© copyright nhs institute for innovation and improvement 2009 the productive series

© Copyright NHS Institute for Innovation and Improvement 2009

The Productive Series


Cost effective

care

Team performance and leadership

Safe and reliable care

Patient’s Patient’s experience experience & outcomes& outcomes

Principles of The Productive Series


Critical factors for success with any Productive

Leadership at Executive level √

Aligned with strategic direction √

Governance of the programme √

Continuous improvement √

Capability and knowledge √

Right people in place √

Source: NHS London Review May 2009


The perfect operating list……..every list, every day, every patient

Effortless for everyone

Great team communication

Quiet & smooth

Fast but not rushed

No glitches

Safe, reliable care

Finish on time……………

Building teams for safer care


Efficiency data

0

1

2

3

4

5

6

7

1 2 3 4 5 6 7 8

week

nu

mb

er o

f se

ssio

ns 22 unused,

cancelledsessions

32 extra sessions

Over 8 weeks:

Cost of cancelled, unused sessions £31,746

Cost of extra sessions£81,664


% Session Utilisation

86

88

90

92

94

96

98

100

Apr

May Ju

n

Jul

Aug

Sep Oct

Nov

Dec Ja

n

Feb

Mar

Apr

May Ju

n

Jul

Aug

Sep

Mean – 90%

Mean – 99%


Number of waiting list initiatives

0

2

4

6

8

10

12 TPOT meeting

reviews data


Start, turnaround and finish times

August 2008

June 2009


Well organised theatre

Overstock in main store room (4 theatres) resulted in financial reimbursement of £27, 500

Out of date stock in main store room (twin suite) valued at £9,385

Overstock in prep and anaesthetic rooms (2 theatres) valued at £10,400

Potential financial benefit for a twin theatre suite

to make a ‘one-off’ saving of £24,150


% compliance with team brief

% of lists performing team brief

0102030405060708090

100

site 1 (2theatres)

site 2 (8theatres)

site 3 (2theatres)

site 4 (4theatres)

before TPOT

associate site - 6 monthsafter TPOT

field test site - 12 monthsafter TPOT


Problems avoided by Team Brief

Week 4 - June 2009

0 1 2 3 4 5 6 7

No extended recovery / HDU bed

extra patient added to list

lack of staff

further investigation needed

awaiting bloods

operation not listed correctly

no junior doctor to assist

issue on ward causing delay

problem with, or no equipment

list order changed

Week 4 - Sept 2009

0 1 2 3 4 5 6 7

No extended recovery / HDU bed

extra patient added to list

lack of staff

further investigation needed

awaiting bloods

operation not listed correctly

no junior doctor to assist

issue on ward causing delay

problem with, or no equipment

list order changed


Impact on staff

Mean Score from SAQ before and after introduction of briefing and debriefing

0

10

20

30

40

50

60

70

80

Team workClimate

SafetyClimate

JobSatisfaction

Perceptionsof

Management

WorkingConditions

StressRecognition

before

after

p<0.05


Improvement drivers for key aims Value and efficiency 1 – main driver modules

Reduced cancellations– Scheduling & patient prep– Operational status at a glance

Improved utilisation and Reduced over-runs– Scheduling– Start-up, patient prep, turnaround, handover– Operational status at a glance

Avoiding cost of defects– Team-working– Handover– Recovery

Materials management– Well Organised Theatres– Consumables and equipment

Value & efficiency

Team performance &

leadership

Safety & reliability of

care

Patient’s experience &

outcomes


Value and efficiency 2 – benefit estimates (per annum)

174 trusts in the NHS

Total of 2,871 operating theatres,

Average 16.5 theatres per trust

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

© copyright nhs institute for innovation and improvement 2009 the productive series

Documents