Effective Operating Theatres Summit
Chaired by Mr Hugh Rogers Associate Medical Director & Consultant Urologist Chelsea & Westminster NHS Foundation Trust, today's conference will look at what we have learned from the Productive Operating Theatre Programme, measuring, monitoring and driving improvement in theatre performance and understanding what optimum theatre usage looks like.
What have we learned from the Productive Operating Theatre Programme?
Mr Hugh Rogers Associate Medical Director & Consultant Urologist Chelsea & Westminster NHS Foundation Trust
• have we achieved a step change in operating theatre performance?
• improving efficiency and productivity in operating theatres
• improving reliability and outcomes
• system issues and enablers for change
• moving forward: critical success factors
"Our 4 improvement aims:
-Team performance and staff wellbeing
-Patient experience and outcomes
-Safe and reliability of care
-Value and efficiency
Who is in charge in the operating theatre?
Presenting data in a visual way is very powerful
‘5S’ – is a basic technique that comes to us from Lean. Sort / simplify/set in order / sweep and shine / standardise / sustain. It’s a safety issue as well as an efficiency issue.
Process Mapping, 6-4-2. Be very logical about how to structure lists.
Using actual procedure times – Do you use needle to skin to rollout to recovery, or do you allow for overlap? What is critical in theatre turnaround?"
Hugh Roger's Biography
I am now a semi-retired consultant urologist, but for most of my career I have been involved in quality improvement (or modernisation as we used to call it) at local and national level in the NHS. I worked on lean implementation programs - notably the Productive Series - for the NHS Institute for Innovation & Improvement until it was consumed by the ‘bonfire of the Quangos’ in 2011. I had a leading role in The Productive Operating Theatre program (‘TPOT’) and rolled out a nationwide series of training workshops in human factors applied to the operating theatre.
My current work as Associate Medical Director is to reconcile the cultures of two London hospitals merging into a single organization and help to steer transformation within the new integrated organization. We are now working on a substantial IT implementation which will utterly change the way clinicians work. In addition my time as CQC special advisor has given me privileged insight into the way different trusts are improving their operating theatre performance.
Driving improvements in theatre performance: Learning from the Welsh Findings
Lesley Law Head of Planned Care Health and Social Services Group Welsh Government
• learning from the Welsh Audit Office findings and implementing the recommendations
• metrics used to measure theatre performance
• understanding the scope to improve theatre utilisation, reduce late starts and minimise cancellations
• driving improvements in theatre performance nationally
“Safety has improved in Wales. What we want to do is has a system that recognises safety as a key driver to delivering the service
Patient safety focus – This is embedded in Wales and is taken forward. Issue that was raised is whether safety checks are calculated in the start times of the list. We are going to be looking at this for future development.”
Summary – Local and national focus in theatres is needed. Some changes will take longer. Stronger clinical leadership”
Lesley Law's Biography:
I started by career as a general surgical nurse in North Manchester during the late 1980s. While working full time, I completed my BSC (Hons) in nursing. I then got the study bug and went on to study part time for my MBA at Manchester Business School. I moved from nursing into general management and had a number of posts in quality, information and cancer services.
In the 1990s I decided to leave the public sector and test my feet in the private sector and went to work at PricewaterhouseCoopers as an external auditor. While I enjoyed my time in the private sector, after a number of years I was ready to come back to the public sector and in 2005 I joined the Welsh Government.
Why am I presenting
As the Welsh Government’s lead for planned care I am responsible for the development of national policy and performance management. This policy portfolio includes theatre efficiency.
When the Welsh Audit Office undertook a review of operating theatres in Wales in 2015 and reported their findings in 2016 they found that there were opportunities for improvement. In partnership with the NHS, I have been tasked to take this forward.
Lesley Law's Abstract
In 2015 the Welsh Audit office undertook a review of operating theatres in NHS Wales in March 2016 they published a national report
One of its key findings was around the focus of efficiency measures being used locally and nationally.
“Many theatres remain under-utilised and there are barriers to improvement along the entire patient pathway, not just within theatres.
“The focus on theatre efficiency and productivity has waned in Wales in recent years although positively there has been greater focus on surgical safety”
Within the report they made a recommendation that together the NHS and Welsh Government need to explore establishing a national forum and review the focus on theatre efficiency.
At a national event in October these two recommendations were explored and a way forward was agreed.
Theatres are a critical part of the delivery of planned care and each health board in Wales are looking to improve their local services. It is agreed however that learning, sharing and working together should support their local work and a commitment to take this forward has been made.
The presentation looks at how Wales proposes to do that
Improving Patient Experience: the future of Day Surgery
Mary Stocker President British Association of Day Surgery & Consultant Anaesthetist and Lead, Day Surgery Torbay
• introducing new procedures as day surgery
• recent technological advances in day surgery
• understanding and improving patient experience
• the future of day surgery: which procedures in the future will be delivered through day surgery?
“Increase your use of day surgery – Every single elective patient should be considered for day surgery.
Which patients are appropriate for day surgery? It’s all about having a day surgery thinking mind-set.
Medical exclusions for day surgery: unstable, poorly controlled abnormality, neonates, and young siblings of SIDS child. Not many people are excluded.
To return home, patients need to be able to eat or drink post operatively, safely mobilise, low risk of catastrophic complications
Long operating times – surgical procedures lasting 3 – 4 hours are now being dealt with as a day case.
Ideally we want all activity transferred to the Day Surgery unit where possible. There are fewer cancellations."
Mary read chemistry at Oxford University, including research into novel approaches towards drug design, subsequently she worked as a research chemist in the pharmaceutical industry. In 1990 she turned her hand to medicine, qualifying from Bristol University, her anaesthetic training was undertaken in the South West with a year at the University of Virginia, USA. She now works in Torbay as a Consultant Anaesthetist. Since 2004 she has been Director of Day Surgery for South Devon Healthcare Trust, one of the national leading trusts for day surgery in terms of innovation, day case rates and the quality of patient outcomes. She has developed training modules in day surgery for medical students and anaesthetic trainees and a training course for nurses undertaking day surgery preoperative assessment. She worked with the Royal College of Anaesthetists to produce an e-learning package in pharmacology. She has published widely in the day surgery literature and authored a number of book chapters on the subject.
Mary has been a member of the Council of the British Association of Day Surgery for 6 years and their conference secretary for 3. She served as President-Elect of the Association for two years and took up office as BADS President in June 2016.
Mary Stocker's Abstract:
Over the past 25 years there have been a number of initiatives to make day surgery the default option for elective surgery. Some trusts have moved towards this however many still have very conservative selection criteria for both patients and procedures such that a patient has to prove themselves suitable for day surgery rather than being given every option to be so.
In this session we will look at current guidance for day surgery selection and challenge many traditional beliefs that preclude patients and procedures from being undertaken as such. A successful day surgery unit can transform outcomes for not only patients but the trust and more widely the NHS. Moving the majority of elective and more recently some emergency surgical procedures to the day surgery arena results in increased productivity, dramatic reduction in waiting lists, freeing up of beds for patients who truly need them, fewer cancellations, and can also increase staff satisfaction and enthusiasm.
In this lecture I will present the current national recommendations and suggest some strategies to achieve them
Future conferences of interest:
Breast Surgery as Day Surgery: A Joint HCUK & BADS conference
National PROMs Summit 2016
Innovations in Day Surgery: Development of Emergency Day Surgery Pathways
In-depth legal masterclass: Informed Consent After Lanarkshire
11 November 2016