Transcript The Productive Operating Theatre

The Productive Operating Theatre
Building teams for safer care
Amanda Fegan
Lead Associate, NHS Institute
Hugh Rogers FRCS
Consultant Urologist
Senior Associate, NHS Institute
Film clip
Introduction to The Productive Operating Theatre
(From DVD in the TPOT foundation modules boxed set)
The perfect operating list
Getting started
• Visioning workshop
The perfect operating list
Effortless for everyone
Great team communication
Quiet & smooth
Fast but not rushed
No glitches
Safe, reliable care
......building teams for safer care
Staff select the issues they want to be resolved
The Productive Operating Theatre aim:
To improve 4 key dimensions of quality
Team performance &
leadership
Safety &
reliability of care
Patient’s
experience
& outcomes
Value
Development principles
Co-production with 3 hospitals
• Starting small
Combining strategies:
• staff empowerment
• lean thinking
• team working
Testing prototypes and measuring impact
© Copyright NHS Institute for Innovation and Improvement 2009
Programme Leader’s Guide
• Form the team
• Programme planning
• Running the visioning workshop
Executive leader’s guide
Gather data and run
trust board workshop
Role of executive lead
and steering group
Knowing How We Are Doing
Early efforts
Team-working & staff wellbeing
Patient experience & outcomes
Safety & reliability
Efficiency & value
More refined
Well organised theatre: 5S
Sort
Simplify/Set in order
Sweep & Shine
Standardise
Sustain
Typical before 5S
Anaesthetic store after 5S
Well organised theatre
Overstock in main store room (4 theatres) resulted in
financial reimbursement of £27,500
Out of date stock in main store room (twin suite) valued at
£9,385
Overstock in prep and anaesthetic rooms (2 theatres)
valued at £10,400
Potential financial benefit
for a twin theatre suite
to make a ‘one-off’ saving of £24,150
Operational Status at a Glance
Team-working
Who is the leader?
Pre-list team briefing
Problems avoided by
Team Brief
Week 4 - Sept 2009
Week 4 - June 2009
list order changed
list order changed
problem with, or no equipment
problem with, or no equipment
issue on ward causing delay
issue on ward causing delay
no junior doctor to assist
no junior doctor to assist
operation not listed correctly
operation not listed correctly
awaiting bloods
awaiting bloods
further investigation needed
further investigation needed
lack of staff
lack of staff
extra patient added to list
extra patient added to list
No extended recovery / HDU bed
No extended recovery / HDU bed
0
1
2
3
4
5
6
7
0
1
2
3
4
5
6
7
Impact on culture
(safety attitudes questionnaire)
Mean Score from SAQ before and after introduction of briefing and
debriefing
80
70
60
50
before
40
after
30
20
10
0
Team work
Climate
p<0.05
Safety
Climate
Job
Satisfaction
Perceptions
of
Management
Working
Conditions
Stress
Recognition
Briefing - Checklist - Debriefing
•
Briefing:
•
WHO surgical safety checklist
‘Sign in’
Time out (pre-op pause)
‘Sign out’
•
De-briefing
Local adaptation of time-out
Time out
Anaesthetist holds consent form and drug chart
Surgeon holds notes and id bracelet
Patient’s name and DOB
Name……….
What operation are you doing?
I’m doing a ……………
Are there potential problems?
Potential problems are ……..
Which side are you operating on?
I’m operating on the ……. side
DOB………..
Surgeon demonstrates side on PACS screen to anaesthetist
What antibiotic have you given?
I have given …………….
Has Heparin been given?
Heparin was given …………….
Are TED stockings on?
TED stockings are on
Key: surgeon text, anaesthetist text
Context: Patient stable on table, prior to surgical scrub
Debriefing
Hierarchy of interventions for efficiency
Session utilisation
7
number of sessions
6
4
22 unused,
cancelled
sessions
3
32 extra sessions
5
2
1
0
1
2
3
4
5
6
7
8
w eek
Over 8 weeks:
Cost of cancelled, unused
sessions £31,746
Cost of extra sessions
£81,664
Session Utilisation
100
Mean – 90%
98
96
94
92
Mean – 99%
90
88
Sep
Aug
Jul
Jun
May
Apr
Mar
Feb
Jan
Dec
Nov
Oct
Sep
Aug
Jul
Jun
May
Apr
86
08
8
09
Mar-
9
09
Sep-
Oc t- 0
9
09
Aug-
J ul-0
9
J un-0
May 09
Apr- 0
9
09
Feb-
9
8
J an-0
De c0
No v0
Oc t- 0
8
Sep-
Number of waiting list initiative sessions
12
10
8
6
4
2
0
Informed scheduling:
Variation in procedure time and turn-round time
Phaco-emulsification and intra-ocular lens insertion for cataract
Procedure time
Turn-round time
List utilisation
Start, turnaround and finish times
August 2008
June 2009
The ‘Perfect’ list ?
List end time
List start time
Only worthwhile if it stops overruns, or adds more patients
Summary of key events & milestones
Summary of benefits
Safety & team working
•
Recovery: pain scores < 6 to 88%, body temp temperature >35° to 98%
•
Measurable increase in job satisfaction, team working climate and safety climate
Consumables and equipment
•
£10K one off stock reduction per theatre
•
£9K annual saving per theatre on consumables
Session and list utilisation
•
Improved session utilisation from 90% to 99% with abolition of extra sessions
•
25 minute reduction in average start time, 63% reduction in average turnaround time
•
16% increase in touch time
Overall gain for an average trust (estimated)
•
approx £2 million per annum