Concept Analysis of Synergism in the Perioperative Services Environment

Perioperative services carry the highest expenditures while simultaneously accounting for the largest portion of net income for a hospital.  For example, up to 65% of net revenue and 40% of resource costs originate from perioperative services for large healthcare organizations (Saadouli, Jerbi, Damaak, Masmoudi, & Bouaziz, 2015; Welder, 2013). Each minute of operating room staffed time is estimated to be worth an average of $52, and ranges from $22 to $80 depending upon the complexity of the case (Akron General Medical Center, 2016; Macario, 2010; Volpin, Khan, & Haddad, 2016).  The costs and revenue aspects of perioperative services is a major focus of healthcare. As payment systems shift from procedure-based to outcome-based as a result of the Affordable Care Act, it is imperative that hospital leadership and perioperative services management understand how to effectively and efficiently maximize quality outcomes. 

The multi-unit and multi-disciplinary constitution of perioperative services requires teamwork, communication, working toward a common goal and synchronization of scheduled events to create value over and above what would otherwise be possible.  A concept analysis of synergism was conducted using the methodology of Walker and Avant (2011) to determine its applicability to a perioperative services environment. The concept analysis served as an initial step in the creation of a comprehensive model to manage perioperative services from a holistic perspective.

Extensive literature searches were conducted to ascertain how the concept of synergism has been used within and outside of healthcare.  The literature searches consisted of online websites—using google scholar, the Association of Perioperative Registered Nurses (AORN) website, dictionaries, thesauri, and dissertations.  Databases searched were “all databases” from GALILEO and EBSCOhost to include CINAHL, PubMed, Ovid, ProQuest, Science Direct, Business Source, Education Source, and PsychInfo from 2001 to 2015.  Database searches were limited to full-text, English language articles in published in scholarly journals. The search for synergy initially yielded 333 articles and the search for perioperative services initially yielded 509 articles. Summary of records were reviewed and 34 articles were included in the concept analysis.

The concept synergism was found to be used in many areas outside healthcare including corporate mergers in business, psychology, information technology, and theology.  Some examples of the use of synergism outside of healthcare include the positive value added as a result of merging individual companies, and the value that emerges when compatible information technology assets are combined with other organizational resources.  In healthcare, the concept has been employed to explain the supra-additive effects of combined medications, biological systems, teamwork, patient care, and quality assurance procedures for cleaning effectiveness.  The examination of how the concept has been used across these contexts highlighted two defining characteristics: an emergent property not present in the constituent components or antecedents, and an emergent value that is positive.  A case was presented to illustrate the use of this concept in perioperative services. 

The tactical and strategic allocation of resources, with an emphasis on team cohesion, careful scheduling, enhanced communication, and a common focus on the patient can maximize synergism leading to increased patient and staff satisfaction, a positive organizational culture, a high net-revenue stream, and optimized outcomes.  Future plans are to utilize the concept of synergism to create and validate a comprehensive model of perioperative services.  Forming a framework through which the complexities of perioperative services can be researched and discussed, the model will serve as a useful tool to improve the management of and practice within perioperative services; bridging the knowledge gap between the research and clinical lanes.     

References:

Akron General Medical Center (2016) Patient Price Information List: Operating Room Charges. Available at http://www.akrongeneral.org/portal/page/portal/AGMC_PAGEGROUP/ Price_guide/PRICE_GUIDE. Accessed March 28, 2016.

Macario, A. (2010). What does one minute of operating room time cost? Journal of Clinical Anesthesia, 22(4), 233-236. doi:http://dx.doi.org/10.1016/j.jclinane.2010.02.003

Saadouli, H., Jerbi, B., Dammak, A., Masmoudi, L., & Bouaziz, A. (2015). A stochastic optimization and simulation approach for scheduling operating rooms and recovery beds in an orthopedic surgery department. Computers & Industrial Engineering, 80, 72-79.doi: http://dx.doi.org/10.1016/ j.cie.2014.11.021

Volpin, A., Khan, O., & Haddad, F. S. (2016). Theater Cost Is £16/Minute So What Are You Doing Just Standing There? The Journal of Arthroplasty, 31(1), 22-26. doi:http://dx.doi.org/10.1016/j.arth.2015.08.008

Walker, L. O., & Avant, K. C. (2011). Strategies for Theory Construction in Nursing (5th ed.). Boston: Prentice Hall.

Welder, M.D. (2013). Strategic model: Operating room utilization. (Ph.D.), Walden University.