1. Amanda Fegan Lead Associate, NHS Institute Hugh Rogers FRCS Consultant Urologist Senior Associate, NHS Institute The Productive Operating Theatre Building teams for safer care

2. Film clip Introduction to The Productive Operating Theatre (From DVD in the TPOT foundation modules boxed set)

3. The perfect operating list

4. Getting started Visioning workshop

5. The perfect operating list Effortless for everyone Great team communication Quiet & smooth Fast but not rushed No glitches Safe, reliable care......building teams for safer care

6. Staff select the issues they want to be resolved

7. The Productive Operating Theatre aim: To improve 4 key dimensions of quality Value Team performance & leadership Safety & reliability of care Patient’s experience & outcomes

8. Development principles Co-production with 3 hospitals Starting small Combining strategies: staff empowerment lean thinking team working Testing prototypes and measuring impact

9. © Copyright NHS Institute for Innovation and Improvement 2009

11. Programme Leader’s Guide Form the team Programme planning Running the visioning workshop

13. Executive leader’s guide Gather data and run trust board workshop Role of executive lead and steering group

14. Knowing How We Are Doing Team-working & staff wellbeing Patient experience & outcomes Safety & reliability Efficiency & value Early efforts More refined

15. Well organised theatre: 5S Typical before 5S Sort Simplify/Set in order Sweep & Shine Standardise Sustain Anaesthetic store after 5S

16. Well organised theatre Overstock in main store room (4 theatres) resulted in financial reimbursement of £27,500 Out of date stock in main store room (twin suite) valued at £9,385 Overstock in prep and anaesthetic rooms (2 theatres) valued at £10,400 Potential financial benefit for a twin theatre suite to make a ‘one-off’ saving of £24,150

17. Operational Status at a Glance

18. Team-working Who is the leader?

19. Pre-list team briefing

20. Problems avoided by Team Brief

21. Impact on culture (safety attitudes questionnaire) p<0.05

22. Briefing - Checklist - Debriefing Briefing: WHO surgical safety checklist ‘Sign in’ Time out (pre-op pause) ‘Sign out’ De-briefing

24. Local adaptation of time-out

25. Debriefing

27. Hierarchy of interventions for efficiency

28. Session utilisation Over 8 weeks: Cost of cancelled, unused sessions £31,746 Cost of extra sessions £81,664

29. Session Utilisation Mean – 90% Mean – 99%

30. Number of waiting list initiative sessions TPOT meeting reviews data

31. Informed scheduling: Variation in procedure time and turn-round time Phaco-emulsification and intra-ocular lens insertion for cataract Procedure time Turn-round time

32. List utilisation Start, turnaround and finish times August 2008 June 2009

33. The ‘Perfect’ list ? List start time List end time Only worthwhile if it stops overruns, or adds more patients

34. Summary of key events & milestones

35. Summary of benefits Safety & team working Recovery: pain scores 35° to 98% Measurable increase in job satisfaction, team working climate and safety climate Consumables and equipment £10K one off stock reduction per theatre £9K annual saving per theatre on consumables Session and list utilisation Improved session utilisation from 90% to 99% with abolition of extra sessions 25 minute reduction in average start time, 63% reduction in average turnaround time 16% increase in touch time Overall gain for an average trust (estimated) approx £2 million per annum