The Productive Operating Theatre Programme
An enabler for productivity, safety and performance
improvements in Operating Theatres.
Joe McDonald
Senior Advisor
Clinical Improvement and Productivity
Sector Capability and Innovation Directorate
Ministry of Health
Understand
the real
issues and
challenges.
Identified coproduction
partners in
the NHS and
from industry
Observing
and
enquiring in
other high
risk, lean
organisations
Terminal 5,
Unipart –
logistics
Other
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.
Launch in
Ongoing
Sept 2009,
ROI and
followed by
benefits
regional
realisation
start-up
capture
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
NZ
174 trusts
21 DHBs
Operating Theatres
numbers
2,871
203
Average theatres per
16.5
9.6
£ 1,200
($2,601)
$ 1,680
2008/09
Trusts/DHBs
Trust/DHB
Running costs for an
Operating Theatre
per hour
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
Effortless for everyone
Great team communication
Communications
Training
Staff Skill mix
Quiet & smooth
Equipment
Fast but not rushed
Attitudes/behaviours
No glitches
Safe, reliable care
List Scheduling/utilisation
Start/Finish Times
Patient Prep








Team working MDT
Scheduling
Session start up
Patient preparation
Patient Turnaround
Handover
Consumables and equipment
Recovery (PACU)







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









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.
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 NHS
Total of 2,871 operating theatres,
Average 16.5 theatres per trust
Theatres represent
Most theatres have had many
25-50% of most hospitals Improvement Projects often with
income generation
limited sustainable effect
Theatres cost approximately
£1000 – 1200 per hour
(excluding medical personnel)
Unstaffed hours
still generate capital and
estate costs
Team-working
Mean Score from SAQ before and after introduction of briefing and
debriefing
80
70
60
50
before
40
after
30
20
10
0
Team work
Climate
p<0.05
Safety
Climate
Job
Satisfaction
Perceptions
of
Management
Working
Conditions
Stress
Recognition
Team-working
7
number of sessions
6
4
22 unused,
cancelled
sessions
3
32 extra sessions
5
2
1
0
1
2
3
4
5
6
7
8
Over 8 weeks:
w eek
Cost of unused sessions £105,600
Cost of extra sessions >£153,600
Potential saving over 1 year >£660,000
Scheduling
100
98
96
Mean – 90%
94
Mean – 98%
92
90
88
Sep
Aug
8
6
4
2
09
Sep-
Oc t- 0
9
09
Aug-
J ul-0
9
9
J un-0
May 09
Apr- 0
9
09
Mar-
Feb09
9
J an-0
8
De c0
8
0
No v0
Potential saving in 1 year £510,400
10
Oc t- 0
8
Cost of extra sessions £81,664
12
08
Cost of unused sessions £31,746
Number of waiting list initiative sessions
Sep-
Over 8 weeks:
Jul
Jun
May
Apr
Mar
Feb
Jan
Dec
Nov
Oct
Sep
Aug
Jul
Jun
May
Apr
86
Hazardous
(>1/1000)
Ultra-safe
(<1/100K)
Regulated
Health Care
100,000
Driving
Total lives lost per year
10,000
1,000
Scheduled
Airlines
100
10
Chartered
Flights
Bungee
Jumping
1
1
10
European
Railroads
Chemical
Manufacturing
Mountain
Climbing
100
1,000
10,000
100,000
Number of encounters for each fatality
40 %
admissions
experience
error in
care
4 % harmed
0.8-1%
die
from errors
Nuclear
Power
1million
10million
Tribal nonalignment
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).






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”
“Since TPOT
everyone uses the
data to evidence
problems and
measure
improvements”
“Well organised theatre has
improved the organisation
of stores and equipment
which has had a direct
impact on theatre
efficiency”
Theatre Practitioner
Consultant Surgeon
“TPOT improves
communication
between theatre
staff and
clinicians”
Theatre Sister
Programme Lead
“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
“The team brief
gives people a
voice. Patient care
improves, errors
go down and
morale goes up”
Consultant
Surgeon
www.hiirc.org.nz
Contact information:
Joe McDonald
Ph: 04 8162571
email: Joseph_McDonald@moh.govt.nz
THANK YOU!