Masursky Danielle, Dexter Franklin, Nussmeier Nancy A
Department of Anesthesiology, State University of New York Upstate Medical University, Syracuse, New York, USA.
Anesth Analg. 2008 Dec;107(6):1989-96. doi: 10.1213/ane.0b013e31818874a8.
Implementation of initiatives to increase anesthesia group productivity depends not just on anesthesia groups, but on operating room (OR) nursing administration. OR nursing directors may encourage organizational change based on the needs of their hospitals and nurses. These changes may differ from those that would increase the anesthesia group's productivity. We assessed reward structures using (A) letters of nomination for the "OR Manager of the Year" award offered annually by the publication OR Manager, and (B) data from a salary/career survey of OR directors by the same publication.
(A) There were 164 nomination letters submitted from 2004 through 2007 for 45 nominees. The letters contained n = 2659 full sentences and n = 50,821 words. We systematically created a list of 36 terms related to finance, profit, and productivity. We also analyzed the frequency of use of these terms relative to the use of the 15 most common relationship-oriented terms (e.g., compassion, encourage, mentor, and respect). (B) The salary/career survey's questions relevant to anesthesia group productivity had responses from 303 US OR directors, 97% of whom were nurses. We tested the strength of the relationship between the budget responsibility of the OR nursing director and his or her annual salary.
(A) 2.6% of sentences in the nomination letters included at least one term related to profit and productivity (95% confidence interval 2.0%-3.2%). Relationship-oriented terms were 9.0 times more prevalent (95% confidence interval 7.1-11.4). (B) There was statistically significant positive proportionality between the OR nursing director's operational budget (including personnel) and his or her salary (Pearson r = 0.64, P < 0.001). The 10th percentile of the operational budget was $1 million and the 90th percentile was $36 million. The budget of $1 million was associated with a salary 22% less than the median and the budget of $36 million was associated with a salary 22% larger than the median.
Through (A) organizational constituencies, and (B) compensation, many US OR nursing directors likely are encouraged to enhance relations with nursing staff, not to champion organizational initiatives that would reduce under-utilized OR time and OR nursing labor costs. Resulting decisions can differ from those that would increase the productivity (profit) of the anesthesia group. Anesthesia groups need to champion initiatives to increase anesthesia productivity, while being sensitive to institutional expectations of nursing directors.
实施提高麻醉团队工作效率的举措不仅取决于麻醉团队，还取决于手术室（OR）护理管理部门。手术室护理主任可能会根据医院和护士的需求鼓励组织变革。这些变革可能与提高麻醉团队工作效率的变革不同。我们使用（A）由《手术室管理》杂志每年颁发的“年度手术室经理”奖的提名信，以及（B）同一杂志对手术室主任进行的薪资/职业调查数据来评估奖励结构。
（A）2004年至2007年共提交了164封提名信，涉及45名被提名人。这些信件包含n = 2659个完整句子和n = 50821个单词。我们系统地创建了一份与财务、利润和生产率相关的36个术语列表。我们还分析了这些术语相对于15个最常见的以关系为导向的术语（如同情、鼓励、指导和尊重）的使用频率。（B）薪资/职业调查中与麻醉团队生产率相关的问题得到了303名美国手术室主任的回复，其中97%是护士。我们测试了手术室护理主任的预算责任与其年薪之间关系的强度。
（A）提名信中2.6%的句子至少包含一个与利润和生产率相关的术语（95%置信区间2.0% - 3.2%）。以关系为导向的术语出现频率高9.0倍（95%置信区间7.1 - 11.4）。（B）手术室护理主任的运营预算（包括人员）与其薪资之间存在统计学上显著的正比例关系（皮尔逊r = 0.64，P < 0.001）。运营预算的第10百分位数为100万美元，第90百分位数为3600万美元。100万美元的预算对应的薪资比中位数低22%，3600万美元的预算对应的薪资比中位数高22%。
通过（A）组织选民群体，以及（B）薪酬，许多美国手术室护理主任可能受到鼓励去加强与护理人员的关系，而不是支持那些会减少手术室未充分利用时间和手术室护理劳动力成本的组织举措。由此产生的决策可能与提高麻醉团队生产率（利润）的决策不同。麻醉团队需要支持提高麻醉生产率的举措，同时要对护理主任的机构期望保持敏感。
