The Productive Operating Theatre Programme

An enabler for productivity, safety and performance improvements in Operating Theatres.

Joe McDonaldSenior AdvisorClinical Improvement and ProductivitySector Capability and Innovation DirectorateMinistry of Health

How The Productive Operating Theatre has been developed

Understand the real issues and challenges.

Identified co-production partners in the NHS and from industry

Observing and enquiring in other high risk, lean organisationsTerminal 5, Unipart –logisticsOther healthcare settings, USA

Generated and tested lots of ideas with the field test sites

Test the idea in another environment / team with the Associate sites.Failure was learning

Consolidate the learning, consider delivery mechanisms, marketing, launch

Internal/external peer review. Frequent learning sets. Continual understand and reflect.

Ongoing ROI and benefits realisation capture

Launch in Sept 2009, followed by regional start-up events for NHS England

Since April 2010 initiated 10 cohorts of training and implementation support to 90 of 174 acute trusts in NHS England.Delivered Master Training internationally in Wales , Scotland, and Northern Ireland and New Zealand. Coming to Australia, Canada and South Africa soon!

UK compared to NZ Operating Theatres

  UK NZ

Trusts/DHBs 174 trusts 21 DHBs

Operating Theatres numbers

2,871 203

Average theatres perTrust/DHB

16.5 9.6

Running costs for an Operating Theatreper hour

£ 1,200 ($2,601)

$ 1,6802008/09

What is The Productive Operating Theatre?

•Modular improvement programme for theatre teams

•Systematic way to deliver significant improvements

•A proven method of enabling frontline teams to transform the way they work

•Concentrates on the HOW not the WHAT

•Vehicle to deliver organisational objectives

The modules

Programme timelinekey events and milestones

The Productive Operating Theatre aim:To improve 4 key dimensions of quality

The perfect operating list?

Effortless for everyone

Great team communication

Quiet & smooth

Fast but not rushed

No glitches

Safe, reliable care

Communications

Training

Staff Skill mix

Equipment

Attitudes/behaviours

List Scheduling/utilisation

Start/Finish Times

Patient Prep

Programme focus areas: Team working MDT Scheduling Session start up Patient preparation Patient Turnaround Handover Consumables and equipment Recovery (PACU)

Critical success factors

Leadership at Executive level Alignment with strategic direction Governance of the programme Continuous improvement / measurement Capability and knowledge Local expert with time allocated Clinical engagement

Benefits achieved in UK and potential opportunities for NZ Increase in the proportion of patients in recovery with a

pain scores < 6 from 73% to 88%. Increase in the percentage of patients with temperature on

arrival in recovery above 35.4°from 91% to 98%. Reduction in patient safety incidents and complications

through improved team working and communication. Statistically significant increase in job satisfaction, team

working and safety climate 63% reduction in average turnaround time. Start time delays reduced by average of 25 minute. 16% increase in touch time. Minimum £5K stock reduction per theatre. Minimum £9K recurring saving per theatre on theatre

consumables per year.

Value and efficiency – benefit estimates (per annum) UK

  Per theatre Per DGH

Reduced cancellations £ 23k £ 388k

Improved utilisation & reduced over-runs

£ 120k £1,980k

Avoiding cost of defects £ 30.5k £503k

Materials management  £6k+£6k one-off

£100k+£100k one-off

Total £179.5+£6k one-off

£2,971k+£100k one-off

174 trusts in the NHSTotal of 2,871 operating theatres, Average 16.5 theatres per trust

Efficiency: the financial ‘engine room’

Theatres cost approximately £1000 – 1200 per hour

(excluding medical personnel)

Unstaffed hoursstill generate capital and

estate costs

Theatres represent 25-50% of most hospitals

income generation

Most theatres have had many Improvement Projects often with

limited sustainable effect

Impact on culture (safety attitudes questionnaire)

Mean Score from SAQ before and after introduction of briefing and debriefing

0

10

20

30

40

50

60

70

80

Team workClimate

SafetyClimate

JobSatisfaction

Perceptionsof

Management

WorkingConditions

StressRecognition

before

after

p<0.05

Team-working

Team-working

Session utilisation

0

1

2

3

4

5

6

7

1 2 3 4 5 6 7 8

week

nu

mb

er o

f se

ssio

ns 22 unused,

cancelledsessions

32 extra sessions

Over 8 weeks:

Cost of unused sessions £105,600

Cost of extra sessions >£153,600

Potential saving over 1 year >£660,000

86

88

90

92

94

96

98

100

Apr

May Ju

n

Jul

Aug

Sep Oct

Nov

Dec Ja

n

Feb

Mar

Apr

May Ju

n

Jul

Aug

Sep

Session Utilisation

Mean – 90%

Mean – 98%

Scheduling

0

2

4

6

8

10

12

Sep

-08

Oct

-08

No

v-0

8

De

c-0

8

Jan-

09

Feb

-09

Mar

-09

Apr

-09

May

-09

Jun-

09

Jul-0

9

Aug

-09

Sep

-09

Oct

-09

Number of waiting list initiative sessionsOver 8 weeks:

Cost of unused sessions £31,746

Cost of extra sessions £81,664

Potential saving in 1 year £510,400

Improved session start times

Patient safetyUltra-safe(<1/100K)Regulated

Hazardous(>1/1000)

Ultra-safe(<1/100K)Regulated

Hazardous(>1/1000)

Number of encounters for each fatality

To

tal

live

s l

os

t p

er

ye

ar

1

10

100

1,000

10,000

100,000

1 10 100 1,000 10,000 100,000 1million 10million

Health Care

Mountain Climbing

Bungee Jumping

Driving

Chemical Manufacturing

Chartered Flights

Scheduled Airlines

European Railroads

Nuclear Power

40 % admissions experience error in

care

4 % harmed0.8-1%

die from errors

AN

AE

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RG

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URSES

MA

NA

GE

RS

EX

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‘Culture eats strategy for breakfast’

Tribal non-alignment

Whole system benefits

These improvements may be further enhanced through improvements in benefits that are less easy to quantify financially, in particular, reducing errors or complications (reduced length of stay, reduced drug expenditure, reduced admissions to ICU).

Programme to date: Application and selection process (June 2010) Review panel selected 8 DHBs Review panel selected a DHB clinical expert

group, to lead and train the programme in NZ Training delivered by NHSI experts (Aug 2010) DHBs involved: Waitemata, Auckland, Tairawhiti,

Bay of Plenty, Hawkes Bay, Whanganui, Hutt Valley and Southern.

Next steps: Process will begin again in 2011 for next adopting DHBs and NZ training will be delivered by NZ clinical expert group.

“Since introducing TPOT there has been a

noticeable change in culture …staff are

clearly empowered to make changes”

Consultant Surgeon

Staff feedback from UK

“The team brief gives people a

voice. Patient care improves, errors

go down and morale goes up”

Consultant Surgeon

“Since TPOT everyone uses the data to evidence

problems and measure

improvements”

Programme Lead

“Well organised theatre has improved the organisation of stores and equipment which has had a direct

impact on theatre efficiency”

Theatre Practitioner

“TPOT improves communication between theatre

staff and clinicians”

Theatre Sister

“Debrief is a terrific opportunity to give credit where it’s due and let people know they’ve done well. At the same time it’s

an ideal opportunity to see where lessons need to be learned”

Consultant Surgeon

Any Questions?

Contact information:Joe McDonaldPh: 04 8162571email: Joseph_McDonald@moh.govt.nz

www.hiirc.org.nz

THANK YOU!