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Bill Nettles, Surgical Services Manager,
sat in his office and wondered why his surgeons could not start their first
operation of the day on time. He knew that some morning delays were
inevitable, but many seemed preventable. Moreover, these delays were
likely to be very costly both in terms of dollars and in their ripple effect on
surgeries scheduled later in the day. A few days later, he discussed his
concerns with Dr. Helen Mirden, Chief of Surgery. Dr. Mirden agreed and
they presented their project entitled “Reduction of First Start Delays and
Cancellations in Surgery” to the hospital’s quality improvement council.
After going through a project prioritization process the project was
approved and a timeline developed.

As the hospital used the six
sigma process to improve quality, it began with the Define
phase. Bill Nettles, Dr. Mirden, and Margaret Jordan (a nurse by
training, six sigma black belt and the project leader) selected a
multi-disciplinary team consisting of an orthopedic surgeon, a thoracic
surgeon, an anesthesiologist, one nurse anesthetist, two operating room nurses,
a holding nurse, a circulator nurse, two pre-operative clinic staff, and two
registration staff. After orientation and training in basic six sigma
methodology and tools, the team created the following goal statement:

We aim to increase the number
of first start cases wheeled out of Main OR holding by the scheduled start time
to a room ready operative suite to 100%.

The team further defined the
process by creating a SIPOC Diagram (Figure 1) which outlined the key
stakeholders (suppliers and customers) in the process and provided a high level
overview of the process (inputs, process, and outcomes) to be improved.

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The team next moved to the Measure
phase where the team created a value stream map to confirm the current process
flow and identified outputs, inputs and process variables that impact the
project goals. The process involved four interrelated people or groups
preparing for the surgery: registration (Figure 2), patient holding
(Figure 3), anesthesiologist (Figure 4), and Surgeon (Figure 5)..blackboard.com/courses/1/OAD-48563-SU-2017-OA/content/_2132798_1/dir_week3.zip/Week3Flowcharts.pdf”>Click here to download a pdf version of the
flowcharts.

Figure 2 Registration

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Figure 3 Holding Room Flowchart

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Figure 4 Anesthesiologist Flowchart

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Figure 5 Surgeon Flowchart

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The World Health Organization
(WHO) has created a surgical safety checklist to reduce errors that can occur
in the OR. Take 5 minutes to watch this video to get a sense of the
complexities in an OR: World Health Organization (WHO) surgical safety
checklist:

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Thinking about the video and the
WHO checklist and looking at Figures 2, 3, 4 and 5, what are your first
impressions? Do there appear to be any redundancies in this system? [Hint: Look
closely at Figures 3 and 4. How many times is the patient asked to give
consent?] What else do you see? Are these redundancies for patient safety? What
about the utility of other models such as the WHO checklist? Looking at Figures
2, 3, 4 and 5, make a list of the number of times when a patient interacts separately
with a staff person (clerical, medical, or nursing). Think about the WHO
surgical safety checklist. How many separate interactions does the
patient have with healthcare providers in that scenario?

Compose a 2-3 page analysis in
APA format with a title page, introduction, conclusion and reference page. Cite
1-2 scholarly references beyond your text to support your opinions.

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