Are you too busy to improve? Lean improvement of Nurse Scheduling in the

Operating Theatre

Presentation PICA center

Kjeld Aij

ICT

ICT

Declining healthcare: value (=Q/€)

ICT

Bron: Amalberti, René, et al. "Five system barriers to achieving ultrasafe health care." Annals of internal medicine 142.9 (2005): 756-764.

Average rate per exposure of catastrophes and associated deaths in

various industries and human activities.

Research Article

A focus on Throughput: Lean Improvement of Nurse Scheduling in the

Operating Theatre

Kjeld Harald Aij, Frederique Elisabeth Simons, Merel Visse & Guy A.M.

Widdershoven

12-03-20 makigami current situation

Reasons for Research

Lean is…

Continuously improving, every day,

by everyone, everywhere,

for the patient

Solution? LEAN

Lean is designed to improve the efficiency of processes by eliminating

unnecessary activities in terms of variation, overload and waste

VSM Value adding activities

Non value adding activities

Makigami:

Type of Value Stream Mapping, especially designed for mapping

processes in complex environments

How to Improve the OR Nurse Scheduling?

Multidisciplinary team of 9 healthcare professionals

Makigami process:

1. Current state

2. Setting the ideal state

3. Fishbone analysis

4. Actions

5. Mapping the revised process

1. Current state

3 sessions: total of 8 hours

Also: daily problems were monitored (direct observations over 7 days,

spread out over 2 months)

2. Setting the ideal state

The right people

At the right time

At the right place

First time right planning

No wastes

Patient safety and employee satisfaction

3. Fishbone analysis: identify root causes

4. Actions

5. Revised process

Discussion

Results indicate that Makigami can assist in optimizing OR

nurse scheduling and help to identify waste and indicate

relevant improvements.

Application of this method was found to reduce outcome errors by

90% and waste in the process by 41%.

The Makigami tool also taught the team members the importance

of a multidisciplinary approach.

Challenges and limitations

Challenges

The demand for information and requirements varied

between the OR nurses in charge of nurse scheduling

It is a challenge to involve the different stakeholders in the

process

OR environment is less standardized than that of an

automobile factory

Limitations

One specific clinical process; problem of representativeness

Processes studied may not be applicable to smaller units

Observations do not have statistical support

Future research

Studies looking at different processes

Examine other OR personnel as well

(anaesthetists and recovery nurses)

Develop quality- and patient-oriented

scheduling solutions that offer new

opportunities for research on system

design for OT scheduling

Conclusion of this study

The Lean method (Makigami) is effective as a means of reducing

waste and for standardizing processes in OR nurse scheduling

Wrap up

Time for questions

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