5S for OR Equipment Room

Before picture:

This is one of our equipment room. On the day I took this picture, the room was completely full with equipment, tables, chairs, suction units. It was simply impossible to find an item or retrieve it;  there was no space left for accessing any item in the room.

This seems to be a common occurrence in hospitals: equipment is replaced, and old equipment is not removed from the unit, but placed in a corner. The hallways accumulate more and more items, and transporting a patient turns into an adventure. Patients are always amazed by the amount of items that seem to invade every square foot of space, and also by our ability to steer the stretchers around all these obstacles.

There is a definite need for improvement here. So, I decided to start small, with one room of equipment at one end of the hallway. By using the 5S Lean tool, these are the steps taken for starting this improvement project:

Space Organization in the OR

OK, so I have decided to start a small, easy and much needed quality improvement project on my unit. As many of you know, clutter is one of the biggest issue on surgical floors. Equipment is stored everywhere, on hallways, around corners, behind doors. Tables, chairs, props, accessories...the list goes on an on. Space is at a premium, and no matter where you turn, you incessantly see a piece of equipment. Many times when transporting patients to their theatre, they are amazed by the amount of carts, equipment and supplies on the hallways.

Why targeting this area for improvement?

Here are some areas of opportunity where we can make a difference:
1. Delays: when there is a pull for a piece for equipment, the nursing attendant goes to look for that piece, retrieves it and transports it to the theatre. At the moment, there is no standard placement for equipment, so staff inevitably spend precious time looking for it, then 'digging' it out from in-between other items, and finally transport it. This search = delay = patient/surgical team waiting = OR $$

2. Inventory: OR equipment is expensive. We like to remind each other to be careful with handling it, caring for it. But when it comes to storage, we forget about that. Many pieces of expensive equipment (i.e. laser machines, endoscopic units etc) are stored chaotically between more often used equipment, and end up being moved improperly, getting hit and damaged. This carelessness costs money and creates frustration for staff who have to go around it to retrieve some needed accessory.

3. Motion. This relates to both 1 and 2. Staff perform an incredible amount of unnecessary movement by looking for equipment, trying to relocate or move equipment and transport it where needed. By not having standard, designated places for equipment staff end up tired and frustrated, and are always in a frenzy when they should be able to know and easily retrieve any piece of equipment easily.

Stay tuned for the next phase: Using 5S to organize the equipment room

Shifting Culture in Healthcare

It is a fascinating idea, and it is (and will be) proved to be successful: implementing a new way to achieve better healthcare. From Tommy Douglas to Lean, Saskatchewan ran already a multitude of processes to improve healthcare (listen to podcast here). There is also debate on implementing Lean in healthcare, and many are also skeptical on the results. So how do we shift culture in healthcare?

People have to look at the processes from a patient's perspective, and whether you call it Lean, 4Dx or something else, this will not change the basic idea, that the ultimate person of interest is the patient (and not the physician). Removing waste, removing what is of no value and shift your viewpoint will ultimately make a difference. Sadly, leadership and healthcare management want to 'kill the mosquitoes' , without 'draining the swamp'. That means assigning a person to 'do the improvement work', and come back and report (while being held accountable for failures). But the data out there- and the examples from many Lean organizations- prove that improvement without senior management involvement is difficult, if not impossible to achieve long term.

My opinion on culture shifting: start talking about improvement, talk about tools and what is being done out there. Make nurses aware that they have power to improve their workplaces, and encourage involvement. Healthcare improvement happens everywhere in the world, and it is a real movement, not a fad. We can slow it down, but we can't stop it. So you are either be prepared, or find yourself on a burning platform!

Achieving Ultrasafe Health Care: 5 barriers

Here is a sort synopsis of an interesting and mind provoking article by Amalberti, Berwick, Auray and Barach. It brings back the discussion about how do we compare with ultra safe industries, and how many steps do we have to take to bring us to that much needed point of safety.

Becoming ultrasafe may require health care to abandon traditions and autonomy that some professionals erroneously believe are necessary to make their work effective, profitable, and pleasant.
Reliable measurement of health care and patient safety outcomes is the first challenge for health care benchmarking

The 5 barriers to achieve ultra safe health care are: