The Equipment Room Challenge

Remember my previous post about attempting a 5S organization of the OR equipment room?
This is how the room looked before starting 5S, and after:

After 5S

Before

As you will see from the new photo, there is less equipment in the room. I have used visual controls to assign space for each item on the floor, as well as labels on the wall with the name of the equipment. Equipment was allocated space according to frequency of use and grouped as much as possible by service to make it simple.

Here are the lessons I have learned so far:

To Check(list) or Maybe Not?

You probably read Atul Gawande's 'The Checklist Manifesto', in which he talks about how the safe surgery checklist came to life. I enjoyed the read especially as it seemed to have come to fruition so unexpected and yet so logical. And of course, as with anything related to quality improvement, the part that was the most challenging was yet to come: implementation.

It has been now 6 years since the WHO published the first edition of the Safe Surgery Checklist Implementation manual, and so far it has been widely adopted in hospitals around the globe. Sometimes, regulations and mandates have been used to ensure compliance.

Then, in March 2014, a study in the NEJM conducted by a group of Ontario researchers concluded that the implementation of the checklist was not associated with 'significant reductions in surgical mortality and complications'. And the debate started: what are we to make of this? Although it is a checklist, the obvious fact is that not ticking the boxes is what makes the surgery safe, but performing those actions. Also, implementation of this tool is hard, in an area where tradition is strong, egos are big and change is difficult. When hospitals are under pressure to conduct audits for compliance, how truthful are those audits? Another study looking at the OR and PACU safety culture in comparison with other hospital units concludes that the OR/PACU actually score lower than other hospital units, which means the OR is an area where improvements on the understanding of safety culture is much needed. We first need to understand what a safety culture is, in order to really successfully apply tools to improve this culture.

The Value of Thanking Employees

Last week was the Perioperative Nurses Week. With this occasion, the nurse educators on our unit prepared a series of short events each day, to show appreciation and motivate nurses: from a pledge board, to photos and presentations and even a chocolate fondue! Of course, all these events were possible with the educators' involvement; they brought their own kitchen gadgets, used their time to put everything together and ensure staff is having fun. We all know that healthcare is one of those areas where funds are limited (or inexistent). While this effort is laudable, I was wondering: where is the management? Peer appreciation is great, and it does make one feel great. But how about appreciation from our leaders and management? Why is that so rare and how important is that to the frontline staff?

It appears that actually, two of the top actions that employers can do to value staff are actually...free! Praise from managers and attention from leaders are followed by opportunities to lead. In healthcare, being recognized by your direct manager can make a huge difference. And surprising enough (for those who believe people are only motivated financially), a whopping 78% of employees would work harder if they would be recognized! I can only imagine what this would do on any unit. The nursing profession is based on a deep personal value, of helping people. Because ultimately, team members who feel poorly regarded by the leader are going to have the human propensity to remain disconnected from the leader and the common goal (J. Nance, Why hospitals should fly). 


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