Who is responsible for operating room management and how do we measure how well we do it?

Background: Managing the surgical process in the operating suite - often the most expensive unit in the hospital - is vital, yet challenging. While sensible management can improve efficiency, unclear managerial structures can hinder the optimal use of resources. Despite that, no previous data exists as to how the operating room management is organized and the performance monitored in our country. Methods: A survey was sent to chief anesthesiologists and head nurses of 103 surgery units of 60 public hospitals regarding the current structures of daily management, as well as metrics and tools used for monitoring the performance of the operating room. Results: The overall response rate was 87%. Nurses' and anesthesiologists' perceptions differed significantly on which care provider they held responsible for the daily operative management of the operating room. In doctors' opinion, that person was an anesthesiologist - either alone or in combinations - more often than in nurses' opinion (66% vs. 35%, P < 0.001). Anesthesiologists' involvement increased by the type and size of the hospital, being greatest in the university hospitals. Operating room performance was measured most often by number of procedures in a time unit, utilization and turnover time. Monitoring was complicated by old-fashioned information systems, and seldom seemed to lead to organizational changes. Conclusion: The structure of the daily operative management of an operating room needs redefining. There should be more focus on collaboration and communication between the care providers.