2.  Patient wait times too long  Increased patient anxiety  Stress response in the patient causes physiological rise of catecholamines (increase blood pressure and cortisol release decrease in immunity/healing (McCance & Huether, 2006)

4.  Cases finish on time  Decrease in the amount of staff on overtime pay  Patient satisfaction scores increase  Repeat business and new business from patient family and friends

5. A survey was distributed to the surgical and nursing staff to help identify problems. A Pareto chart such as the one used below helps to identify 80% of observable defects and 20% of the causes. (This is known as the 80-20 rule.) (Fairbanks, 2007) Recognition of a problem is the first step in finding a solution. Figure 1 Problems Identified by Survey Respondents

6.  Who are the change managers and stakeholders? CEO, CNO, CFO  Nurse Managers and Clinical Leaders  Nurses, Surgical Technologists, Anesthesia Techs, Patient Support Staff, Transporters and Surgeons  The key to all change management is to have all stakeholders actively involved in the process” (Byers & White, 2004)

7.  Six Sigma and Lean Principles (Reduce redundancy and waste, replace with quality and create value  Spaghetti Diagrams (Showing the path of where you have been and where you can save steps)  The Rapid Process Improvement (RPI) Team: This is everyone nurses, doctors, scrub techs, transporters  Keep asking “why” to get to the heart of the problem (Patterson, 2009)

8. Before: A process map shows the typical thoracic case had 66 steps in the turnover process, and team members walked a total of 2.4 miles. (2007) After: During the RPI project, the number of steps and distance walked were reduced by 46%. (2007)

9.  Identify the personnel who have the greatest impact on the surgical team  Discover the conditions in which the team performs  Explore the factors that contribute to high performing teams (Leach, Myrtle, Weaver & Dasu, 2009 )

10.  A Lean process called Kaizen (continuous improvement) is implemented- Ongoing changing happening today not a future event (Patterson, 2009)  Months are needed in order to realize trends in accomplishment of time goals  Data entry by staff and OR scheduling coordinators is the most time consuming and work intensive part of the process (Fairbanks, 2007)

11.  The goal of this project is to have on time first starts and decreased turnaround times  Measurement used to determine are actual times being charted  On time starts will increase from 54 percent to 82 percent in six months  Turnaround times will decrease from 30 minutes to 17 minutes within 1 year  Patient satisfaction scores will increase from 80 percent to 98 percent within 6 months  Project success can be demonstrated by using a program already in place-Microsoft Excel

12.  Intensive first week for the assembly of teams  Increased staff needed for coverage of team leaders in rooms (1 week)  Savings will be realized:  Less staff working overtime hours  Increase of employee satisfaction (reduced employee turnover rate)  Increased patient satisfaction scores  Decreased hospital stay due to infection  Repeat and new customers

13. Byers, J.F. & White, S.V. (2004) Patient safety: Principles and practice. New York, NY: Springer Fairbanks, C. (2007). Using six sigma and lean methodologies to improve or throughput. AORN Journal, 86(1), 73-82. Retrieved from CINAHL Plus with Full Text database. Leach, L., Myrtle, R., Weaver, F., & Dasu, S. (2009). Assessing the performance of surgical teams. Health Care Management Review, 34(1), 29-41. Retrieved from CINAHL Plus with Full Text database. Patterson, P. (2009). The diary of one OR's kaizen event. OR Manager, 25(5), 16. Retrieved from CINAHL Plus with Full Text database. (2007). Lean thinking at the University of Washington. OR Manager, 23(3), 12. Retrieved from CINAHL Plus with Full Text database