Perioperative Operations · Lean Six Sigma · Workforce Development

When the OR Works,
Everything Works.

Terrina McKinnon brings 10+ years of perioperative leadership, Lean Six Sigma Black Belt rigor, and frontline OR expertise to drive measurable, lasting improvement in health systems.

CST CRCST CLSSBB CPIS
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+24 pts
FCOTS improvement in 90 days
~$880K
Projected annual savings, preference cards
1,123%
First-year ROI, OR delay reduction
Terrina McKinnon, CST · CRCST · CLSSBB · CPIS — Perioperative Operations & Lean Six Sigma Consultant

Excellence is the goal, Integrity is the foundation.

— Terrina McKinnon
About Me

Perioperative Expertise Meets Lean Six Sigma Discipline

I am a Certified Surgical Technologist (CST), Certified Registered Central Service Technician (CRCST), Lean Six Sigma Black Belt (CLSSBB), and Certified Perioperative Improvement Specialist (CPIS) with more than 10 years of progressive leadership experience across perioperative services, sterile processing, accreditation, workforce development, and organizational improvement.

My work spans the full arc of healthcare operations — from the OR floor preparing for first cases, to designing enterprise-level leadership frameworks for board review. I understand why the night shift matters for 7:30 AM first cases, how an SPD tray defect cascades across a 12-room schedule, and how to build systems that hold after I leave the room.

I combine EPIC-sourced data analytics, DMAIC methodology, and deep frontline experience to deliver interventions that are defensible in the boardroom and durable on the floor.

CST

Certified Surgical Technologist — NBSTSA

CRCST

Certified Registered Central Service Technician

CLSSBB

Lean Six Sigma Black Belt — CSSC

CPIS

Certified Perioperative Improvement Specialist

Selected Career Wins

  • Lifted FCOTS from 62% to 86% in 90 days — without added staffing or capital investment
  • Designed preference card governance system projecting $880K annual savings and 1,123% first-year ROI
  • Built a 22-week surgical technology apprenticeship pipeline that eliminated $1.9M in traveler spend — saving over $900K net, returned to the operating budget
  • Achieved initial CAAHEP accreditation for two Surgical Technology programs — zero citations on both
  • Maintained accreditation compliance above 90% over a 10-year period
  • Sustained national certification pass rates above 92%, exceeding required benchmarks
  • Graduated and trained more than 300 Surgical Technology professionals
  • Awarded Program Director of the Year on two separate occasions
  • Designed an enterprise Leadership Capability Framework — Supervisor to Director — for succession planning, performance management, and selection calibration
What I Do

Core Consulting Services

Every engagement is scoped to a specific operational gap. I bring the methodology, the tools, and the domain knowledge — you get sustainable results.

First Case On-Time Starts

Diagnostic and improvement work targeting FCOTS delays — surgeon arrival standardization, pre-op readiness protocols, EHR workflow enhancement, and accountability infrastructure that holds post-engagement.

DMAICSurgeon ComplianceEHR Workflow

Preference Card Optimization

Systematic audit, ownership assignment, and governance for preference card accuracy — reducing supply waste, OR rework, and missing-item delays with a sustainable update workflow tied to item master changes.

Card AuditGovernanceSupply Chain

OR–SPD Integration

Communication protocols, instrument defect tracking, case-signout workflows, and daily readiness huddles that close the handoff gap between sterile processing and the surgical suite.

Sterile ProcessingDefect ReductionStandard Work

OR Performance Analytics

Baseline measurement, Sigma level calculation, DPMO, turnover time analysis, surgeon variance reporting, and block utilization assessment — built to DMAIC standards and presentable to executive leadership.

EPIC DataSigma LevelExecutive Reporting

Leadership Development

Capability framework design from Supervisor to Director — defining observable behaviors across strategic alignment, systems thinking, change leadership, and patient-centered decision making for succession, selection, and performance management.

OD DesignSuccession PlanningCapability Framework

Workforce Pipeline Development

Apprenticeship design, surgical technology program architecture, and traveler-reduction strategies — building internal workforce pipelines that eliminate costly contract labor dependency and return funds to the operating budget.

ApprenticeshipTraveler ReductionPipeline Design
Results

Results That Hold

All facilities are anonymized to protect client and organizational confidentiality. Metrics represent actual project outcomes.

OR Performance · First Case On-Time Starts

Restoring First Case On-Time Starts at a 12-OR Regional Medical Center

62% → 86% FCOTS in 90 days

A mid-sized regional medical center operating 12 ORs across orthopedic, general, and specialty service lines engaged me to address eroding morning OR performance. Surgeon arrival variability was driving late consents, incomplete pre-op assessments, and cascading downstream disruption. I applied a structured DMAIC approach — validated root cause across multiple delayed cases, then designed four coordinated interventions: a standardized arrival policy, a real-time visibility dashboard in the daily OR huddle, automated EHR consent alerts, and a monthly service chief review cadence. The result was a 24-point FCOTS improvement in 90 days — without added staffing or capital investment.

+24 pts
FCOTS improvement
62% → 86%
72%
Reduction in consent delays
vs. prior quarter
91%
Surgeon arrival compliance
New standard set
Supply Chain · Preference Card Governance

Preference Card Accuracy & OR Waste Reduction

$880K Projected annual savings

A surgical services department with 75.8% preference card accuracy (target: 95%) engaged me for a DMAIC-driven initiative. Root-cause analysis identified unclear ownership, missing post-case update workflows, and unsynchronized item-master changes. Interventions included weekly card audits, surgeon-level scorecards, a 30-day vendor change protocol, and a card governance escalation path. The financial model projected $880K in gross annual savings from reduced OR delays, rework labor, and supply waste — with first-year ROI exceeding 1,100%.

75.8%
Baseline accuracy
Target: 95%
94–96%
Control period accuracy
Sustained
1,123%
First-year ROI
Net savings: $786K
Sterile Processing · OR–SPD Integration

OR–SPD Communication & Instrument Reliability

Closed-Loop Defect-to-correction system

Recurring instrument-related OR delays at a multi-OR regional medical center — missing trays, incomplete sets, last-minute substitutions — were traced to broken communication at the OR–SPD handoff. I implemented a case-signout defect capture form, overnight FCOTS readiness checklists, a T-15 daily readiness huddle, and a priority escalation protocol. This established a closed-loop feedback system between the OR and SPD that reduced tray defects and improved case cart reliability across all service lines.

4
Checksheets deployed
Standard work
T–15
Daily readiness huddle
All service lines
Loop
Defect-to-correction
Closed-loop system
Workforce Development · Traveler Elimination · Pipeline Design

22-Week Surgical Technology Apprenticeship: From $1.9M Traveler Dependency to Internal Pipeline

$900K+ Net savings returned to operating budget

A large health system in Florida was spending nearly $1.9 million annually on surgical technology traveler contracts to cover persistent staffing gaps in its perioperative services department. Leadership recognized the financial and operational risk of sustained traveler dependency — including quality variability, scheduling unpredictability, and escalating contract costs — and engaged me to design a sustainable internal workforce solution. I developed and implemented a structured 22-week Surgical Technology Apprenticeship Program: a competency-based, accelerated training pathway that recruited, trained, and onboarded candidates directly into the health system's surgical teams. The program was designed with CAAHEP-aligned clinical competency milestones, mentored OR rotations across multiple service lines, and a cohort model that allowed the health system to phase out traveler contracts as internally trained staff became independently competent. Within the first implementation cycle, the health system was able to eliminate its reliance on surgical technology travelers entirely. The gross traveler spend of approximately $1.9 million was reduced to the cost of running the apprenticeship program — producing a net savings of over $900,000 that was returned directly to the operating budget. The investment generated a strong, measurable return and created a self-sustaining internal pipeline that gave the health system long-term control over its perioperative staffing stability.

$1.9M
Annual traveler spend eliminated
Full dependency removed
$900K+
Net savings to operating budget
Strong ROI
22 wks
Apprenticeship program length
Internal pipeline built
How I Work

The DMAIC Framework, Applied to Perioperative Reality

Every engagement follows the same rigorous structure — so results are defensible, reproducible, and built to last beyond the project window.

D
Define
Problem scope, CTQs, project charter, stakeholder map
M
Measure
Baseline, DPMO, sigma level, EPIC data collection
A
Analyze
Fishbone, 5 Whys, Pareto, root-cause confirmation
I
Improve
PDSA pilots, countermeasure scoring, rollout plan
C
Control
Control plan, P-charts, ownership, sustained monitoring

What Makes This Different

  • Data sourced directly from EPIC perioperative modules — not estimates or anecdote
  • DPMO and sigma-level tracking that translates OR performance into executive language
  • Root-cause validation across multiple cases, not single-incident analysis
  • Control plans with assigned owners, targets, and documented reaction plans
  • Financials tied to specific operational levers — delay cost, rework labor, supply waste, traveler spend
  • Frontline standard work designed to hold without ongoing support — sustainable by design

The Frontline Advantage

Most process improvement consultants understand DMAIC. Fewer understand why the night shift matters for 7:30 AM first cases — or how a single SPD tray defect ripples across a 12-OR schedule, or why traveler-dependent staffing is a quality risk as much as a cost problem. My work is grounded in the practical reality of perioperative environments because I've lived it. That combination of Black Belt rigor and frontline knowledge produces interventions that actually stick.

EPIC
Native Analytics
LSS BB
Certified Rigor
OR/SPD
Frontline Experience
OD
Leadership Architecture
Leadership Architecture

Building Leaders Who Build Systems

Beyond operations, I design the leadership capability architecture that makes improvement sustainable — from frontline supervisors to department directors.

Supervisor Level

Reliable Frontline Execution

Supervisors convert strategy into daily team priorities, recognize system problems behind individual performance gaps, and maintain data discipline through frontline documentation and huddle leadership.

  • Huddle facilitation & visual management
  • Frontline coaching and psychological safety
  • Escalation of structural barriers
  • Adoption reinforcement after change
Manager Level

Cross-Unit Integration

Managers align people, workflow, and metrics across departmental boundaries — sustaining measurable performance over time through data-informed decision making and structured change leadership.

  • End-to-end workflow mapping
  • Cross-functional problem solving
  • Leadership bench strength development
  • Service-line performance accountability
Director Level

Strategic System Design

Directors design governance structures that enable whole-system oversight — building organizations that can sustain transformation after any single initiative concludes.

  • Enterprise analytics agenda
  • Talent and succession strategy
  • Culture and accountability architecture
  • Patient-centered strategic governance
Latest Insights

Perspectives on Perioperative Performance

Practical thinking on OR operations, Lean Six Sigma methodology, and healthcare leadership — drawn from real experience on the floor and in the boardroom.

OR Performance

Why Your OR's First Case Starts Are a Leadership Problem, Not a Scheduling Problem

Most hospitals treat FCOTS failures as a scheduling issue. In reality, they are accountability and systems failures that require a fundamentally different response from leadership.

Read More →
Supply Chain

The Hidden Cost of Inaccurate Preference Cards — And How to Fix It

Preference card inaccuracy is one of the most overlooked cost drivers in perioperative services — and one of the highest-ROI problems you can solve.

Read More →
OR–SPD Integration

OR and SPD Are One Team — It's Time to Operate That Way

The OR–SPD relationship is often adversarial. That tension costs case time, staff morale, and patient safety. A structural collaboration strategy fixes it.

Read More →
Lean Six Sigma

What Lean Six Sigma Actually Looks Like in a Perioperative Environment

A lot of healthcare leaders have heard of Lean Six Sigma but aren't sure what it looks like applied to real OR problems. Here's what it actually involves.

Read More →
View All Posts
Get In Touch

Ready to Improve Your OR?

Whether you're facing a specific FCOTS challenge, a preference card accuracy problem, a workforce staffing crisis, or want to build a stronger leadership structure — let's have a direct conversation about what's getting in the way.

Email terrinamckinnon@keystonehealthconsulting.com
Toll-Free 1-888-453-7967
Direct Line 360-872-0534

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