1. 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
TPOT is regarded as an enabler programme and hopr to tell you why it is considered so!

2. How The Productive Operating Theatre has been developed
Understand the real issues and challenges.
Identified co-production 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
Launch in Sept 2009, followed by regional start-up events for NHS England
Ongoing ROI and benefits realisation capture
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!
Internal/external peer review. Frequent learning sets. Continual understand and reflect.
Key message:
Rigour, timescales and investment that has gone into developing the programme.
Where the Programme came from, where we are with TPOT currently
What to say
In line with world class best practice, the institute uses a work process
Structured way of developing innovative solutions
Incorporates analysis, creativity and prototyping of ideas
Based on experience with The Productive Ward
Co-production with 3 hospitals
starting small: 2 theatres
Combining strategies:
lean thinking (staff empowerment)
team working (human factors & non-technical skills)
Testing prototypes and measuring their impact
3 further hospitals
Sequence of modules
Rolling out to the NHS
Implementation support package 2

3. UK compared to NZ Operating TheatresUK NZ
Trusts/DHBs
174 trusts
21 DHBs
Operating Theatres numbers
2,871
203
Average theatres per
Trust/DHB
16.5
9.6
Running costs for an Operating Theatre
per hour
£ 1,200
($2,601)
$ 1,680
2008/09
The slides acknowledges the difference between UK and NZ and the scale of the health systems

4. 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
Key message:
What is this programme all about……..
Creating the perfect operating list!!
Every day for every patient 4

5. The modules

6. Programme timeline key events and milestones
Approx time at start of this slide – – (takes approx 2 mins)
the steps that need to be taken to run the programme are …..explain timeline refer to PLG handbook pgs 18-19
There are three key events in the start up – Visioning, Measures workshop and Trust Board workshop – all outlined in PLG – but will hear more about this during the day
The focus for today is to give you the information you need to get you started once your organisation has signed up to doing this programme of work and give you an opportunity to spend time in your Trust groups to start your plans 6

7. The Productive Operating Theatre aim: To improve 4 key dimensions of quality

8. The perfect operating list?
Communications
Training
Staff Skill mix
Equipment
Attitudes/behaviours
List Scheduling/utilisation
Start/Finish Times
Patient Prep
Effortless for everyone
Great team communication
Quiet & smooth
Fast but not rushed
No glitches
Safe, reliable care
The black colour is what the UK research defines as aspects of the Perfect OT list,
the BLUE is what has come up at NZ vision workshops

9. Programme focus areas:
Team working MDT
Scheduling
Session start up
Patient preparation
Patient Turnaround
Handover
Consumables and equipment
Recovery (PACU)

10. Critical success factors
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

11. Benefits achieved in UK and potential opportunities for NZ
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.

12. Value and efficiency – benefit estimates (per annum) UK
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
£2,971k
174 trusts in the NHS
Total of 2,871 operating theatres,
Average 16.5 theatres per trust

13. Efficiency: the financial ‘engine room’
Theatres represent
25-50% of most hospitals
income generation
Most theatres have had many
Improvement Projects often with
limited sustainable effect
Theatres cost approximately
£1000 – 1200 per hour
(excluding medical personnel)
Unstaffed hours
still generate capital and
estate costs

14. Impact on culture (safety attitudes questionnaire)
Team-working
Impact on culture (safety attitudes questionnaire)
This graph shows the impact of team brief on staff attitudes
By conducting a staff attitudes questionnaire before and after implementing team briefing this test site were able to demonstrate any improvement on staff attitudes
Implementation of team brief was anticipated to improve attitudes to teamworking, safety and job satisfaction but it was not expected that perceptions of management, working conditions or stress recognition would improve
An unpaired t-test was used to assess the statistical significance of the improvement – p values were found to be less than 0.05 i.e. statistically significant in the three categories predicted to improve
p<0.05 14

15. Team-working

16. Session utilisation Over 8 weeks: Cost of unused sessions £105,600
Cost of extra sessions >£153,600
Potential saving over 1 year >£660,000
Over that same 8 week period where 22 sessions were unused, 32 extra sessions were run –
Definitely a problem worth solving – explain costs…these were calculated based simply on staff salaries excluding the surgeon for cancelled sessions – in addition there are other costs that can be calculated such as loss of income from cancelled sessions 16

17. Number of waiting list initiative sessions
Scheduling
Session Utilisation
Mean – 90%
Mean – 98%
Number of waiting list initiative sessions
Over 8 weeks:
Cost of unused sessions £31,746
Cost of extra sessions £81,664
Potential saving in 1 year £510,400
Based on another test site that has worked on scheduling - the % of funded sessions utilised has increased from a mean of 90% utilisation last year to a mean of 99% utilisation for the same period this year 17

18. Improved session start times

19. Patient safety 40 % admissions experience error in care 4 % harmed
0.8-1%
die
from errors 19

20. ‘Culture eats strategy for breakfast’
Tribal non-alignment E X C s S U R G E O N M A N G E R S O D P S / T E C H s A N E S T H I N U R S E P O R T E S
‘Culture eats strategy for breakfast’

21. Whole system benefits
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).

22. Programme to date: 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.

23. “TPOT improves communication between theatre staff and clinicians”
Staff feedback from UK
“Well organised theatre has improved the organisation of stores and equipment which has had a direct impact on theatre efficiency”
Theatre Practitioner
“Since introducing TPOT there has been a noticeable change in culture …staff are clearly empowered to make changes”
Consultant Surgeon
“Since TPOT everyone uses the data to evidence problems and measure improvements”
Programme Lead
“The team brief gives people a voice. Patient care improves, errors go down and morale goes up”
Consultant Surgeon
“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
“TPOT improves communication between theatre staff and clinicians”
Theatre Sister
So what have staff been saying about the programme
(read each quote in turn)
Finish at 14:25 (IF 5 MINS SPARE ??? PLAY INTRO DVD) – ??OFFER 5 MIN COMFORT BREAK 23

24. Any Questions? THANK YOU! www.hiirc.org.nz
Contact information:
Joe McDonald
Ph:
THANK YOU!