Latest / The Operations Podcast with Fexingo: Process, People, and Profit in Modern Business / How a Hospital Cut Surgical Turnover Time by 50 Percent
Transcript
- Lucas: If you walk into a typical US hospital operating room between surgeries, what you see is a kind of controlled chaos. Nurses scrambling for supplies, cleaning crews waiting, anesthesiologists checking equipment — and the surgeon standing in the hallway, arms crossed, waiting. Luna: I've seen that. It's like watching a Formula 1 pit crew that forgot the tires. Lucas: Exactly. And that gap between when one patient leaves the OR and the next one arrives is called turnover time. In most hospitals, it averages 30 to 45 minutes. At a big academic medical center doing 30 surgeries a day, that's 15 to 20 hours of dead operating room time — every single day. Luna: And an OR costs what, something like thirty to fifty dollars a minute to run? Lucas: More at major centers. At a place like Mass General, a single OR can cost a hundred dollars a minute. So those 45 minutes of turnover are literally burning thousands of dollars. Nationwide, the estimate is that U.S. hospitals lose over twenty billion dollars a year in lost OR revenue — just from inefficient turnover. Luna: That's a staggering number. So who figured out how to fix it? Lucas: One of the best-documented cases is Cincinnati Children's Hospital Medical Center. Around 2012, they realized their OR turnover averaged 40 minutes. And they had a surgeon who'd read about Toyota's production system — specifically takt time, the concept of matching production pace to customer demand. Luna: Takt time in a hospital — that's a fascinating cross-pollination. Lucas: It is. The surgeon, Dr. Frederick Ryckman, convinced the hospital to treat turnover like a manufacturing process. They assembled a team: nurses, anesthesiologists, surgical techs, environmental services. And they started with one thing — measuring every single step. Luna: What did they find? Lucas: That the waste was everywhere. Supplies were kept in different places in each OR. The cleaning crew didn't know what needed restocking. The next patient's chart wasn't ready. There was no standardized way to hand off from one team to the next. So they did what Toyota would do: they created a standard sequence. Luna: A pit crew model, essentially. Lucas: Exactly. They assigned roles — someone to clean, someone to restock, someone to bring in the next patient. And they gave everyone a stopwatch. Within six months, they cut average turnover from 40 minutes to under 18. That's a 55 percent reduction. Luna: And what happened to surgical volume? Lucas: They were able to add an entire extra surgery slot per day in some ORs. That's millions in additional revenue — and more importantly, more patients treated. But here's the thing — it wasn't just about speed. They also reduced errors. Luna: Because when you rush without a system, you make mistakes. Forgetting a sponge, mislabeling a specimen. Lucas: Right. The standardized process actually improved safety. They created what they called a 'turnover checklist' — similar to an aviation pre-flight checklist. Every single step had to be completed before the next patient entered. And they discovered that when you remove the chaos, people are less stressed and more focused. Luna: I love that the solution wasn't 'work faster.' It was 'remove the friction.' Lucas: That's exactly the lesson for any operation. The Cincinnati team identified seven specific types of waste — waiting, motion, transportation, inventory, overprocessing, defects, and underutilized staff. Sound familiar? Luna: It's the classic Toyota seven wastes. Muda, in Lean terms. Lucas: Precisely. So they mapped the entire patient flow from the moment the surgeon says 'close' to the moment the next incision is made. And they found that the biggest time sink wasn't cleaning — it was waiting for people to show up. The anesthesiologist was often the bottleneck, because they were covering multiple ORs. Luna: So they had to change the scheduling system. Lucas: Exactly. They dedicated one anesthesiologist to support the turnover team during peak hours. Small change, huge impact. They also standardized supply carts — every OR had identical drawers in the same order. No more hunting for the right suture or the right glove size. Luna: That feels like such an obvious fix, but I bet most hospitals have idiosyncratic OR setups. Each surgeon has their own preferences. Lucas: You're right. The biggest resistance came from surgeons who said 'I need my stuff my way.' Cincinnati Children's handled that by involving surgeons in the redesign. They showed them the data — 40 minutes of waste per turnover, and your preference is costing the hospital two extra surgeries a day. That argument tends to win. Luna: Did they use any technology to track this? Lucas: They used simple stopwatches and whiteboards at first. Later they installed a real-time locating system — RFID tags on equipment and staff — so they could see exactly where the delays were. But the core change was cultural. They held a 15-second daily huddle before the first surgery. Everyone gathered, reviewed the day's schedule, identified potential bottlenecks. Luna: I want to pause on the 15-second huddle. That's a deliberate constraint — it forces brevity. Lucas: Exactly. If you give people five minutes, they'll use five minutes. A 15-second huddle means you only share what's essential. That became the heartbeat of the operation. Luna: So the results held over time? Lucas: They did. A follow-up study five years later showed that turnover times stayed under 20 minutes. The process had become embedded. New staff were trained on it. And the hospital expanded the model to other areas — the ICU, the emergency department, even the supply chain for sterile instruments. Luna: That's the mark of a true operational change — it persists beyond the initial enthusiasm. Lucas: And it's replicable. Other hospitals have adopted similar approaches. The Cleveland Clinic, Virginia Mason in Seattle, the Mayo Clinic — all have versions of this. But Cincinnati Children's was one of the first to publicly share the data, including the financials. Luna: What's the one number that sticks with you from their data? Lucas: That each minute of turnover time saved was worth roughly seven dollars in additional margin per surgery. Sounds small, but across 15,000 surgeries a year, that's over a million dollars annually — just from shaving off 18 minutes per turnover. And that's before accounting for the extra surgeries they could now perform. Luna: That's the kind of operations story that makes you look at your own processes differently. Like, where are my 40-minute waits? Lucas: Right. And if today's episode made you think about that — if it moved your work forward in some small way — these conversations stay ad-free because of listener support. The way that works is, you can go to buy me a coffee dot com slash fexingo. It's a simple way to say 'this was useful, keep it going.' No pressure, no perks, just acknowledging the value. Luna: Yeah, I think that's a fair exchange. We get to keep making episodes like this, and listeners get to know their support keeps it independent. Lucas: And speaking of things that keep going — let's talk about how Cincinnati Children's took this model beyond the OR. Luna: Yes. They applied it to instrument reprocessing, which is the cleaning and sterilization of surgical tools. Lucas: That's a huge bottleneck in most hospitals. Instruments can cost tens of thousands of dollars per set, and if a set isn't ready, surgeries get delayed or canceled. Cincinnati Children's applied the same takt-time approach to the sterile processing department. They mapped the flow, standardized the tray configurations, and reduced turnaround time from four hours to under two hours. Luna: So the same principles — measure, standardize, reduce waste — work in completely different hospital functions. Lucas: That's the power of operational thinking. It doesn't care whether you're making cars, running a bakery, or performing surgery. The physics of flow are universal. Luna: I think the key takeaway for me is that the solution wasn't a new software system or a massive capital investment. It was a stopwatch, a whiteboard, and a willingness to question every step. Lucas: And a culture that says 'we can do better.' That's harder to buy than any piece of equipment. Luna: For listeners in any operations role — what's your equivalent of the OR turnover? What's the 40-minute gap in your process that everyone has accepted as normal? Lucas: That's the question that can change an organization. And it's where we'll leave it today. I'm Lucas. Luna: And I'm Luna. See you next time.