I was working in an operating room last week with a team of OR staff. We were improving operating room turnaround times using Lean Healthcare principles. Part of the process was to identify how long it should take to set up the next case. As you may guess, the overwhelming answer was, “it depends.” In fact, the team observed and identified that the amount of time it takes to turn over a room depends on many factors.
However, you could have knocked me over with a feather when the OR charge nurse commented, “If we had access to this room turnaround data, we could review it weekly. We could look at it and recall what happened in particular cases to cause the turnaround time to be longer than expected. Then we could address those issues in the moment.”
Here is the back story to explain why I was so pleasantly surprised:
First of all, for those that have studied Lean Healthcare you recognize that Lean is a problem-solving methodology. We like to remind the staff with whom we work that Lean Healthcare is about “making the right work easier to do.” Of course, a prerequisite for effective problem solving is that we know why something is a problem. Previous to our Lean efforts, operating room statistics, including turnaround time, were published monthly. The data was posted on the wall near the break room and was promptly ignored by staff (I refer to this as autopsy data. The patient is already dead and we are just finding out the cause of death). Nobody cared about the data because it seemed irrelevant. There was no connection between the data and the daily pulse of the OR.
Secondly, we had been working at this particular facility for months trying to pull together data in order to provide clean statistics for room turnaround. We had progressed from the monthly posting of data to weekly. We had the ability to break down the turnover times by operating room and by staff. In fact, the OR had even included the data in their weekly newsletter. And yet, turnover times had only improved marginally. Front line staff members were still waiting for the Lean team to solve their problems. It wasn’t until the charge nurse brought the data closer to the problem — a weekly review with key staff and anesthesia — that they made the connection between the data and the day-to-day.
There is much evidence that the current healthcare system is in crisis. There are countless problems plaguing a system which spends too much and delivers too slowly. A key component to transforming healthcare will be tapping into the natural problem-solving skills of the frontline workers. Data and reports may be reviewed regularly by top leaders at a facility, however, when we move the data closer to the problems – day-to-day problems – we are closer to making lasting and necessary improvements possible.
This week’s article was written by Tom Stoffel, a director & consultant for HPP. Before joining HPP, Tom served as President of Transformation Group, Inc,. Tom developed TGI Healing Healthcare – a brand of Lean Healthcare training tools designed to share lean principles through hands-on learning. Tom has led healthcare organizations in both the development of high-level Lean Strategies down to hands-on implementation of Lean in a clinical setting. Tom has achieved the levels of Certified Lean Specialist from the Business Improvement Group and the National Institute of Standards and Technology (NIST), along with being an ASQ Certified Quality Engineer. These certifications build on an Engineering Degree from the University of Michigan. Training experience includes Lean, Quality, and Leadership Training, as well as serving as an Adjunct Faculty Member at Waubonsee Community College.