Royal College of Surgeons in Ireland [email protected] Unscheduled patients: the introduction of a structured booking form to enhance workflow patterns from point of booking until transition to the operating theatre. AUTHOR(S) Bernadette Kilmartin CITATION Kilmartin, Bernadette (2014): Unscheduled patients: the introduction of a structured booking form to enhance workflow patterns from point of booking until transition to the operating theatre.. Royal College of Surgeons in Ireland. Thesis. https://doi.org/10.25419/rcsi.10812062.v1 DOI 10.25419/rcsi.10812062.v1 LICENCE CC BY-NC-SA 3.0 This work is made available under the above open licence by RCSI and has been printed from https://repository.rcsi.com. For more information please contact [email protected] URL https://repository.rcsi.com/articles/thesis/Unscheduled_patients_the_introduction_of_a_structured_booking_for m_to_enhance_workflow_patterns_from_point_of_booking_until_transition_to_the_operating_theatre_/108120 62/1 Semester 3/4: Dissertation MSc in Healthcare Management 2012/2014 Unscheduled patients: the introduction of a structured booking form to enhance workflow patterns from point of booking until transition to the operating theatre. A dissertation submitted in part fulfillment of the degree of MSc in Healthcare Management Institute of Leadership, Royal College of Surgeons in Ireland, Dublin Word count: 14,751 Date: 14/05/2014 Student number: 12141330 Declaration RCSI Reservoir House, Ballymoss Road, Sandyford, Dublin 18, Ireland. “I hereby certify that this material, which I now submit for assessment for part fulfillment of MSc Healthcare Management is entirely my own and has not been submitted for assessment at any other university.” Student’s Signature: Date: 14/05/2014 Student’s Number: 12141330 2 Table of Contents Abstract .................................................................................................................................................. 6 Acknowledgements .............................................................................................................................. 7 Section 1: Introduction to the Dissertation ........................................................................................ 8 1.1 Overview ..................................................................................................................................... 8 1.2 Nature of the change ................................................................................................................. 9 1.3 Scope of project ....................................................................................................................... 10 1.3.1 Inclusion criteria ................................................................................................................ 10 1.3.2 Exclusion criteria ............................................................................................................... 10 1.4 Rationale for carrying out the project .................................................................................... 11 1.5 Context of the change (Climate/Culture) .............................................................................. 12 1.6 Aim and objectives .................................................................................................................. 13 1.6.1 Aim ...................................................................................................................................... 13 1.6.2 Objectives .......................................................................................................................... 13 1.7 Change concept diagram ....................................................................................................... 14 1.8 Conclusion ................................................................................................................................ 14 Section 2: Literature Review ............................................................................................................. 16 2.1 Introduction ............................................................................................................................... 16 2.1.1 Search Strategy ................................................................................................................ 17 2.2 Health Services under Pressure............................................................................................ 17 2.3 The Productive Operating Theatre........................................................................................ 19 2.4 Challenges within the surgical arena .................................................................................... 20 2.5 Conclusion ................................................................................................................................ 23 Section 3: Change Process .............................................................................................................. 26 3.1 Introduction ............................................................................................................................... 26 3.2 The concept of change ........................................................................................................... 26 3.3 The current workplace climate ............................................................................................... 27 3.4 Choice of change model for this project ............................................................................... 28 3.5. The Change Process ............................................................................................................. 29 3.5.1 Overview ............................................................................................................................ 29 3.5.2 Create an Urgency for Change ...................................................................................... 30 3.5.3 Create a Guiding Coalition .............................................................................................. 32 3.5.4 Create a Powerful Vision and Communicate that Vision ........................................... 34 3.5.5 Empowering others to act on the vision ........................................................................ 36 3 3.5.6 Creating Short Term Wins and Consolidating Improvements ................................... 37 3.5.7 Institutionalising new Approaches ................................................................................. 39 3.6 Conclusion ................................................................................................................................ 40 Section 4: Evaluation ......................................................................................................................... 43 4.1 Introduction ............................................................................................................................... 43 4.2 Healthcare evaluations; what can be evaluated? ............................................................... 43 4.3 Why carry out an evaluation? ................................................................................................ 44 4.4 Choice of model/framework for evaluation .......................................................................... 45 4.5 Scheduling Process ................................................................................................................. 46 4.5.1 Sources of Delay .............................................................................................................. 46 4.5.2 Workload within the theatre department ....................................................................... 47 4.5.3 Procedure completed within core hours ....................................................................... 48 4.5.4 Workflow mapping ............................................................................................................ 51 4.6 Introduction of the booking form ............................................................................................ 53 4.6.1 Compliance with use of the booking form..................................................................... 53 4.6.2 Compliance with completion of booking form .............................................................. 53 4.6.3 Workflow mapping post introduction of booking form ................................................. 55 4.6.4 Time demands to book an unscheduled patient .......................................................... 58 4.6.5 Potential monetary savings under TPOT provisions ................................................... 60 4.7 Reflections on key learning on leadership and organisational development through evaluation ........................................................................................................................................ 62 4.8 Conclusion ................................................................................................................................ 63 Section 5: Discussion ........................................................................................................................ 65 5.1 Introduction ............................................................................................................................... 65 5.2 Impact of the change on the organisation ............................................................................ 66 5.3 Strengths and limitations .......................................................................................................