Transforming Theatres - 1000 Lives Plus€¦ · Transforming Theatres Learning Objectives By the...

Transforming TheatresWell Organised Theatre (WOT)

&Operational Status At A Glance (OSAG)

Transforming TheatresWelcome Back

Paul Cottingham - [email protected]

Mike Fealey - [email protected]

mailto:[email protected]

mailto:[email protected]

Transforming TheatresProgress To Date

Powys HB

“Powys Operating Theatres aims to be an efficient, safe & patient centred environment, that provides the highest quality care for the local community”

Transforming TheatresUrology Theatres Vision

Achieving

Good communication

Our patients well being

Observation of care

Dedicated team

Delivery of well planned lists

Allowing a good experience for staff and patients

Yes to efficiency and value

Transforming Theatres

Well Organised Theatre (WOT)

Operational Status At A glance (OSAG)

2nd & 3rd Foundation Modules

TPOT

Transforming TheatresLearning Objectives

By the end of this session you will be able to:-

Understand And Apply The Model For Improvement & The PDSA Cycle

Learn Tools & Techniques For Improvement

Waste Spotting (8 Wastes)

5S – (Sort, Set, Shine, Standardise, Sustain)

Activity Mapping (Spaghetti Diagrams)

Operational Status At A glance (Visual Management)

Decide As A Team Which Areas You Are Going To Improve First


Model For Improvement

&The PDSA Cycle

Transforming TheatresModel For Improvement

WOT & OSAG

What are our aims in implementing this program

What data will we collect to understand how we are doing

Interventions or changes we make as part of the program

KHWD

Transforming TheatresThe PDSA Cycle

Plan:Choose an area or ProcessLearn how it look‟s and function‟s nowMeasure performance before changesReview things you have tried in the past

Do:Use 5S, Activity/Process Mapping, Visual Management, etc to make change

Study:Measure Improvements madeAssess layout, stock levels and usageCollect feedback from the teamEvaluate the results

Act:Abort – not working – start againAdopt -Standardise and Sustain

Bright

idea!

Improvement !!

Transforming TheatresPDSA – Area or Process Improvement

Examples:

Reduce Time Staff Spend In Stock Room

Flow Of Patient/Information

Transportation Of Patient To Theatre

Storage Of Surgical Sets

Interruptions In Theatre

Late Start / Early Finish

Staff Communication

Equipment Failure


Waste Spotting

Transforming TheatresWaste In A Service Context

Service waste can be defined as:

Process waste (Waiting etc..)

Information waste (Duplication)

Work waste (Out Of Date Items)

Human energy waste (Effort)

(Scottish Executive: Lean Masterclass)

Transforming TheatresWaste Spotting

Transportation

Unnecessary

Motion

Inappropriate

ProcessingMistakes

Uncoordinated

Activity

Stock

Waiting

Human

Resource

Bed requested and held

“just in case”

Over-stocked consumables

etc.

Re-work e.g. incomplete pay cards

touched twice each by ward,

payroll, post team

Preparing more than is

necessary

Unnecessary movement of

material or hand-offs of

information

Transforming TheatresDay Surgery Process Mapped

Patient

seen by

pre-op

nurse

Patient

waits

Patient

waits

Patient

arrives and

is admitted

Patient

discharged

X-rayPre-op

assess-

ment

Out-

patientsSurgeryGP Discharge

Etc. until finally…

X X


5S In The NHS

Transforming Theatres5S In The NHS

Sort/SiftSet

ShineStandardise

Sustain

5S is a method of standardising the work environment, so that issues are easily spotted. This means they can be controlled and corrected, before they become a major concern.

Consistent application and adherence of 5S principles leads to the concept of „Visual management‟


Cross out numbers in sequence from 1 – 49 with a diagonal line as illustrated – bottom left to top right

Do not turn over the sheet until instructed

Do not rotate sheet of paper

13start

end

= OK

13

13= Reject


Most often than not, items are kept in work areas or in stores that have been there for years, and are being kept just in case!

Sorting is about reviewing ALL items:

-Do we need them?-What are they used for?-How often will we use or need them?-When did we last use them?-Are they still valid? (In-date, relevant, latest level)

Cluttered, messy work areas are not just an eyesore, they also create waste: wasted time searching for specific items or materials, ineffective use of space, furthermore, in extreme cases, messy work areas can pose serious health and safety risks if left unattended.

• 1S – Sort/Sift


Once the initial area is cleared of irrelevant items which are not needed or even out-of-date, then we need to Set the area so that we can instil control.

Set is about:-Positioning items where they are needed-Visual Management -Communicating why things have been re-positioned (Shifts)-Make the locations easy to find and see

In a manufacturing environment, it is commonplace to mark locations of key items, to ensure that they remain there. This can also be practised in the NHS environment too, although it is important not to get carried away.

It is also good practice to clearly identify key items (uniform and clear labels for materials or medical equipment) and their location.

• 2S – Set


Once we have cleared the work areas of all irrelevant items and installed control, we can Clean the work area.

Shine is about:-Cleaning the area -Demonstrates Control -Is a form of Inspection (Autonomous Maintenance)-Helps create the right impression-Ensures we maintain our area(s) to a high standard

In a NHS environment, 5 minutes spent tidying and sorting the immediate work area at the end of the day can save hours in a week searching for materials or equipment.

• 3S – Shine


Once we have completed the first three S‟s we need to Standardise the area

Standardising is about:-Agreeing a Standard-Communicating the Standard (Shifts/Areas)-Documenting the Standard (Displaying)-Following the Standard.

Standards can be presented in many forms: Visual Aids Photos Worksheets

• 4S – Standardise


Once we have completed the 4S‟s we should have a well organised and Standardised area to be proud of. The hardest part is to maintain and improve the area so that it always looks in control and in a good condition.Sustaining is about:

-Using 5S as part of daily operations-Continuous Improvement (Improve Standards)-Auditing

• 5S – Sustain


Lean NHS Summary

Lean Tools can be just as effective in a NHS environment as they are in manufacturing.

5S in the NHS is used to instil workplace management and housekeeping disciplines in the hospital work areas. It helps remove piles of unwanted materials, stock and equipment, manages the numerous documents, or records found in hospitals and keeps the working areas neat, tidy and organised.


Before After


3 second rule

Transforming TheatresWOT – Visual Management

Transforming TheatresJade Theatres- Urology


Activity Mapping

(Spaghetti Mapping)

Transforming TheatresActivity Mapping

The Spaghetti Diagram is used to decide how to set out an area

There are a number of Simple Rules:

Fast moving items close to the door Heavy items stay close to the floor Slow moving items towards the back and, Lighter items go higher on the stack

Transforming TheatresActivity Mapping Exercise

Commodes are situated at the far end of the sluice room where commodes and other stock items are randomly places in the sluice.

How many steps in the process does it take to collect a commode for a patient on the ward returning it back to the sluice?


Oxygen

Gloves and ApronsCupboards Cupboards

Weig

hin

g

Sta

tion

Urinals

Bedpans

BinsClinimatic

Sink

Co

mm

od

es

Transforming TheatresO

xygen

Gloves and Aprons & Bedpans

Cupboard

sCupboard

s

Weighing

StationUrinals

BinsClinimatic Sink

Commodes & Bedpans

Shelf

Shelf

Transforming TheatresActivity Mapping – Case Study

Before

Transforming TheatresActivity Mapping – Case Study

After

Transforming TheatresActivity Mapping – Saving Effort

By reducing the number of steps from 40 to 16 (24 saved steps) and, if each step averaged 0.5 metre then the team saved:-

24 x 0.5 = 12 Metres each occasion (20 Metres before)

12 x 50 = 600 Metres saved per day

600 x 365 = 219,000 Metres per year

Which equates to 219 Km Unnecessary walking Saved !!

Transforming TheatresActivity Mapping – Saving Time

By reducing the number of steps from 40 to 16 and, by re-arranging the room, the team reduced the time taken to perform this task from 12 to 11 minutes.

Only a 1 minute saving – but !!!!

1 x 50 = 50 Minutes saved per day

50 x 365 = 18,250 Minutes saved per year

Which equates to 304 Hours Saved !!


1: Wipe handle 4: Remove lid

2: Wipe back plate 5: Wipe lid top

3: Wipe arms 6: Wipe lid bottom

7:New wipe 10: New wipe

8: Wipe seat top

9: Dispose of wipe

1

2

3

3

56

8


11: Wipe Legs

12: Tip up commode

13: Wipe frame 15:Wipe rack

14: Wipe underneath

11

14

13

15


Operational Status At A Glance

OSAG

Transforming TheatresOSAG – Visual Management

And The 3 Second Rule

Visual Management is used to

Communicate the status of an area or process

within 3 seconds

It ensures any communication process is very

clear and simple

Aims: To make the most frequently used information clearly accessible so that it can be understood in

Three Seconds



Based on your daily operational experiences - What information do you think is essential to helping the smooth running of your theatres.

Discuss on your table

Write down your ideas

Feedback

Top ideas from each table.

Transforming TheatresTPOT

Toolkit & Specific Process Modules – Valuable Resource !


Summary

A Photographic Look At Your Theatres


What Area Do You

Want To Improve First ?


Building on your Vision, and data from your Knowing How We Are Doing board, and based on your daily operational experiences - which area‟s do you think require immediate improvement

Discuss on your tableWrite down your ideas

FeedbackTop ideas from each table.


Next Steps:

Improve an Agreed Area !

Fortnightly NLIAH &

Program Support Visits!

Transforming Theatres - 1000 Lives Plus€¦ · Transforming Theatres Learning Objectives By the...

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