1. 1 On our way to The Productive Operating Theatre Vancouver Coastal Health Authority Felicia Laing – Quality and Patient Safety Andra Grigore – RN Perioperative Services, LGH

2. 2 Key Areas of Focus What is The Productive Operating Theatre? Knowing How We Are Doing Well Organized Theatre Team-Working Operational Status At A Glance

3. 3 The Productive Operating Theatre A modular improvement program developed by NHS UK A structured way of approaching challenges and opportunities specific to our OR team Tools to improve communication between front line staff and senior leadership

4. 4 Productive Series Sites

5. TPOT Modules 5

6. TPOT AIM 6

7. Lions Gate Hospital 7

8. Before TPOT No common goal or vision Poor communication Disorganized Operating Rooms Minimal team-building Limited quality improvement 8

9. Knowing How We Are Doing 9 Set objectives Measure how we are doing across the 4 domains of quality PDSA and sustain

10. Visioning Workshop Staff discussed barriers to perfect work day Nurses, Surgeons, Anaesthetists, Periop Aides, Anaesthetic Assistant 10

11. Themes and Dot-Voting Themes similar across ORs Essential for high functioning & reliable ORs Physicians voted for efficiency themes 11

12. Vision Statement “The LGH Perioperative Staff inspires a supportive and dedicated team environment and is committed to achieving excellence in outstanding patient care.” 12

13. Communication 13

14. Well Organized Theatre 14 5S Tidy OR Slang Binder

15. Before & After 15 BeforeAfter

16. Before & After 16 Before After

17. Safety Cross & Pareto Chart 17

18. Equipment 18

19. Slang Binder 19

20. Teamwork 20 Create a calmer working environment Reduce hierarchies and give everyone an equal voice Perform the Surgical Safety Checklist Review the slate and identify any glitches that can be remove

21. Grand Kick-Off Tremendous interdisciplinary turnout Establish action plan 21

22. Operational Status at a Glance 22 ORs ready to go All equipment is available & working Right staff in the right place Slate starts on time No cancellations, no delays Finish on time

23. First Case Starts January 2015 Baseline 23

24. Mapping Out the Patient’s Journey 24

25. Culture Eats Strategy for Lunch 25

26. Moving Forward Increase teamwork and communication Empower the perioperative team Improve efficiency of the OR (e.g. first case start times) Reduce waste by optimizing workflow and productivity Improve patient experience and outcome 26

27. Thank You 27 Andra.Grigore@vch.ca Felicia.Laing@vch.ca