Theatre Improvement & Lean

1. Theatre Improvement& Lean Sharon Westmorland

2. Lean & Value Added • Lean is about identifying processes that Add Value and causing them to FLOW without interruption.

3. KAIZEN A Rapid Improvement Event

4. Admissions Team • Improve 1st Patient in anaesthetic room time from 09:15 to 08:45 • To reduce patient waiting time between admission and procedure start (current average 3 hours 29 minutes) – staggered admissions • Change Over Team • Reduce average procedure to procedure change over time from 42 minutes to 30 minutes • Recovery Team • Reduce average patient transfer to ward delay from 30 minutes • Minimise extended patient lengths of stay in recovery (current average 20 minutes) • Performance and Planning Team • To maximise list utilisation through effective use of facts and data • To promote ways of working and visual controls that drive performance improvement • Environment Team • Provide an environment that supports efficient and effective running • To rationalise number of prostheses used across NHS-L Orthopaedics

5. Where are we now? Admissions team: we did have the patient into the AR for 08.45 initially, but the institution of the surgical brief and pause has meant we have had to relax this target to 09.00 but we are actually achieving 08.55 on average Staggered admissions: only a handful of surgeons have not adhered to this but this is work in progress

6. Where are we now? Change over team: we now have consistently low average T-A-T of 12 minutes. Recovery team: we have reduced the delayed discharge from 30 mins to 5 mins (target was 11 mins) Still have issues with the length of stay due to bed flow

7. Where are we now? Performance and planning: metrics, daily theatre utilisation board, weekly performance graphs, TOGs, monthly NTIG figures. Environment team: storage, prep area, rationalisation of prostheses

8. What next?

9. Spread Look at utilisation in other specialities ENT – concerns around cancellations, turn-around times (surgeons opinion) and under-runs Gyn – surgeons complained of our T-A-Ts General surgery – concerns about over-runs, same day cancellations, under-runs

10. ENT PDSA - first • Turn-around times - 13% of total available time. Average 16, 12 & 7 minutes. • DNAs – 15% of booked patients do not turn up on the day surgery • Under-runs – 27% of total time available unused, average 72, 53, 48 mins • Over-runs – 1% of total time available.

11. Using The Findings Share utilisation figures with service manager & surgeons Discussed at divisional meeting Clinical Service Improvement Groups Pro-active booking Schedule management Increase use of DSU in Monklands DSU Patients contacted 2 days prior to confirm admission

12. ENT PDSA – re-visit Turn-around times - average between 11, 12 or 8 minutes DNAs – 3%, 0%, 1.5% Under-runs – 49, 15, 27 minutes under-run average. (23%, 12%, 17% of available time under-run) Over-runs – 0%, 4% 11% over-runs of total available time.

13. Gynaecology PDSA The average turn around times for the Social Gynaecology list are only 5-8 minutes. This list usually has an extra member of staff to assist quick TA times. The average TA time for the other elective lists in gynaecology was 23 minutes. Revisited after staff education and Lean awareness training, the TA times are now 12 minutes; this has been sustained over the last year

14. Gynaecology

15. % cases cancelled

16. General Surgery PDSA Concerns about under-runs, over-runs and the number of short notice cancellations

17. Under-runs by surgeons

18. Planned vs done: general surgeons

19. Over-run by Surgeons

20. Under-runs by Ortho Surgeons

21. Planned vs cancelled cases – ortho 2009

22. Over-runs by Ortho Surgeons

23. The Future Continue analysing and reporting all activity for all surgeons Visual Management Tie in with SPSP

24. Daily Bed Meeting • Weekly T.O.G • Clinical Lead • Lean Champion • Visual management in key areas