Greater Baltimore Medical Center

OR Performance Improvement on Track at Greater Baltimore MC.


Greater Baltimore Medical Center (GBMC), Maryland, lacked a governance structure to monitor its perioperative services and OR utilization, resulting in underused ORs and excessive downtime in between surgical cases.

A stoplight scorecard of operating room performance showed nearly all categories in red—indicating subpar performance for the hospital’s 24 operating rooms (ORs), a costly misstep considering that perioperative services typically generates 68 percent of a hospital’s revenue.

Specific areas of concern were:

  • First surgical cases of the day were started on-time in only 79 percent of the cases; best practice is a minimum of 90 percent first-case on-time starts;
  • Turnover time for the ORs stood at 53 minutes for inpatient cases and 31 minutes for outpatient cases; best practice is 20 minutes;
  • Eight percent of surgeries were cancelled; best practice is 1 percent.


Surgical Directions conducted a comprehensive assessment of the hospital’s practices that involved meetings with not only the c-suite, but also all levels of administrators, clinicians, and staff, including frontline caregivers and schedulers. Schedulers, for example, were asked how surgical cases were scheduled and materials managers described how they manage supply inventory. On-site observations of OR processes proved to be critical in identifying problems. For example, when a circulating nurse left an OR several times to retrieve supplies, it became clear that inventory of supplies in the OR was insufficient.

The improvement process began with creating a surgical services executive committee comprised of surgeons representing the hospital’s service lines, along with administrative and medical executives, such as the chief operating officer, chief nursing officer, and anesthesia medical director. The committee is charged with developing definitions for metrics that are used to gauge OR performance (e.g., how is utilization defined) and providing direction and oversight of improvement plans. In addition, Surgical Directions helped GBMC form process improvement teams made of frontline staff who help to develop new approaches and manage implementation of new processes.


Surgical Directions is working with the hospital to implement a work plan that will help it transform current practices to best practices in all areas of OR performance, providing a more solid financial foundation for meeting future healthcare challenges.

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