For San Juan Regional Medical Center, a community hospital in Farmington, N.M. that serves the remote Four Corners region, surgical access is a lifeline. The nearest large tertiary medical center is roughly 180 miles away.
Until recently, the hospital’s Excel-based OR tracking created bottlenecks, operational blind spots and limited capacity, directly constraining patients’ access to surgical care. That changed in just 90 days. After implementing LeanTaaS’ iQueue for Operating Rooms, San Juan Regional opened up surgical access and delivered a two-fold return on investment, reaching 88% user adoption in the same window.
During an Oct. 13 webinar hosted by Becker’s Healthcare and sponsored by LeanTaaS, San Juan Regional’s CIO and physician informatics executive shared why the working relationship between IT and clinical leadership mattered as much as the software. The panelists were:
- Carlo Hallak, MD, physician informatics executive at San Juan Regional Medical Center
- John Gaede, CIO at San Juan Regional Medical Center
Below are five takeaways from their conversation.
Note: Quotes have been edited for length and clarity.
1. Strong OR governance couldn’t make up for month-old, manual data
San Juan Regional runs 10 operating rooms and performs about 7,500 surgeries a year. Before implementing iQueue for Operating Rooms, the hospital had already brought in external consultants and stood up a governance structure focused on OR capacity, Dr. Hallak said. What it lacked was timely data.
Scheduling and tracking ran through disconnected manual processes. Admissions nurses called floors to find clean rooms, and physicians signed paper forms to schedule cases. Leaders had no live view of block utilization, turnover times or first-case on-time starts. Because pulling reports from the EHR required complex workarounds, governance meetings relied on month-end data.
“We were addressing problems 30 days after they happened,” Dr. Hallak said. “That’s not management, that’s really archeology.”
2. Executive sponsorship and a clinical frame set the tone
Mr. Gaede, who spent nine years as a medical technologist before moving into IT, brought the case for the new OR operations technology to the board from day one. He tied it to the hospital’s mission and its goal of being the premier regional medical center. Better visibility, he argued, would create healthy accountability in the OR, open up blocks on the schedule and increase access.
Dr. Hallak said the team treated the effort as a clinical operational transformation rather than an IT project. Physician and IT leaders worked side by side to validate surgeons’ concerns and meet them where they were.
3. Validating data against the EHR turned skeptics into supporters
Mr. Gaede called data trust the first milestone of the project. “If you’ve been in healthcare for any time, the first thing that happens on any of these kinds of projects is the caregivers say, ‘I don’t believe the data. I don’t believe the data. I don’t trust the data,'” he said.
To help get ahead of that reaction, LeanTaaS’ team spent weeks working alongside the hospital’s nurse informaticist to confirm that what the platform showed matched the EHR. The hospital’s medical director of anesthesiology became a key validator. He had long maintained the OR’s Excel spreadsheets and was a trusted voice on the data. When some providers questioned the numbers at the first governance meeting, he was there to confirm they were correct.
A general surgeon, meanwhile, drove adoption among her fellow surgeons by modeling point-of-care scheduling. During clinic visits, she logged into the platform, created the case and booked OR time on the spot, without the paper forms or follow-up calls the old process required.
4. Flexibility and on-site support built trust quickly
The LeanTaaS team was embedded on site, listened to pain points and documented feedback, Dr. Hallak said. One early test surfaced on turnaround time. The system defaulted to 30 minutes, but surgeons said that wasn’t realistic for San Juan Regional, so the team adjusted it to 45 minutes. That change eliminated scheduling gray spots and built trust immediately.
Dr. Hallak said addressing problems transparently, rather than defending the system, was central to that trust. On the hospital side, San Juan Regional’s nurse informaticist, a former OR circulator, provided at-the-elbow support to schedulers and nurses. Managers who once spent hours each week assembling spreadsheets can now pull turnover and block utilization reports in a few clicks.
5. The results: 88% user adoption and capacity the hospital didn’t know it had
In the first 90 days, the hospital reached 88% user adoption, with 71 active users across schedulers, staff and physicians. It logged 498 approved requests for booked or open OR time slots. Mr. Gaede said those cases might have been delayed or not scheduled under the old system. The average lead time for case requests is now 10 days, allowing more proactive scheduling and better patient preparation.
The hospital also saw a two-fold return on investment in the first quarter. Mr. Gaede noted the calculation used a conservative contribution margin estimate, and the team is refining it with LeanTaaS and the hospital’s CFO. If the margin is higher, the return will be greater.
Dr. Hallak said the organization now works from a single source of truth. At the most recent throughput governance committee meeting, the OR director presented data from the platform rather than Excel sheets. Surgeons can see open time at the point of care and book cases immediately, which reduces patient wait times. Leaders can track how fully rooms and equipment such as surgical robots are being used.
Where San Juan Regional goes from here
Next, the hospital plans to give six surgeons personalized dashboards that show how they use their OR time and how they schedule cases. It is also adding a same-day view of OR activity, so leaders can act on problems as they happen rather than after the fact. New tools will let the hospital shift OR time between surgeons as demand changes. In the long term, leaders are looking at capacity tools for inpatient and infusion care.
For Dr. Hallak, the lesson for other health systems is that the relationship drove adoption more than the technology did.
“If John and I hadn’t built this bridge between IT and operations, this would have been just another software rollout that nobody used,” he said. Mr. Gaede’s advice for leaders facing similar OR challenges: Find a clinical champion, validate the data, meet people where they are and be transparent.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
