We recommend starting with an assessment to see OR Room turnover as a part of a larger context. It would be counterproductive to engage in a whole OR Turnover improvement program to find out that is not the one issue that would have made the most significant impact for patients or clinicians.
The first implementation should be considered a pilot program as many unknowns will be faced by the team. We have always reaped benefits from these pilot programs and we answered many questions, hence preparing the team better for future implementations.
Data Gathering: Work Steps
We will look at and document every work step every participant takes from the start of the OR Turnover to the end of it. For this step, we will use the Standard Work Definition forms that will be provided.
Data Gathering: Video
If possible, we will confirm the documented work steps using video recordings of the OR Turnover.
Data Gathering: Work Times
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.
Data Gathering: Supplies
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?
Data Gathering: Players
For every "Actor" we will take an initial look at 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.
Data Gathering: Cleaning Methods
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.
Data Gathering: Reverse Logistics
We are hoping that by using a fancy term ("Reverse Logistics") to describe the removal of trash, we will make people take it as seriously as it deserves to be taken. We will spend some focused time in the documentation of all steps related to things going into the OR Suite, but also everything that must come out of it.
Quick Changeover Phase 1: Separate
This set of steps if focused on identifying and cataloguing each 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 every external step so there is not wait time caused by them.
Quick Changeover Phase 2: Convert
The team will focus on converting as many internal work steps into external work steps, hence reducing the length of the OR Turnover. Not all opportunities will be capitalized upon within the project, since some of them may require investment or time to make them happen.
Quick Changeover Phase 3: Streamline
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.
Document New Procedures
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.
The team will put together a training session to inform all staff of the new procedures, to explain the expectations, and to lay the ground for the next project(s)
Review Results and Plan for Next Target
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.