An OR nurse and perioperative leader for most of my 20+ year nursing career it’s startling to note the exponential changes affecting healthcare and specifically the perioperative environment. Recently, there has been increased attention to operating rooms of the future, most notably a prediction for addition of integrated and/or hybrid operating rooms to more than 35-45% of ORs around the world over the next couple years.  Already noted to be a highly technical, high-pressure environment with strong personalities and a determination to make sure things work out no matter what; the perioperative environment of care still seems to be struggling to leave the status quo of “work-arounds” behind for a variety of reasons. Technological advances in the last ten years have pushed the limits on our space, documentation, equipment, communication, and even our workflows and patient care practice, yet full integration still lags behind due to proprietary and regulatory barriers that even the grocery and banking industries resolved decades ago with standardized barcoding and tracking as only a couple of examples.

As a clinician, when I hear the word “integration” my mind immediately considers how much better everything could be if the EMR, imaging, other devices, and equipment talked to each other.  The time savings, patient safety, and improved communication between clinicians and support staff that could occur if patient information and documentation did not have to be duplicated over and over again.  Many facilities have to choose whether to place their diminishing financial resources toward EMR upgrades or the latest and greatest technology and equipment just to compete; so, integration for even basic equipment will likely continue to be out of reach. Those facilities that boast technology integration still often lack “full implementation/optimization” of their current product necessitating staff (and providers) “clinging” to old-school methods.  An analogy I sometimes use is “putting Jetson’s technology in a Flintstones environment”.  There are talented people from almost every industry contributing to healthcare and trying to “make things better” yet this phenomenon continues.  This new focus on the perioperative environment should provide a better platform for change, but only by using clinicians with experience specific to the area, comfortable working with representatives of supporting industries and a desire to be a knowledgeable liaison and voice between the clinical and non-clinical entities.

With my own deep roots in the construction industry and being a change agent within the healthcare environment, becoming that voice has motivated me to continue to grow and expand my own knowledge even further into the construction industry to help close the gap. I have found that words like functional programming, indicative design, and design development are some of the most important elements of a project where an informed clinical presence can truly make the most difference to move the baseline closer to reality; where the design either supports or hinders the final environment for end-users. The one thing that has become obvious to me is that industries are trying to understand, but they are speaking different languages, have different expectations, motivations, and can only see through their own lenses and past experiences.

Many clinicians have an unspoken expectation where they want the design industry to provide feedback and experience of best practice and what has worked well for others in similar settings while also recognizing current state workflow successes into the design. There are also institutional hierarchies of administration, providers and staff to be considered, financial resources along with the business of continuing to provide patient care with the expertise of those very people.  The results are generally ongoing frustration, expense, lots of rework and finally an end-product that doesn’t meet the needs of those who use the space. Instead, the underlying result is the very definition of insanity “doing the same thing and expecting different results”.  I believe that  utilizing an experienced “subject matter expert with high level perspective” clinician to get the baseline closer to reality at the beginning of the project would result in a better starting point, and an ongoing liaison relationship would facilitate trust and expertise to the end-users and the project success.

Changes in healthcare, patient expectations and a general healthcare revolution is requiring us to approach every aspect of our “world” and blend the best of old and new to reinvent ourselves and create a new “standard”. New hospitals and renovation projects are at an all-time high across the country and never has there been such a need (and opportunity) for nurses with these specialty area skills to be the bridge and liaison advocating for solutions that work while continuing to stretch clinicians in excellence.