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Time & Motion at work
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Message 1.Â
Posted by Ell Kaye (U7798599) on Saturday, 18th April 2009
Sat, 18 Apr 2009 13:30 GMT
As some of you know I work in an Operating Theatre of a local general hospital, due to a retirement of a collegue, and the modern pressures of the health service, I am now in charge of this theatre and have to implement a more efficient way of working.
Not many months ago we were achieving 5-6 cataract operations in a 4 hour session, we now have a new consultant surgeon and he is completing 8 operations in a 3 hour period, and could conceivably complete 10 operations.We were finding that the paper/computer work was taking longer than the operation, and we were rushing to keep up.
Now this is obviously not the way to continue, the initial reaction was that the surgeon should be prevented from doing so much, but that is not what our masters wish to hear.
My initial reaction was to look at what we were doing and why. I asked why were we documenting the same thing 3-4 times and what was actually necessary, the paper work has now been reduced.
I also borrowed a pedometer to measure how much walking to and from tasks, that have to be repeated 8 times, the upshot was by turning the operating table round 90deg the footsteps can be halved.
The consultant is impressed, the nurses are not, they just think I do not like exercise, I say that pointless unproductive walking is taking time away from the patient care, and I'll get a dog if I need more exercise...
The hospital has adopted a 'Lean Fix Its' but this is seen as being another HR thing and 'not for us'. I have to say that the literature is pretty in penetrable.
I've trawled the net and cannot find the definitive flow chart on how endless walking backwards and forwards is not good.
Can anyone help me here?
Thanks in advance. -
Message 2
Posted by Dunlurkin NL (U2675855) on Saturday, 18th April 2009
These are probably not quite relevant but may help to prove a point
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Message 3
Posted by Dunlurkin NL (U2675855) on Saturday, 18th April 2009
Just wondering - you might get more replies in TB as this relates to a whole range of jobs.
Dunlurkin -
Message 4
Posted by sagethyme (U5272261) on Saturday, 18th April 2009
Hi Ell Kaye
Interested in your question. No knowledge of working in hospitals, but I do have experience of improving processes in other areas, and getting agreement from the folk affected.
I suggest that your nurses will not be impressed by flow charts and instructions from elsewhere. They should have a hand in designing them.
Would it be possible to sit them down and ask them how they would design the system in an ideal world? If you could then incorporate at least some of their ideas, even if not exactly what you or the surgeon wanted, they would have more interest in making changes.
I have seen this approach work, when people were so surprised to be asked their opinion, that they cooperated fully with the new processes. -
Message 5
Posted by petal jam (U1466691) on Saturday, 18th April 2009
Sat, 18 Apr 2009 14:25 GMT, in reply to Ell Kaye
Ell your proposition(?) is really interesting. Don't know a great deal about the various theories of work, except that they exist, but I think Sagetime is probably onto something. If you are managing change it now seems fundamental to ensure that your team will have a vested interest in making those changes - not just understanding that they work, but really owning them.
My hunch is that you might find something helpful if you look at Quality Circles. Obviously you've already identified that a major contribution can be made to patient care by time-saving. What you need is to show your team that it is their tchnical skills and experience which will make it efffective.
Hope that GEM or Loot or one of the Motivators is along soon. -
Message 6
Posted by Sunny Clouds (U7606212) on Saturday, 18th April 2009
Have you looked into why they don't want to walk less? Does walking contribute to mental/physical recovery time between tasks? Will walking less affect concentration?
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Message 7
Posted by Jane Eyre (U5521427) on Sunday, 19th April 2009
I'm not sure that this is exactly on the point, but thought it might interest you Ell Kaye.
I was at the Science Museum recently and they had an exhibition about Formula One and how developments made in that field had been found to be applicable in other spheres (bear with me here, I will get to the point.)
One of the bits that I found fascinating was how doctors from Great Ormond Street had come to observe how they handled pit stops to see whether they could learn anything that they could apply to the transfer of critical patients from the operating theatre to intensive care. From memory some of the things they learnt were:
1 having someone in overall charge
2 getting rid of unnecessary people milling about
3 being very clear about what tasks each person was responsible for
4 having a checklist of what had to be done which was handed over to the IT team once completed
5 having a set order in which things happened (eg patient's airway dealt with first.)
They found that this increased speed and efficiency and prevented things being missed or duplicated. You might be able to get more information via GOSH. I know that it isn't so much to do with the unnecessary walking about that you are concerned with but might help to show how small changes can lead to greater efficiency and improve patient care. -
Message 8
Posted by petal jam (U1466691) on Monday, 20th April 2009
Mon, 20 Apr 2009 22:40 GMT, in reply to Ell Kaye
Just bumping this becuase I'm hoping that someone with management science background or expertise at managing change will see it.
[Also I'm really, really interested to see how Ell solves the challenge.] -
Message 9
Posted by DeathToSSGs (U11202885) on Tuesday, 21st April 2009
The other crucial point about jane-eyre's post re GOSH learning from F1 is that you don't have to be in a particular profession to be able to see how procedural improvements can be made.
The staff at GOSH were particularly impressive for not getting all defensive about F1 being so utterly unlike medicine.
Regarding getting the nurses to stop being obstructive, my personal inclination would be to say something about tails wagging dogs and GA*G but that's why I hated my time in HR. -
Message 10
Posted by Angua - the vegetarian werewolf and Official Shoe Monitor (U3750755) on Tuesday, 21st April 2009
Tue, 21 Apr 2009 22:33 GMT, in reply to DeathToSSGs in message 9
There was a radio programme about this years ago R4, ref benchmarking and process improvement F1/hospitals IIRC. I used it at work as part of Improvement Process Ampping and problem solving.. -
Message 11
Posted by celladefarm (U13688521) on Wednesday, 22nd April 2009
Do excuse me, as I am not in the medical profession, and never was, and you would find it challenging to T&M a Nursery Dept!
I was just wondering if a couple of 'wild balls' would, maybe, introduce some ideas outside the box.
Could you fit this highly efficient surgeon and his theatre nurse with small microphones, have them dictate everything that needs recording, as it happens, and have someone elsewhere typing it up as the Operations are happening?
I am impressed with the idea of a 90 degree turn on the operating table. Sometimes the simplicity of a solution is amazing.
Hope you don't think I'm an intrusive 'rock head' but I find this thread interesting. Cella -
Message 12
Posted by Ell Kaye (U7798599) on Wednesday, 22nd April 2009
Wed, 22 Apr 2009 09:54 GMT, in reply to celladefarm in message 11
Thank you all for your replies & interest.
Over the weekend I did a mini 5 page power point type presentation, and showed it to my line manager, she was ecstatic, as this ticks all the boxes for the hospital lean team, I'm to fine tune it and make sure my name is on it and she is going to take it up to her bosses, in the hope that my instinctive understanding of what needs doing can be rolled out over the other 8 operating theatres....gulp!
My line manager, is now insisting that this is the way to go, as it eliminates all risks, I mean *all* risks of slips, trips, & falls for the patients & staff, and as importantly frees up more time for patient care which in this case includes documentation, dispensing drugs, lenses, dressing etc. as well as general care of the patient.
I have followed up all your very useful links, thanks again, and I've decided to get myself on the hospital in-house course toot sweet, and book 'awkward one' on a subsequent course.
The 'awkward one' is sulking, the others are ok. The 'awkward one' hinted that in my absence she would switch things back, the surgeon told me that was not going to happen, so I told her that I expected the layout to stay as it is, she muttered "we'll see......" under her breath.
Today I'm not at work, so yes "we'll see", I'm confident that things will not change back.
Now if only I could bring my 'organisational skills' home with me...... -
Message 13
Posted by kentishmannotmok (U13880279) on Wednesday, 22nd April 2009
Two things spring to mind in connection with your problems:
1) Jane-eyre is absolutely spot on in the F1 connection, I believe further back in time an F1 team looked at how ferries were turned around in the Port of Dover in order to improve pit times in F1 races. Essentially you are looking at a similar problem, turnround. Budget airlines seem to manage this enormously well, though the whole process extends up to two hours before and probably another hour after the turnround whilst the plane, your doctor, is only on the ground for half an hour. I'm sure there will be some case studies you could get hold of.
2) The nurses aren't really making a joke about exercise, they're objecting to the changes. People don't like change very much even if it's for the good. change is destabilising and people feel threatened by it. In your situation it seems you have been promoted, but you're still working with the same people, they could infer also that you are just flexing your new muscles. They have to 'buy in' to the change rather than have it sold to them.
It's not easy but you should have support from above, after all the health service is supposed to be the biggest single employer in Europe, the resources that ought to be readily at your disposal should be fabulous. -
Message 14
Posted by Marmalade Drizzle (U2239190) on Wednesday, 22nd April 2009
Ell Kaye
Just want to say;
Bluddy well done you! I know how hard it is to make changes in a hospital environment and appreciate the effort that you must have gone through to achieve this.
This is no mean feat - congratulations!
marms -
Message 15
Posted by Sunny Clouds (U7606212) on Wednesday, 22nd April 2009
Is there anything you could do to get the awkward one on your side? Any sort of nice thing that could happen to her? Any way you could involve her on a very individual level like getting her to give you her own feedback on what else could be improved?
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Message 16
Posted by Ell Kaye (U7798599) on Wednesday, 22nd April 2009
Wed, 22 Apr 2009 15:28 GMT, in reply to kentishmannotmok in message 13
2) The nurses aren't really making a joke about exercise, they're objecting to the changes. People don't like change very much even if it's for the good. change is destabilising and people feel threatened by it. In your situation it seems you have been promoted, but you're still working with the same people, they could infer also that you are just flexing your new muscles. They have to 'buy in' to the change rather than have it sold to them.Â
Thanks for your reply Kentishmannotmok, the problem is the work load has increased, whether we like it or not, so gentle democratic 'change mangement' did not feature in the first place, we had no option but to get on with it.
Retiree went as soon as she realised that she could not keep the work load the same, she maintained that there should be more staff etc etc....
You are right I am working with the same people and long before my collegue retired they were aware that I did not like the 'Fussy Nursey' way she had of working, other nurses will know what I mean.
Anyway, the decision has been made for me, my bosses are delighted with the change and the others will have to get used to it I'm afraid.
PS Thanks Marms -
Message 17
Posted by Ell Kaye (U7798599) on Wednesday, 22nd April 2009
Wed, 22 Apr 2009 15:31 GMT, in reply to Sunny Clouds in message 15
Is there anything you could do to get the awkward one on your side? Any sort of nice thing that could happen to her? Any way you could involve her on a very individual level like getting her to give you her own feedback on what else could be improved?Â
So far I've drawn a blank. -
Message 18
Posted by Helen (U1476131) on Wednesday, 22nd April 2009
This is precisely my line of work, and in my experience the "awkward ones" do come round to it, and often turn into the ones who do most to keep the new arrangements running, once they've got used to them. It just needs firm management to start with, which it sounds like you have, if she's being told "No, it's not going to be changed back"
I've never heard so much fuss as I got from one operator in an assembly task which I "Leaned"-up and Poke-Yoka'd (errorproofed), but by the end of the week, she was the fastest and most competant of any of the operators using the new jigs and fixtures which I'd put in to make things go more smoothly and cut out a few quality issues we were having. -
Message 19
Posted by kentishmannotmok (U13880279) on Wednesday, 22nd April 2009
Well of course the work load has increased, the surgeon's working full time.
The health service spends multi-millions on this sort of stuff, they don't need to leave you in the sh... struggling for solutions, they have so much expertise resource that ought to be at your disposal.
I wouldn't mind betting there's all this fabulous money spent in the health service on management training and so on, but just one tiny percentage on practical application.
I know this isn't really helpfull Ell Kaye but I believe that when people put pressure on you from above, you need to bat it back to them with a bit of top spin. If there's pressure, share it. -
Message 20
Posted by Ell Kaye (U7798599) on Wednesday, 22nd April 2009
Wed, 22 Apr 2009 20:24 GMT, in reply to Helen in message 18
This is precisely my line of work, and in my experience the "awkward ones" do come round to it, and often turn into the ones who do most to keep the new arrangements running, once they've got used to them. It just needs firm management to start with, which it sounds like you have, if she's being told "No, it's not going to be changed back"Â
Helen, I love you, so now we can do 'firm'.....ooh bliss,
My whole point is that as the manager of this situation, it could be a production line for the latest lippy, or getting the fav cheepo line in Lidls, 'IT WILL BE DONE' there is no argument, no negotiation, no discussion..... end of.
I'm not a professional in industrial management, but in my limited experience the 'trial period' is set up to last long enough for the objectors to forget what they were objecting to.
Ho hum. -
Message 21
Posted by Go away historians of the future (U1484964) on Wednesday, 22nd April 2009
>> the 'trial period' is set up to last long enough for the objectors to forget what they were objecting to. <<
Sounds about right, but you don't say that out loud.
The 'What, Why, How' technique is useful: What are we trying to change, Why are we trying to change it, How are we going to do it. By asking those questions of people you give them an interest in the outcome - most people who are resistant to change (or arsey, if you like abbreviations) are that way because they're not involved in the process. Change that and you change them.
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