In July 2005, the report of the Surgical Process Analysis and Improvement Expert Panel (chaired by Valerie Zellermeyer, Program Director, Peri-operative Services, St. Michael's Hospital) was released by the Ministry of Health and Long-Term Care.

One of the key recommendations of this panel was to provide hospitals with assistance to build capacity to continually improve operating room efficiency, access and quality of service. In particular, the Expert Panel recommended that Ontario's Wait Time Strategy invest in the development of Peri-operative Improvement Coaching Teams to help the government understand peri-operative issues and assist hospitals to improve peri-operative efficiency and performance.

The coaching teams will coach hospitals in effective peri-operative management techniques such as planning, mapping processes, and determining optimal human resource use and scheduling.

The MOHLTC will provide team members with full training, an opportunity to engage in a provincial quality improvement initiative and compensation (including travel expenses) according to experience and expertise. Additionally, members of the Canadian College of Health Service Executives (CCHSE) may obtain up to two credits for participating in this initiative.

The Expert Coaching Teams are made up of peers with experience in effective management of peri-operative resources. The Peri-Operative Improvement Expert Coaching Teams assist hospitals to build system capacity by continually improving operating room efficiency, access and quality of service. This is achieved by assisting organizations in :

• clearly defining gaps;
• providing advice on how to implement system improvements, standardize processes and implement best practices.

Most importantly, the Peri-Operative Improvement Expert Coaching Teams are considered a dedicated provincial resource (funded through the MOHLTC not independent consultants) where all hospitals in Ontario with a surgical program are eligible for a site visit by a coaching team.

To assist Ontario hospitals to analyze their peri-operative processes and help with the identification of improvements required to maximizing peri-operative efficiency and effectiveness.

The overall goal of the Peri-Operative Improvement Coaching Team program is to maximize the efficient and effective use of peri-operative resources in Ontario hospitals.

In addition, the teams will seek to enhance peri-operative quality improvement skills, explore innovative ways to provide consultation services to improve efficiencies, and facilitate the translation and embedding of best practices.

Teams are made up of three to four members from hospitals across the province and with a wide-range of skills. Each team has at least :

• one physician lead (surgeon or anesthetist);
• administrative lead (VP or Director of Perioperative Services); and
• an Operating Room leader (OR Manager).

Team composition changes for each institution, to maximize the coaches' skill sets and to provide each coach with an opportunity to interact and learn from a number of other coaches.

The hospital is responsible for completing a detailed pre-visit survey outlining where they currently stand in terms of the best practices as identified within the SPAI Expert Panel report. This survey along with an expression of interest (with details of their 5 major challenges) is used as a guide for the coaches during their visit.

Coaches spend 1.5 days observing the peri-operative staff and processes as well as interviewing key individuals. The last 1.5 days is used to coach the peri-operative team in building an action plan which will bring them closer to best practice. This information is then sent to the MOHLTC, LHIN and hospital. In six-to-nine months, one of the coaches from the original team revisits the hospital to evaluate how successful the peri-operative team has been in implementing the action plan.

With each Coaching Team visit, hospitals have an opportunity to implement changes which improve peri-operative management and performance. Coaches are both welcomed and encouraged to share resources including tools that might be of use to an organization in making improvements.

All coaching team members are trained in effective coaching styles and techniques by The Hire Net.Work Inc, a professional team of trained business coaches. This training, along with the expertise each coach brings from the field, helps create an atmosphere of collaboration and generates a buzz which rarely occurs through more traditional review processes.

An ideal candidate will have the following experience :

• Demonstrable experience in effective peri-operative management;
• Demonstrable experience with implementing quality improvement initiatives and/or change management;
• Broad experience in a variety of settings (academic, community, small/rural hospital);
• Strong interpersonal skills;
• A willingness to learn and a commitment to the principles of quality improvement and the process of coaching; and finally
• Related coaching experience (consulting work, accreditation, etc)

• A mandatory training session;
• Perform at least two visits within fiscal year 2005/06; and
• Participate in the ongoing training of new members.

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