Capstone Reflection Essay: Turnover Time Issues in Operating Room
This capstone reflection essayrequires you to develop and present a professionally relevant integrative portfolio that showcases critical reflection and synthesis of the knowledge and skills gained through your Masters level studies.
The make-up of the portfolio will vary, depending on individual capstone experiences.
The capstone experience project examined in the present context of capstone reflection essay aims to benefit the students determining the professional goals regarding identifying roles and responsibility in an operating room. This project experience also aims to assess the expected outcomes of learning and real-life outcomes including the limitations and places to improve. Most importantly, this project also aims at analysing the power and effort of leadership in nursing along with identifying the required enthusiasm in the project along with the support of the department. However, this essay focuses on presenting a self-assessment statement and critical analysis of my performance all through the project.
In this essay, I have worked on identifying my effort and power to reach the learning outcomes all through this capstone project experience on the basis of the practice change and policy change due to this project along with feedback from managers and colleagues. Along with that, it will consider the previous assignment and two student presentations under the capstone project experience that hold my experience of learning new aspects of my ability. Professional portfolio of this essay focuses on supporting and integrating my experience as a nurse in operating rooms and my ability as a leader. Along with that, I am going to demonstrate the process of increasing my communication, organisational, technical, and conceptual skills.
Moreover, the primary reason for selecting this project for me is to improve my capacity as a leader by identifying and completing my roles and responsibilities more efficiently.
The selected topic for this experience revolves around solving turnover time issues in the operating room when it comes to work more efficiently. At the same time, this experience in the capstone project is all about developing a better leadership skill that reflects in one written assignment and two presentations. However, I will use Gibbs reflective model, SMART, and PDSA cycle to complete the self-assessment while going through this experience. Primary reason for selecting this experience is to demonstrate my dedication and process of improvement along with the places for improvement that can help me in future to work more efficiently.
I have always provided extreme attention to the selected process to reach my individual learning outcomes. In such a condition, I have worked effectively on assessing my improvement in the whole process of reducing the TOT time in the operating room. Turnover time within an operating room plays a critical role in helping a patient to get preferred services that help to heal faster in future (Aravinthanet al. 2020). For example, I was determined to reduce the TT from an average of 22 times to 20 minutes to improve overall conditions regarding completing the task of operation without facing any hiccups.
However, before that I was determined to identify the benefits that could help my team to improve skills. At the same time, it has helped me to assess the attitude to the care team while reducing TT along with the process of applying knowledge in this field. At the same time, I was intended to promote the importance of teamwork in OR, and this approach has helped in identifying the roles and responsibilities of every team member.
Before reaching the individual learning outcomes I have focused on selecting the most effective process of self-assessment along with the process of assessing the entire situation. Along with that, before analysing my process of work I have gone through the definition of turnover time. For example, TT revolves around the time gap between leaving a patient from the operating team and entering the next planned patient for an operation (Aufeggeret al. 2019). In this place, I have learned about factors such as technically complex cases and different surgery policies. However, I have also learnt about adverse circumstances such as delays in subsequent surgery and lower satisfaction level among patients and workers. In this specific place, I have also learnt about activities during turnover time including cleaning the operating room after completion of an operation.
Resetting equipment is another essential aspect that helps to get ready for the next case. At the same time, it is also essential to open the sterile instruments to complete the next operation effectively. Furthermore, activities of TT also include checking the medical report of the next patient from the preoperative area along with counting tools before transporting them to the operating room. In this case, scrubs nurse helps in completing the last activities.
After reviewing literature on TT, I have identified and gained knowledge on the importance of completing every task in the operating room within minimum time. Primarily, completion of every task effectively within minimum TT helps nurses to assist doctors without facing any hiccups along with providing best services and care to patients. In this way, the level of staff satisfaction also remains maintained. It is essential for nurses to reduce the TT and reach the expected TT to improve experience from both sides (Chernovet al. 2017). In this specific area, I have reached individual learning outcomes by learning about benefits of reducing TT. Moreover, my experience in this capstone project revolves around reducing the average TT from baseline of 22 minutes in OR to 20 minutes. This has helped in increasing the satisfaction level of surgeons and patients. It is essential for nurses to assist surgeons to improve quality of work and minimise the TT to complete the operation on time.
This project has come with different experiences for me including being frustrated and depressed due to excessive workload along with working efficiently after developing better collaboration among team members. In this case, I have developed a clear understanding regarding the process of working as a leader. Communication and interpretation of every action is essential along with motivating teams (Christopher et al. 2018). It is not possible for any leader to work effectively without working efficiently and improving process of work by considering the talent and importance of every worker. In this project, I have also learnt about the importance of helping each other to complete the work within the limited time.
I have witnessed anger among patients and their family members due to long waiting times. Primarily, due to lack of efficiency in completing the task of managing TT the planned patient for the next operation requires waiting for a long time. At the same time, surgeons complain about longer TT. Most importantly, it is quite frustrating for patients, surgeons, and nurses when it comes to cancellation of any operation due to late start or extra turnover time (Dusseet al. 2021). Hence, I have learned the process of reducing TT to resolve issues of unstable TT. Moreover, smooth practice in OR can only help in completing the task of working efficiently in this place.
Moreover, integrating reflective practice and reflection process have helped me to complete self-assessment. For example, I developed smart goals all through this capstone project experience. However, before that, I have used Gibbs reflective model to describe the experience along with feelings that I have gone through during that period. At the same time, I have evaluated and analysed my feelings while completing this task. On the other hand, I have also concluded the places for improvement before developing an action plan to improve my working process. At the same time, I have worked efficiently as a leader all through the project that has helped me to understand the importance of working collaboratively. Along with that, I have noticed that it was not possible for me to complete this project of reducing the TT without the proper help and support from the department to maintain the enthusiasm all through this project (Fairley et al. 2019).
The PDSA cycle that includes factors such as Plan, Do, Study, and Action has helped in reaching the individual learning outcomes due to working efficiently in places such as communicating with participants, collecting data regarding the process of reducing TT and the data about progression of the entire task. At the same time, analysis of the collected data is another crucial part of the study part of PDSA cycle that has helped in replanning interventions to reach expected outcomes. On the other hand, Actions include aspects such as utilising collected information related to operating room and standard of workflow (Inomata et al. 2018). However, it is also important to note that after identifying the places of improvement such as communication and collaboration among team members I worked on developing SMART goals.
My specific goal regarding this capstone project experience revolves around improving efficiency as a nurse to reduce 2 minutes of TT within one month. In this concern, my measurable goal was to collect and prepare documents on the gap between discharge time and arrival of the next patient in the operating room. However, I worked on the area of eye surgery only to maintain the uniform and pattern of the surgery. Attainable goal was to reduce the TT by 10%, and it includes my intention to reach TT of 20 minutes from the current base time of 22 minutes. On the other hand, the relevant goal in this case is all about developing better communication between working staff along with developing better skills of the workers. It is not possible to complete the task of reducing TT without improving the skills and talent of working staff along with the collaboration among the team members (Keller et al. 2019).
However, to complete this task, it is essential for the leader to work efficiently in listening to the needs and requirements of the team makeovers to motivate them working more efficiently. At the same time, I was working as the leader of the team, and it was my duty to show my powerful and effective leadership skills in managing every team member along with keeping them on the same page.
All through this project I have learned about the importance of working as a team to reach any goal. Most importantly, I have learnt about the processes of improving the preoperative activities to provide the best experience to the patients and the surgeons simultaneously. However, while working on the capstone project I came across Gibbs reflection model, PDSA cycle, and SMART goals model to complete the entire project efficiently. At the same time, while completing the presentations I worked on improving my technical and communication skills.
After working on the presentations regarding reducing the TT efficiently I got feedback from the managers and colleagues. For example, in the first presentation I have identified places of improvement such as reliance on cue cards along with creating better PowerPoint slides. At the same time, I have found some issues in facial expression along with modulated voice, body language, pace of presentation and eye contact. I had also noticed in this period that I need to work on my capacity to engage the audience without any mistakes. It is quite satisfying for me that I have overcome these issues in the second presentation.
Moreover, as a leader while presenting the data and approaches regarding reducing TT and helping every teammate to work effectively I have shown my capacity to stay accurate regarding demonstrating the aspects of selected topics. At the same time, I worked on my organisational skills that covered the entire topic and demonstrated and presented my feelings and intended words within a time limit (Kumar &Malhotra, 2017). At the same time, I was determined to show my technical skills. In this case, I have identified that I am capable of presenting contents with correct spelling and grammar.
I have never failed to acknowledge the sources I have used to gain my knowledge and create the project. At the same time, I used relevant journal articles and books to complete the task of the capstone project. In this project, I have learnt that it is quite tough for a student to complete this experience by only focusing on the subject without working on technical aspects. For example, I have always provided a relatable brief regarding selecting and demonstrating the reduced time of TT.
Along with that, I have never missed to develop an argument on the basis of literature review and identification of the problem statement regarding this project (Lo, 2020). It is worth noting that, even after presenting satisfactory knowledge and learning on the selected topic, I have the opportunity to excel my capacity of presenting the knowledge I have gained with excellent communication and organisational skills.
Operating areas are the most important places in healthcare service providing organisations, and it is essential for leaders to work on developing a friendly organisational culture regarding operating rooms that can help in resolving issues identified in OR when it comes to TT. For example, in the present hospital, eye surgeons require more improved assistance from nurses while completing any operation and going for a new operation. In such a condition, it was quite effective to improve overall conditions regarding OR that can help the nurses and working staff to complete the allocated roles and responsibilities.
It is also essential for every working staff to learn and understand the importance of having a clear idea regarding expectations of leaders. For example, efficiency of nurses in OR depends on other critical aspects rather than the talent and skills of nurses. For example, allocation of staff, scheduling of cases, required time for induction and preparation of anaesthesia (Ninanet al. 2017). At the same time, performance of the surgery is also essential to count when it comes to measuring OR performance and management. Most importantly, I have noticed in this capstone project that preoperative actions are critical to reduce the TT and to improve the OR performance.
Most importantly, the first presentation has helped me to understand the importance of the operative room along with the importance of different individuals and variable surgical cases to manage multifaceted and complex conditions. At the same time, TT reflects improvement of quality of the OR management system. However, it is also essential to enhance cooperation to improve staff satisfaction and patient satisfaction along with decreasing expenses of running operating actions. In this case, to reflect my experience in this capstone project, I am going to use Gibbs reflective Model.
Gibbs Reflective Model
Gibbs Reflective Model will help in this place to describe and evaluate my experience in this project regarding working for one month in QMH, a Hong Kong west cluster based hospital with many operating rooms. A well-managed OR helps in reducing the postoperative complexities along with improving performance parameters. However, before that, it is essential to identify the parameters of performance regarding the schedule of the case and complexity of the case (Schoenfelderet al. 2021). Accurate estimation of case-duration can only help in improving the overall condition regarding managing hospital systems and average time of turnover.
Experience of every week was different for me as in the beginning I worked as a circulating nurse assisting cataract operation. Every teammate works effectively to clean the OR and set the room for the next patient at minimum time. However, we ended up completing the tasks in 22 minutes, and we missed the standard time of TT that is 20 minutes as per the policy of the hospital. Due to this reason, waiting time for the next surgery increased and operating staff and patients became unsatisfied. Hence, it was a crucial issue in the operating management system. At the same time, as a team member, I became disappointed and dissatisfied with our performance. Furthermore, I was determined to improve this condition along with reducing the period of waiting.
Frustration and work stress became inevitable for me. At the same time, I disappointed the patients as they became angry and depressed due to this poor performance. After that, we worked hard to reduce this time after identifying the roles and responsibilities of every teammate (Taaffeet al. 2018). However, before that, it was also essential to identify the reason for the failure and increased time of TT. It has also been identified in this case that even after implementing transformational leadership the entire team has faced issues regarding meeting the expected TT. Primary reason for such a fact is lack of human resources. This hospital requires sufficient human resources when it comes to managing the preoperative activities in the operating room. It is not possible for the leader to influence and motivate the team members to complete others tasks without doing their own.
After facing issues while completing this task, I was feeling depressed and frustrated in the first week. However, I started to gather my motivation and working spirit to get back to work with all of my efficiency. I have also found out other reasons that could affect my performance all through the project. Most importantly, inflexible and unrealistic scheduling cannot help the OR team to conduct work efficiently (Umali&Castillo, 2020). From that aspect, I have learned the processes of staying informed and helping the entire team to stay on the same page. In this way, the entire team can participate in the improvement of overall performance along with measuring the effectiveness of providing and delivering the expected service. However, the most critical part of this project was to motivate the working staff after witnessing such a frustrating and depressing experience in the first week. However, I have gone through a transformation of my job role and the process of helping the entire team to stay attached while working.
I have identified the importance of every role in the team that completes the entire task and could complete the task of managing the entire process without wasting any time. For example, a technical assistant requires knowing the process of assisting scrub nurses and preparing consumable items and lenses for the operation. However, before that, it is also essential to clean phacoemulsification and eye microscopy for the next patient.
Thus, feeling regarding this experience has helped me to create intention to develop a better understanding regarding the importance of every working staff and patients in improving the overall conditions of the operating room. Most importantly, quality and complexity of the cases also create differences to the working process and management.
It is quite clear from the description of the experience that after the first week I have the opportunity to improve the overall performance along with leading the team. Hence, multidisciplinary changes in OR management practice are required to be implemented. It is not possible for us to get better patient centric outcomes without utilising skills and talent of people. At the same time, it is also essential for organisations to work efficiently under a strong per operative leadership. This approach will help in identifying accountability of working staff along with helping in managing the schedule.
Schedule of operation as per the complexity of the case is an essential aspect in developing a better OR managing system that will help in reducing the TT. However, after facing problems such as delayed surgery, I have identified other critical factors that affect the delay in operations including the nature of the surgery and anaesthetic. It is worth noting that even better performance of OR working staff cannot help in improving the timing without analysing complexity of the operation along with the impact of the anaesthetic on the body of the patient. However, coordination of the turnover team is the most crucial aspect of reducing TT along with having high quality communication and collaboration with housekeeping, anaesthesia, and nursing.
The team has failed to reach the expected outcome; however, it has tried its best to manage the working process. Most importantly, I have learned in this working experience that everyone works effectively and no one shows an irresponsible attitude. Most importantly, it is not possible for any team to avoid other factors that are out of the skills and control of the team members. For example, in the third week due to presentation of wrong consent from patients the delay occurred. It was quite frustrating for my team to face issues regarding completing the task and getting depressed reactions from patients. However, it is quite tough for the team to complete the task of reducing TT even while facing adverse situations. Utilisation of OR is the only effective way to provide better patient centric outcomes; however, with lack of human resource it is quite tough for my team to cope with this situation.
Therefore, even after facing external problems that created a critical condition and prevented us from reaching our goals. Even after witnessing issues and problems all through this project I have learnt about the importance of being positive and starting to find out ways that can help in completing tasks of managing issues in the operating team.
After going through the exhausting and stressful working experience, it was quite natural for the team members to stay depressed. However, I managed to overcome this situation to go far away from the present condition to reach our goal along with becoming more efficient in our respective work. At the same time, I learned about the importance of becoming an effective leader to promote efficiency and effectiveness of work. Due to this reason, while leading this team in the other weeks of this project, I work efficiently on dividing the roles and responsibilities of people to stay alert and attain every task without any mistake.
However, before that, I also needed to analyse the reason for facing problems while reducing the TT on the basis of past activities. For example, I have identified that although there are other factors that can affect the turnover time, in this case, our team was fully responsible for being two minutes late as per the policy of the hospital. For example, lack of teamwork is the most critical reason for facing this issue. At the same time, our team members were unknown to specific roles and responsibilities. I also tried to help others without knowing the reason or particular working processes. At the same time, I have also learned about the importance of supporting other team members in identifying difficulties along with resolving them without any hiccups. However, it was crucial to find out specific processes and roles for completing any task.
This situation has also helped in identifying the importance of listening to others while handling teamwork. It is not possible for any team member to complete tasks efficiently without managing and having better communication (Zepeda et al. 2020). Due to this reason, in my second presentation, I have witnessed the importance of transformational leadership while completing this project. In this project, I have learned about creating a vision fit to the goals of the project to inspire the entire team to stay committed towards their work and the shared goal. I have also learned about the importance of gaining support from team members in the form of improved performance and the communication with the team members. I have also analysed the importance of every teammate including the roles and responsibilities of a circulating nurse. It is not possible for the team to complete tasks effectively without having support from the circulation nurse to transfer the patient out of PACU and handover the case to other staff within minimum time. Even after analysing the importance of having proper training and skill as a technical assistant it is also essential to have sufficient staff members to complete the task without facing any issue. However, in this specific place, the present hospital faced issues to provide required support from the department along with providing best quality support. Thus, it was on the team leader to manage the entire process of completing tasks of encouraging OR team members.
Sending specimens after preparing them is also essential for a circulating nurse, and I have witnessed the requirements for checking the entire setting along with preparing the theatre without wasting any time. Checking the next patient regarding whether they are ready for the operation is essential. Scrub nurse is another important part of the team who helps in counting, putting on gowns, and preparing for the theatres after checking the sterile and machines that can help in improving the entire condition of work. Operating room assistant is no less an important aspect of helping in the operating room who helps in preparing the anaesthesia tools after cleaning them.
After revising my entire experience in this project I have learnt that TT plays an important role in managing OR and maintaining the reputation of the healthcare service providers. At the same time, it is essential to have a powerful leadership along with support from the entire department. Primary reason for such a fact is that satisfaction of patients and surgeons is the most essential aspect of OR management. Thus, it requires to develop an action plan that could help in improving the entire task of managing the operating room and preoperative activities without any mistakes. Due to this reason, I have provided importance to leadership that could help in improving the entire process of work that could help to improve the present situation. Furthermore, in the second presentation, I have identified the importance of transformational leadership, and it requires a proper action plan to utilise transformational leadership, and to reach the expected outcome. It is essential to develop training for the entire team that can help in meeting shared goals. Most importantly, I have also gone through factors such as managing the team even after having a poor man power.
I have identified that transformational leadership has the ability to help me to improve the working process of team members by dividing the tasks among the teammates evenly. However, this plan requires providing attention to talent and skill of every working staff to allocate proper work as per their capacity. It has also been identified that to improve the efficiency of TT it is required to work in a collaborative way by communicating with each other efficiently. At the same time, to reach the expected TT it is essential for me to focus on the PDSA cycle that can help in reaching my goal.
Examples of my work
I have completed one assignment and two presentations on reducing turnover time in the operating room. I have also collected feedback from managers and my colleagues. I have worked at QMH that includes sixteen operating rooms, and this hospital is a multifaceted hospital with specialities including ENT, DMF, Ophthalmology, Gynaecology, Surgical, and Orthopaedic. However, I worked in the Ophthalmology section that helped me to develop my understanding on the importance of TT in an operating room (Keller et al. 2019). At the same time, I have experience of working as a leader of an OR team. I have a complete knowledge on the process of dividing roles and responsibilities to people. At the same time, I have also become successful in completing my task regarding managing team members, and influencing them to perform to reach a shared goal.
Skills that I have
I have proved with my work that I have skills to communicate with people effectively. Although I have improved my capacity to complete a communication on the basis of eye contact I always worked effectively to reach my audience through clear and concise messages.
My experience in this capstone project revolves around the surroundings of the OR management team, and completing preoperative activities along with cleaning the room after an operation. Most importantly, I have learned about the importance of TT that can come with adverse consequences due to not completing the task efficiently. I have also identified in this place that integration is the key aspect of getting success in this field of work. At the same time, I have the opportunity to work more efficiently in the future by focusing on transformational leadership. I have gone through different stages of working that have helped in completing the task of cleaning and preparing the operating room for the next operation. However, in this project, I have also learnt about the importance of developing a time table work along with identifying problems before identifying the process of resolving the issue. Most importantly, I have witnessed the importance of training and development of staff when it comes to working effectively and reaching the goals.
Gibbs reflective model has assisted in working efficiently in improving the entire working process by identifying an issue along with evaluating and analysing the characteristics and other aspects of the issue. For example, in this case, I have identified my weakness regarding not achieving the goal of reducing TT to improve the experience and satisfaction level of operating staff, surgeons, and patients. This reflective model has also helped me to reach a conclusion regarding my capacity and places of improvement. Due to this reason, I have also become successful in working effectively when it comes to managing the entire team on the basis of quality of work along with roles and responsibilities. It is quite tough for working staff to reach the shared goal without having any vision and proper guidance from the service providers and the leaders. Hence, I have learnt about the importance of transformational leadership that can help in completing any task more effectively when it comes to teamwork. Most importantly, teamwork is always important to help the entire team to work effectively and to get the expected outcome. I have also identified my quality of work along with the capability of being a better leader in future. Most importantly, I have prioritised learning and developing knowledge through experience.
Thus, I have a PDSA cycle to improve my working process and capacity to reach the expected goals in future. I have also gained fresh experience in this project that has come with new knowledge on the process of leading a team. I did not have any idea of the powerful aspect of a leadership style. However, after revising my process of work and possibilities of reaching goals through staff enthusiasm is a critical aspect of my improvement. For example, I have gained benefits of Gibbs cycle and the PDSA cycle simultaneously to reach the individual learning outcomes. Moreover, I have leant the process of measuring progression on the basis of weekly performance. ?
Ann?Christin, v. V., Swenne, C. L., Gustafsson, B. Å., & Karin, F.
B. (2020). Operating theatre nurse specialist competence to ensure patient safety in the operating theatre: A discursive paper. Nursing Open, 7(2), 495-502.http://dx.doi.org/10.1002/nop2.424
Aravinthan, K., Holmes, C., Nair, S. P., Sharma, A. R., & Murphy, R. A. (2020). Impact of ENT resource nurses in improving operating room efficiency: Journal Canadiend'Otolaryngologie. Journal of Otolaryngology - Head & Neck Surgery, 49, 1-8. http://dx.doi.org/10.1186/s40463-020-00431-8
Aufegger, L., Shariq, O., Bicknell, C., Ashrafian, H., &Darzi, A. (2019). Can shared leadership enhance clinical team management? A systematic review. Leadership in Health Services, 32(2), 309-335. http://dx.doi.org/10.1108/LHS-06-2018-0033
Chernov, M., Vick, A., Ramachandran, S., &Delphin, E. (2017). Introducing “4 Steps-to-Team” — An Innovative Educational Concept for Teambuilding in The Operating Room. Journal of Anesthesia and Perioperative Medicine (JAPM), 4(6), 293-296. http://dx.doi.org/10.24015/JAPM.2017.0080
Christopher, R. H., Green, M. S., Liu, J., Iqbal, U., &Voralu, K. (2018).Using operating room turnover time by anesthesia trainee level to assess improving systems-based practice milestones. BMC Medical Education, 18 http://dx.doi.org/10.1186/s12909-018-1409-6
Dusse, F., Pütz, J., Böhmer, A., Schieren, M., Joppich, R., &Wappler, F. (2021). Completeness of the operating room to intensive care unit handover: a matter of time? BMC Anesthesiology, 21, 1-8.http://dx.doi.org/10.1186/s12871-021-01247-3
Fairley, M., Scheinker, D., &Brandeau, M. L. (2019).Improving the efficiency of the operating room environment with an optimization and machine learning model.Capstone reflection essay Health Care Management Science, 22(4), 756-767. http://dx.doi.org/10.1007/s10729-018-9457-3
Inomata, T., ?, J. M., Iwagami, M., Kawasaki, S., Shimada, A., Inada, E., Shiang, T., & Amano, A. (2018). The impact of Joint Commission International accreditation on time periods in the operating room: A retrospective observational study. PLoS One, 13(9) http://dx.doi.org/10.1371/journal.pone.0204301
Keller, S., Tschan, F., Semmer, N. K., Timm-Holzer, E., Zimmermann, J., Candinas, D., Demartines, N., Hübner, M., &Beldi, G. (2019). “Disruptive behavior” in the operating room: A prospective observational study of triggers and effects of tense communication episodes in surgical teams. PLoS One, 14(12) http://dx.doi.org/10.1371/journal.pone.0226437
Kumar, M., &Malhotra, S. (2017). Reasons for delay in turnover time in operating room- an observational study. Bangladesh Journal of Medical Science, 16(2), 245-251. http://dx.doi.org/10.3329/bjms.v16i2.27473
Lo, B. (2020). The Effect of Morale in the Operating Room on Surgical Outcomes. Journal of Business Studies Quarterly, 10(2), 28-34. https://www.proquest.com/scholarly-journals/effect-morale-operating-room-on-surgical-outcomes/docview/2478619017/se-2?accountid=30552
Ninan, D., Zhu, J., Amanda, K., Wasson, E., Fullerton, T., &Ninan, B. (2017).The Role of Organizational Culture in Operating Room Turnaround Time. Cureus, 9(5) http://dx.doi.org/10.7759/cureus.1257
Schoenfelder, J., Kohl, S., Glaser, M., McRae, S., Brunner, J. O., &Koperna, T. (2021). Simulation-based evaluation of operating room management policies. BMC Health Services Research, 21, 1-13. http://dx.doi.org/10.1186/s12913-021-06234-5
Taaffe, K., Fredendall, L., & Weiss, R. (2018).Managing Service-Specific and Open-Posting Block Sizes when Allocating Operating Room Time. The Quality Management Journal, 25(1), 18-31. http://dx.doi.org/10.1080/10686967.2018.1404371
Umali, M. I. N., & Castillo, T. R. (2020).Efficiency of Operating Room Processes for Elective Cataract Surgeries Done by Residents in a National University Hospital. Clinical Ophthalmology, 14, 3527-3533. http://dx.doi.org/10.2147/OPTH.S277550
Zepeda-Lugo, C., Tlapa, D., Baez-Lopez, Y., Limon-Romero, J., Ontiveros, S., Perez-Sanchez, A., &Tortorella, G. (2020).Assessing the Impact of Lean Healthcare on Inpatient Care: A Systematic Review. International Journal of Environmental Research and Public Health, 17(15), 5609.http://dx.doi.org/10.3390/ijerph17155609