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The Productive Operating Theatre Programme
An enabler for productivity, safety and performance improvements in Operating Theatres.
Joe McDonaldSenior AdvisorClinical Improvement and ProductivitySector Capability and Innovation DirectorateMinistry of Health
How The Productive Operating Theatre has been developed
Understand the real issues and challenges.
Identified co-production partners in the NHS and from industry
Observing and enquiring in other high risk, lean organisationsTerminal 5, Unipart –logisticsOther healthcare settings, USA
Generated and tested lots of ideas with the field test sites
Test the idea in another environment / team with the Associate sites.Failure was learning
Consolidate the learning, consider delivery mechanisms, marketing, launch
Internal/external peer review. Frequent learning sets. Continual understand and reflect.
Ongoing ROI and benefits realisation capture
Launch in Sept 2009, followed by regional start-up events for NHS England
Since April 2010 initiated 10 cohorts of training and implementation support to 90 of 174 acute trusts in NHS England.Delivered Master Training internationally in Wales , Scotland, and Northern Ireland and New Zealand. Coming to Australia, Canada and South Africa soon!
UK compared to NZ Operating Theatres
UK NZ
Trusts/DHBs 174 trusts 21 DHBs
Operating Theatres numbers
2,871 203
Average theatres perTrust/DHB
16.5 9.6
Running costs for an Operating Theatreper hour
£ 1,200 ($2,601)
$ 1,6802008/09
What is The Productive Operating Theatre?
•Modular improvement programme for theatre teams
•Systematic way to deliver significant improvements
•A proven method of enabling frontline teams to transform the way they work
•Concentrates on the HOW not the WHAT
•Vehicle to deliver organisational objectives
The modules
Programme timelinekey events and milestones
The Productive Operating Theatre aim:To improve 4 key dimensions of quality
The perfect operating list?
Effortless for everyone
Great team communication
Quiet & smooth
Fast but not rushed
No glitches
Safe, reliable care
Communications
Training
Staff Skill mix
Equipment
Attitudes/behaviours
List Scheduling/utilisation
Start/Finish Times
Patient Prep
Programme focus areas: Team working MDT Scheduling Session start up Patient preparation Patient Turnaround Handover Consumables and equipment Recovery (PACU)
Critical success factors
Leadership at Executive level Alignment with strategic direction Governance of the programme Continuous improvement / measurement Capability and knowledge Local expert with time allocated Clinical engagement
Benefits achieved in UK and potential opportunities for NZ Increase in the proportion of patients in recovery with a
pain scores < 6 from 73% to 88%. Increase in the percentage of patients with temperature on
arrival in recovery above 35.4°from 91% to 98%. Reduction in patient safety incidents and complications
through improved team working and communication. Statistically significant increase in job satisfaction, team
working and safety climate 63% reduction in average turnaround time. Start time delays reduced by average of 25 minute. 16% increase in touch time. Minimum £5K stock reduction per theatre. Minimum £9K recurring saving per theatre on theatre
consumables per year.
Value and efficiency – benefit estimates (per annum) UK
Per theatre Per DGH
Reduced cancellations £ 23k £ 388k
Improved utilisation & reduced over-runs
£ 120k £1,980k
Avoiding cost of defects £ 30.5k £503k
Materials management £6k+£6k one-off
£100k+£100k one-off
Total £179.5+£6k one-off
£2,971k+£100k one-off
174 trusts in the NHSTotal of 2,871 operating theatres, Average 16.5 theatres per trust
Efficiency: the financial ‘engine room’
Theatres cost approximately £1000 – 1200 per hour
(excluding medical personnel)
Unstaffed hoursstill generate capital and
estate costs
Theatres represent 25-50% of most hospitals
income generation
Most theatres have had many Improvement Projects often with
limited sustainable effect
Impact on culture (safety attitudes questionnaire)
Mean Score from SAQ before and after introduction of briefing and debriefing
0
10
20
30
40
50
60
70
80
Team workClimate
SafetyClimate
JobSatisfaction
Perceptionsof
Management
WorkingConditions
StressRecognition
before
after
p<0.05
Team-working
Team-working
Session utilisation
0
1
2
3
4
5
6
7
1 2 3 4 5 6 7 8
week
nu
mb
er o
f se
ssio
ns 22 unused,
cancelledsessions
32 extra sessions
Over 8 weeks:
Cost of unused sessions £105,600
Cost of extra sessions >£153,600
Potential saving over 1 year >£660,000
86
88
90
92
94
96
98
100
Apr
May Ju
n
Jul
Aug
Sep Oct
Nov
Dec Ja
n
Feb
Mar
Apr
May Ju
n
Jul
Aug
Sep
Session Utilisation
Mean – 90%
Mean – 98%
Scheduling
0
2
4
6
8
10
12
Sep
-08
Oct
-08
No
v-0
8
De
c-0
8
Jan-
09
Feb
-09
Mar
-09
Apr
-09
May
-09
Jun-
09
Jul-0
9
Aug
-09
Sep
-09
Oct
-09
Number of waiting list initiative sessionsOver 8 weeks:
Cost of unused sessions £31,746
Cost of extra sessions £81,664
Potential saving in 1 year £510,400
Improved session start times
Patient safetyUltra-safe(<1/100K)Regulated
Hazardous(>1/1000)
Ultra-safe(<1/100K)Regulated
Hazardous(>1/1000)
Number of encounters for each fatality
To
tal
live
s l
os
t p
er
ye
ar
1
10
100
1,000
10,000
100,000
1 10 100 1,000 10,000 100,000 1million 10million
Health Care
Mountain Climbing
Bungee Jumping
Driving
Chemical Manufacturing
Chartered Flights
Scheduled Airlines
European Railroads
Nuclear Power
40 % admissions experience error in
care
4 % harmed0.8-1%
die from errors
AN
AE
ST
HE
TI
ST
S
SU
RG
EO
NS N
URSES
MA
NA
GE
RS
EX
EC
s
PO
RT
ER
S
OD
PS
/T
EC
Hs
‘Culture eats strategy for breakfast’
Tribal non-alignment
Whole system benefits
These improvements may be further enhanced through improvements in benefits that are less easy to quantify financially, in particular, reducing errors or complications (reduced length of stay, reduced drug expenditure, reduced admissions to ICU).
Programme to date: Application and selection process (June 2010) Review panel selected 8 DHBs Review panel selected a DHB clinical expert
group, to lead and train the programme in NZ Training delivered by NHSI experts (Aug 2010) DHBs involved: Waitemata, Auckland, Tairawhiti,
Bay of Plenty, Hawkes Bay, Whanganui, Hutt Valley and Southern.
Next steps: Process will begin again in 2011 for next adopting DHBs and NZ training will be delivered by NZ clinical expert group.
“Since introducing TPOT there has been a
noticeable change in culture …staff are
clearly empowered to make changes”
Consultant Surgeon
Staff feedback from UK
“The team brief gives people a
voice. Patient care improves, errors
go down and morale goes up”
Consultant Surgeon
“Since TPOT everyone uses the data to evidence
problems and measure
improvements”
Programme Lead
“Well organised theatre has improved the organisation of stores and equipment which has had a direct
impact on theatre efficiency”
Theatre Practitioner
“TPOT improves communication between theatre
staff and clinicians”
Theatre Sister
“Debrief is a terrific opportunity to give credit where it’s due and let people know they’ve done well. At the same time it’s
an ideal opportunity to see where lessons need to be learned”
Consultant Surgeon
Any Questions?
Contact information:Joe McDonaldPh: 04 8162571email: [email protected]
www.hiirc.org.nz
THANK YOU!