OR Efficiency: It Starts With Governance

By Bill Denton, RN, MBA, Senior Principal, GE Healthcare Partners

There are a number of influencing factors that affect and determine operating room efficiency. ORs are becoming increasingly complex with many moving parts: patients and families, technology, supplies, and the surgical team...just to start.

As OR inefficiencies are discovered, what are some of the key elements and leading practices related to efficiency that will get the ball rolling for improved perioperative performance? It all starts with effective governance and leadership.

Simply put, lasting results cannot be achieved if your hospital does not have the proper governance structure in place with selected leaders that are empowered to make change and hold each other accountable. There is little benefit to looking at on-time starts, pre-operative testing or block scheduling and staffing without having all of the key players at the table working together to help find viable solutions or having buy-in for any policy and procedure changes.

An effective OR governance structure includes what I often refer to as the three-legged stool: key surgeons, anesthesiology, and hospital administration. If one of these groups is missing or ineffective, the stool falls down. A strong governance structure can support the perioperative leadership team and enable the OR to continue – or regain – its contribution to the hospital’s bottom line. For many providers, this bottom line is upward of 70%.

So, where do you begin?

Conduct an assessment of your existing governance structure to determine its effectiveness, where there may be shortcomings and recognizable opportunities to gain efficiencies. This assessment includes a review of:

    • The OR Committee Charter. Is the purpose of the group clearly defined? Is it an informational meeting with numerous reports but no action? Are your meetings dominated by individuals with personal agendas
    • Current governance members. Are they hand-selected to ensure the right mix and fit?
    • Physician engagement levels. In addition to administrative leadership, do your key surgeons have a seat at the table and solid voice in the process?
    • Operational Dashboard. Are you metrics driven? Are leaders held accountable to outcomes?
    • Core processes. What are some of the process barriers impacting the efficient operations of your surgical services?

Once the governance team is assembled and the assessment is complete, look for opportunities for a few quick wins to help boost confidence of the group and demonstrate to the rest of the OR team that they are capable of effective change. As the group matures, tackle the tougher issues impacting quality, safety, efficiency, and service.

In summary, know that an effective OR governance structure can establish a culture of accountability and performance, and critical to its effectiveness is having the right committee members appointed that have a leadership mindset and a change management skill set. They must be empowered to lead and have the ability to work cooperatively toward the best interests of both the hospital and the surgical team.


Mr. Denton is an executive vice president with GE Healthcare Partners with more than 30 years’ experience as a clinician, healthcare executive, and consultant. He is recognized industry-wide for his expertise in using evidence-based decision-making to reduce expenses and improve quality of care, with a laser focus on sustainability. Mr. Denton partners with C-suite executives as they work diligently to create a culture of change throughout their organizations to sustain improvements. He possesses extensive experience in healthcare administration and as a clinician, provides that perspective to guide clients through the complex process of identifying and implementing significant cost-saving initiatives with physicians and other clinicians. He may be reached at