One month to faster turnover times
Quick Changeover in the OR
Long changeover (or turnover) times in the OR result in delayed treatment for patients, dissatisfaction for surgeons and staff, and large overtime bills for the hospital. No one wins. The Quick Changeover Program gets at the root of the problem. In one month, your patient turnover time will shorten dramatically, while your staff satisfaction skyrockets!
Benefits of Quick Changeover
We recommend starting with an assessment to observe and document OR Room Turnover as a part of a larger system. It would not make sense to pursue an OR Turnover project, only to find that another improvement target would have offered greater benefits to patients and clinicians.
The recommended method for a global assessment of the Perioperative/Surgical Services Department is Value Stream Mapping. This team-based, revealing analytical method enables all involved to see the issues in the same light and to weight them by importance. The VSM highlights unneccesary delays, excess foot traffic, and activities in the OR Suite (taking up minutes) that could be done ahead of time.
It is highly likely that the Assessment will spotlight a large number of Opportunities for Improvement above and beyond OR suite Turnover. All these Opportunities will be documented and prioritized.
From the list of Improvement Opportunities the assessment team will select the top 3-to-5 highest-ranked opportunities and develop a mini-project plan for each one using the A3 Methodology. If OR Suite Turnover ranks within the top 5, then we will plan for the first pilot implementation.
Selecting the Pilot Target: Working as a team, and based on what we learned from the Assessment, we select one OR Suite, or perhaps a small group of Suites dedicated to one surgical service, as the Pilot Target. We suggest choosing not the easiest possible Target, and not the hardest, but one which offers a high likelihood of quantifiable success, and which will leverage skills for further deployments of Quick Turnover.
Leonardo Group Americas’s training approach is to begin with a brisk classroom session on the Assessment methodology – Value Stream Mapping (about two hours) – and then move directly to “learning by doing” directed by our skilled facilitators. The team may expect to be at work on their OR’s actual issues well before lunch on the first day. As Data Gathering and Work Flow Design activities come along (see below) targeted training modules will be presented. By the end, all participants will have worked through all the stages of a complete OR Room Turnover Project, following our well-tested Roadmap. Every team member will receive all training materials, copies of Current and Future State VSMs, and documented New Procedures.
We will look at and document every work step every participant takes from the start of the OR Turnover to the end of it. We will provide Standard Work Definition forms to document these steps.
If possible, we will confirm the documented work steps using video recordings of the OR Turnover.
With a clean list of work steps, we will start documenting the time it takes to do the work. Each step will be timed independently. Time will be rounded to the next 0.1 minute.
For every step documented, we will ascertain the supplies required and the conditions for its use. Example: How should the floor cleaner be used? Can we step on it before it is dry? Is there a latency time?
For every “Actor” we will review the work balance to see if there is a very substantial imbalance that must be addressed immediately or if there are any other players that should be invited to the program. The key is to perform as many activities as possible in parallel.
Cleaning methods are a crucial part of any Room Turnover project as they cannot be eliminated or performed outside the room. We will pay special attention to these steps as well as the supplies required.
We use the term “Reverse Logistics” to describe any and all outbound movement of equipment, material, supplies and waste required for OR Turnover between procedures. We emphasize the importance of designing and planning this work as seriously as it requires. Drapes, disposable supplies, discarded wrappings, soiled instruments, biohazard, and sharps all require timely, safe and scrupulous attention – each category with its own designed and documented outbound work steps.
Quick Changeover Phases
This activity identifies and catalogues each Turnover work step as either “Internal” or “external”. Internal steps of work must be done inside the OR Suite (wiping the floor) while external steps can be done outside the OR Suite. The goal is to choreograph all external work steps outside the OR Suite so that they cause no unnecessary wait time.
The team will focus on converting as many internal work steps into external work steps, further reducing the length of the OR Turnover. It may be that some of the identified opportunities for doing this will require financial investment, or will need to be planned as future projects.
Once all the internal work steps have been settled upon, the team’s work will focus on making every step as efficient as possible by using the best possible practices, sequence, or supplies. This is to ensure that “no remaining minutes are left on the table”, and that the OR’s Turnover Time (internal) has been reduced as much as possible.
Bringing Everything Together
Each new procedure will be documented using Standard Work Definitions. If required, the hospital/system forms will be used and submitted for approval and turned into official documents. Metrics – particularly the standard Turnaround Time for a given OR Suite or group – are to be documented, tracked, and monitored.
The team will put together a training plan to inform all staff of the new procedures and how they were developed, and to explain the expectations. Plans should be scheduled to reach all affected OR team members – a big challenge given surgical blocks, shifts, weekly schedules, and numerous per-diems and “travellers.” One meeting, or a single memo, does not suffice. We recommend sessions or huddles both to introduce the new Turnover system, and then to reinforce it for sustainability. “Dry Runs” in unused OR suites, and observation/ coaching of “Live” Turnovers, can also be very effective.
A Final Report will be assembled by the team and it will be presented to the Management Team. This is done on the last day of the Pilot Project.
Frequently Asked Questions
What results should we expect in reducing our own OR Turnover times?
A reduction of 20-30% in the total OR Suite Turnover time is very common. You will also benefit from more standardized and predictable methods for the OR Suite Setup.
Can you guarantee the results?
In the same way your doctor can guarantee that “Diet and Exercise” will help you lose weight. As long as your team follows Quick Turnover “Prescription” (the LGA Roadmap), you can take it to the bank.
How many people need to participate in the Pilot Project?
Our preferred number is 6-to-8 plus 2 LGA Team members . We want a mix of Instrument Techs, Circulators, Nurse anesthetist, SPD staff, and OR Support Staff. Charge Nurses, Managers, Directors and other support departments will be asked to be on call to help.
How much classroom training should we expect?
Our curriculum incldes 2 hours of Value Stream Mapping and up to 4 hours of Quick Turnover. We will bring in additional brief training modules to address specific Lean tactics as they are required by your OR’s specific challenges.
We’re short of people now in the OR. How are we supposed to do OR Turnovers even faster when we are understaffed?
A very common concern. What the team looks for is wasted activity and movement, which, when taken out of the work flow, allows time to do the job safely and promptly.
We have lots of per-diems and travelers in our OR – always new staffers coming and going, and every changeover is a little different. Even if we develop “one best way”, how do we teach it to all these players?
After helping you design the “one best way” for your institution, this program emphasizes thorough training for the OR team and related functions. Role-playing, practice in an empty OR suite, and LGA coaching during “live” Turnovers are all part of implementing and sustaining the best possible procedures.
We see those improved Turnover times you claim we can achieve. How can we do that, when an average of 8% of all our case carts are missing something?We see those improved Turnover times you claim we can achieve. How can we do that, when an average of 8% of all our case carts are missing something?
As part of the team’s assessment work and Value Stream Mapping, you’ll identify all the problem spots, or obstacles, affecting your Turnover performance, and develop a structured Action Plan for the highest-impact issues. This project will include any other functions or departments involved.
Our hospital did a Turnover improvement project four years ago, and made some gains. But now we’re right back to where we were before. Why will this program be any different?
We at Leonardo Group Americas have heard and seen that problem before. The solution is two-fold:
- Be sure that your OR, surgical staff and senior leadership understand and support the importance of prompt and accurate Turnovers.
- Leonardo Group Americas emphasizes training and coaching of the process following implementation, to assure good sustainability.