Theatres Capability Rapid Improvement Event Sponsor: Director of Change Sensei: A Leader 1 2 3 4 5 6 7 8 9 Team Members: Hattie Jacques, Sid James, Charles Hawtrey, Bernard Bresslaw, Kenneth Connor, Date Initiated: 25th Sept ‘09 Kenneth Williams, Joan Sims, Barbara Windsor, Jim Dale Event Date: 12 to 16 Oct ‘09 Facilitator: A Helper Process Owner: Dr A Medic End Date: Mar 09 Urgery Go No Go 7. Completion/Implementation Plan Go No Go 1. Reason for Action Go No Go 4. Gap Analysis The Cause of the Problems creating gaps between initial & target state in themes A, B, C & D PATHWAY THEME Types of What Who Start Date Completion Date RAG There is a need to find the capacity in the Day Surgery Change Units to accommodate patients who are being allocated Theatres Capability should consider the following: A. Late Starts/Early Finishes B. Equipment failures Projects Investigate the possibility of new operating trolleys – arrange Sid James 15 Oct ’09 Loan trolleys to be in Done ‘in patient’ beds at St Eleswhere’s who should be day for loan trolleys to evaluate. use by end Oct ’09 A Delivery 8. Personal preference leads to many types of case. Sessions often do not start on time and sometimes finish early 1. Personal disorganisation/attitude Evaluate the trial of operating trolleys and make a case Sid James and Hattie Jaques 13 Nov ’09 7 Dec ‘09 2. Inappropriate timetable equipment for a variety of reasons. Cancelled operating sessions are not Investigate whether staff banding is appropriate Charles Hawtrey 19 Oct ’09 20 Nov ’09 There is the potential to increase utilisation of Day often picked up by other surgeons or specialties 3. Poor organisation/communication in DSU 9. Lack of funding for new equipment 4. Non compliance with schedule/no 10. Slow roll out of procurement leads to vast Investigate whether it is possible to employ short term Charles Hawtrey 15 Oct ’09 20 Nov ’09 Done surgery theatres at St Eleswhere’s Trust using the St array of equipment contract staff rather than bank staff to cover maternity leave. Eleswhere site more efficiently. The Trust wants to B Quality consequence 5. Skill mix (level of experience) 3. Poor organisation/communication in DSU Carry out inventory of equipment Sid James and Hattie Jaques 13 Oct ’09 7 Dec ’09 increase dedicated day case lists by creating more Day surgery theatres (equipment and processes) need to be Done fit for purpose. Staff should be punctual and instruments need 6. Lack of training (procedures) 11. No clear procedure for dealing with efficient and smarter processes. Some of the issues to be available, in good working order and staff with the 7. No consequence of not filling broken/incomplete equipment Redesign medical devices competencies Charles Hawtry and Sid James 13 Oct ’09 Feb ‘10 In progress which are preventing the optimisation of this activity are: appropriate level of training, knowledge and skills need to be schedule/lists 12. Quality control in place when required to fulfill their role successfully in 13. Inadequate organisation (cross site) Carry out inventory of instruments (including amnesty) Barbara Windsor Oct ’09 Feb ’10 theatre. 14. Lack of funding for multi site •Late starts Canvass staff and put together a new mock up rota/rotation. Jim Dale and Joan Sims 13 Oct ’09 New rota in use. Done •Early finishes C Cost / Throughput DS Theatres not Trial to be agreed with Matron th fully/effectively Do Its Design and implement a “delay book” Kenneth Williams 13 Oct ’09 Book in use on DSU •Cancellations of lists Theatre utilization is currently running at 67% (between 7 D. Staff Experience Done •Patient cancellations and DNAs on the day September – 25th September ‘09) where the optimum level C. Theatre Utilisation utilised E-mail surgeons/anaesthetists to inform them of pre-list Kenneth Williams 13 Oct ’09 E-mail sent 15 Oct Done •Issues with instruments and equipments should be 85% based on the national standard (Top Ten High briefings ’09 Impact Changes); patient cancellations & DNAs on the day 15. Inadequate overarching list control 20. Policy/Job description •The need to enhance staff training. Standardise instrument sets Kenneth Connor 13 Oct ’09 1 Dec ’09 Done also need to be reduced 16. No central booking process 21. Employment expectations 17. Inaccurate contact details 22. Lack of standardisation of equipment (many Design book to record broken/missing instruments. Bernard Bresslaw 19 Oct ’09 Book in use on DSU. Done The Trust is also keen to improve turn around times Weekly meeting with CSSD to review. Weekly meeting D Human Dimensions 18. Too many people involved in booking types) between cases which will boost the flow of patients arranged. The Department wants to ensure that there is the correct level 19. Complex booking system (too many 23. Large number of specialties (= many types through the day surgery unit and shorten the waiting of staff with the correct level of skills in the right place at the of equipment Follow up lack of buy in from Surgeons for pre-list briefings Charles Hawtry and Sid James ASAP unknown * right time to optimize the flow through the day surgery unit systems) times for patients going to theatre. 7. No consequence of not filling schedule/list 24. Competition with other Trusts (pay/banding) Picture board of DSU staff to be displayed Sid James and Hattie Jaques 19 Oct ’09 End Nov ’09 Reflections Reflections: * To be addressed at Theatres Management Event Go No Go 8. Confirmed State Monitor and track results against the measures defined in target state. Go No Go Initial State Go No Go 5. Solution Approach Theatres sessions often start late There are many issue caused by A Delivery B Quality A Delivery B Quality November 09 to February 10 no cancellations on and finish early equipment failure Cause Solution Idea Affects Current State Future State Ease/ the day due to missing/broken instruments Late Starts Themes Cost Equipment Failure Late Starts 16/11/2009 - 20/12/2009 73 of 89 sessions which ran started late There was 1 instance where equipment failed 35 1,3,4 08.45 and 13.15 Pre-list brief and A, C 82% late starts 28% late starts ∆ O 20 Delay Book (to record reasons for delay) 140 30 Started on Time 83% of Started Late 15 Incident 120 25 lists occurred 2,7,15 Part of Theatre Planning Event A, C ∆ O 100 started 20 10 late 67% theatre utilisation 85% theatre 80 15 No issue 7 Enforce number on list A, C ∆ O utilisation 5 60 10 Started on 40 Time 5 0 16,15,17,18 Part of Booking Hub Event A, C, D TBD 20 Started 0 Stack Broken Missing Correct Late ,19, Late General Ortho Urology Eyes Gynae ENT Oral System Instruments Instruments Instruments Instruments 9,10,14,231 More funding for equipment/instruments A,D X X 0 3 Theatre sessions are not utilised C Cost D Human The staff experience could be improved 8,13,23 Inventory of equipment, standardised sets B,D 64% confident with 80% confident with O/∆ O C Cost D Human Dimension properly Average and competency document equipment equipment utilisation = Staff Survey 23 Standardisation of procedures for specialities D, a 64% confident with 80% confident with X O Daily Theatre Utilisation Daily Theatre Utilisation 67% Maximum score for each question 110 points equipment, 56% equipment, 80% Daily Ut. Target Daily Ut. Target Average 100% 110 adequately trained adequately trained Staff Survey 100 85 utilisation = 90% 79 90 71 80% 80 62 68% 70% 70 59 4,5,6,21,22 Roster (rotation)/correct staffing/skill mix A,b,C,D ∆ O 100% 95% 100% 93% 60% 60 90% 90% 84% 85% 50% 50 80% 40% 40 30 11,12 Broken/missing instrument book and training B, D, a 1 0 O O 70% 80% 30% 20 20% 10 for DSU staff 22 Oct 60% 10% 0 50% 60% 0% 40% Confident Adequately Sessions Felt Able to 24,20 Revisit job descriptions/bandings D ∆ ? 30% 40% with trained are supported train 20% 10% 20% 08/09/2009 09/09/2009 10/09/2009 11/09/2009 14/09/2009 15/09/2009 16/09/2009 17/09/2009 18/09/2009 21/09/2009 22/09/2009 23/09/2009 24/09/2009 25/09/2009 07/09/2009 equipment smooth Key 0 Easy/Low Cost ∆ Not so easy/ medium cost X Difficult/expensive 0% 0% Reflections: Confident with Adequately trained Sessions are Felt supported Able to train Reflections: Equipment smoot h 30/11/2009 01/12/2009 02/12/2009 03/12/2009 04/12/2009 07/11/2009 08/11/2009 09/11/2009 10/11/2009 11/11/2009 14/11/2009 15/11/2009 16/11/2009 17/11/2009 18/11/2009 6. Rapid Experiments Go No Go Target State Go No Go Reflections: There are many issue caused by A Delivery Theatres sessions often start late B Quality Experiment Anticipated Effect Actual Effect Follow up Action and finish early equipment failure 9. Insights Go No Go Late Starts Equipment Failure Trolley Trial Lessen manual handling Reduced manpower Reduce late starts from 82% to 28% There should be no instances where equipment fails 35 necessary to move patient 20 Lessen manpower 30 Started on Time necessary to move What Helped / Went Well ? Started Late 15 Incident What Hindered / Did Not Go Well ? 25 occurred patient 20 10 1. Presence of consultant 15 No issue 1. Staff not being able to participate in all 4 5 10 2.