How a horse race improved start times for surgeries

A core measure of operating room efficiency is making sure that the first surgery of the day starts on time. When it doesn’t, surgeries for the rest of the day may also be delayed.

In OR parlance, the metric is known as first case on-time start, or FCOT.

Tracking this performance indicator, Stephanie Baker, perioperative services nurse manager at UCHealth Grandview Hospital, noticed an area for improvement. She knew that visual tools and aids help to enhance improvement efforts so she created and displayed a visual aid that would help illustrate the goal of improving FCOT rates.

She knew the visual had to be meaningful, fun and accessible, and she selected the bulletin board in the employee lounge at Grandview Hospital since it is shared with providers and is accessible to all.

Baker’s idea was simple: a horse race. Each surgeon would have a horse on a figurative racetrack. Every month, Baker would do all of the calculations and change each horse’s position accordingly, with placement on the board based on FCOT percentages.

After gaining necessary approvals with key stakeholders, Baker moved forward with her initiative. She educated her team on the idea and displayed the at-a-glance horse race visual aid on the bulletin board beginning in October 2022.

Since then, the numbers have begun to improve. Baker was motivated after “seeing some movement in the right direction.” The visual began to stir up friendly competition to improve numbers individually and collectively.

This new approach had dramatic results improving the FCOT metric, which in turn improved patient satisfaction and patient flow on a daily basis.

“It has increased the conversation,’’ Baker said.

Baker said the horse race theme, which has been displayed for one year, will soon be replaced with a new visual.

“We’re getting ready to start hot air balloons,” Baker said. The hot air balloons will track the FCOT delayed reason instead of the surgeon assigned on the case.

Feedback from colleagues has been positive.

“I think some people thought it was kind of corny,” Baker said. “But that’s okay, sometimes corny works.”

Baker credits her colleagues for making this initiative a success.

“The team really did all of the work to make sure they were always ready,” Baker said. “It’s been a combined effort for everybody who does the work. I’m just here to support them.”

“This initiative is just one example of Stephanie’s admirable ability to engage multiple disciplines to reach a common goal,” said Angie Sherwood, clinical director, who nominated Baker for Celebrating You recognition. “We are so thankful to have her leading our GVH peri-op team!”

Baker has been in the nursing profession for more than 18 years, with 15 of those years working in the OR. She has been with UCHealth since 2019 and has worked at Grandview since 2020.

She enjoys taking care of patients in the OR environment, and she loves working at Grandview Hospital.

“I’ve had team members say working at Grandview has renewed their love for the profession,” Baker said. “And I feel like I could do this forever. It’s a very special place.”