Effective Operating Room First Start and Turnover Time Management Using Lean and Six Sigma Performance Improvement Processes

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Effective Operating Room First Start and Turnover
Time Management Using Lean and Six Sigma
Performance Improvement Processes

• Allison Kathleen Peters, BSN, RNUniversity of
  Central Florida

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Assessment of the NeedOn time starts and
turnover times need to be improved in the
operating room

• Patient wait times too long
• Increased patient anxiety
• Stress response in the patient causes
  physiological rise of catecholamines (increase
  blood pressure and cortisol release decrease in
  immunity/healing
• (McCance
  Huether, 2006)

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Employee Satisfaction

• Cutting down on redundant and unnecessary steps
  decreases turnover times. Implementing Six Sigma
  assists in establishing a sense of cohesiveness,
  collaboration and pride in employee
  accomplishments (Fairbanks, 2007)

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Hospital Revenue

• Cases finish on time
• Decrease in the amount of staff on overtime pay
• Patient satisfaction scores increase
• Repeat business and new business from patient
  family and friends

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Identification of Problem
A survey was distributed to the surgical and
nursing staff to help identify problems. A
Pareto chart such as the one used below helps to
identify 80 of observable defects and 20 of the
causes. (This is known as the 80-20 rule.)
(Fairbanks, 2007) Recognition of a problem is
the first step in finding a solution. Figure 1
Problems Identified by Survey Respondents
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Stakeholders

• Who are the change managers and stakeholders?
  CEO, CNO, CFO
• Nurse Managers and Clinical Leaders
• Nurses, Surgical Technologists, Anesthesia
  Techs, Patient Support Staff, Transporters and
  Surgeons
• The key to all change management is to have all
  stakeholders actively involved in the process
  (Byers White, 2004)

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Implementation

• Six Sigma and Lean Principles (Reduce
  redundancy and waste, replace with quality and
  create value
• Spaghetti Diagrams (Showing the path of where you
  have been and where you can save steps)
• The Rapid Process Improvement (RPI) Team This
  is everyone nurses, doctors, scrub techs,
  transporters
• Keep asking why to get to the heart of the
  problem (Patterson, 2009)

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Spaghetti Diagram
After During the RPI project, the number of
steps and distance walked were reduced by 46.
(2007)
Before A process map shows the typical thoracic
case had 66 steps in the turnover process, and
team members walked a total of 2.4 miles. (2007)
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Project Team WorkDeciding who will be your key
players

• Identify the personnel who have the greatest
  impact on the surgical team
• Discover the conditions in which the team
  performs
• Explore the factors that contribute to high
  performing teams (Leach, Myrtle, Weaver Dasu,
  2009)

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How Long Will It Take?

• A Lean process called Kaizen (continuous
  improvement) is implemented- Ongoing changing
  happening today not a future event (Patterson,
  2009)
• Months are needed in order to realize trends in
  accomplishment of time goals
• Data entry by staff and OR scheduling
  coordinators is the most time consuming and work
  intensive part of the process (Fairbanks, 2007)

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Evaluation

• The goal of this project is to have on time first
  starts and decreased turnaround times
• Measurement used to determine are actual times
  being charted
• On time starts will increase from 54 percent to
  82 percent in six months
• Turnaround times will decrease from 30 minutes to
  17 minutes within 1 year
• Patient satisfaction scores will increase from 80
  percent to 98 percent within 6 months
• Project success can be demonstrated by using a
  program already in place-Microsoft Excel

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Cost and Savings

• Intensive first week for the assembly of teams
• Increased staff needed for coverage of team
  leaders in rooms (1 week)
• Savings will be realized
• Less staff working overtime hours
• Increase of employee satisfaction (reduced
  employee turnover rate)
• Increased patient satisfaction scores
• Decreased hospital stay due to infection
• Repeat and new customers

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References

• Byers, J.F. White, S.V. (2004) Patient safety
  Principles and practice. New York, NY Springer
• Fairbanks, C. (2007). Using six sigma and lean
  methodologies to improve or throughput. AORN
  Journal, 86(1), 73-82. Retrieved from CINAHL Plus
  with Full Text database.
• Leach, L., Myrtle, R., Weaver, F., Dasu, S.
  (2009). Assessing the performance of surgical
  teams. Health Care Management Review, 34(1),
  29-41. Retrieved from CINAHL Plus with Full Text
  database.
• Patterson, P. (2009). The diary of one OR's
  kaizen event. OR Manager, 25(5), 16. Retrieved
  from CINAHL Plus with Full Text database.
• (2007). Lean thinking at the University of
  Washington. OR Manager, 23(3), 12. Retrieved from
  CINAHL Plus with Full Text database