checklists. I think that's the part that gets skipped most often. Lucas: Right. You can't fix what you haven't measured. Wang filmed the process because she didn't trust people's recollection of how long each step took. And she was right — the nurses thought cleaning took 15 minutes. It actually took seven. The gap between perception and reality is where the opportunity lives. Luna: I'd love to see a similar approach applied to, say, airplane turnaround at gates. Airlines already track that, but do they use video time studies? Lucas: Some do. Southwest famously studied gate turnaround with cameras and stopped the clock on things like waiting for the jet bridge. But most airlines still rely on aggregated data, not granular step-level timing. The Cleveland Clinic approach is actually more detailed than what many airlines do. Luna: So the lesson for any operator listening: pick one handoff in your process, time every sub-step for two weeks, and ask the people doing the work what they'd change. You might find a 38 percent improvement sitting in plain sight. Lucas: Exactly. And it doesn't have to be a hospital. It could be a warehouse, a kitchen, a service desk. The structure is the same. I think that's a good note to end on — the next time you're waiting for something at work, ask yourself: is the delay real, or is it a handoff waiting to be simplified?