› Tr a n s f o r m i n g T h e a t r e
Transforming Theatre IN RESPONSE TO LONG WAITING LISTS FOR SURGICAL CARE, RCSI HAS DESIGNED THE TRANSFORMING THEATRE PROGRAMME TO HELP HOSPITALS MAXIMISE THEIR THEATRE RESOURCES AS EFFICIENTLY AS POSSIBLE
Professor Deborah McNamara, MD, FRCSI
rofessor Deborah McNamara, MD, FRCSI is a Consultant General and Colorectal Surgeon at Beaumont Hospital in Dublin, a Clinical Professor of Surgery at RCSI, Co-Lead on the National Clinical Programme in Surgery and the chair of RCSI’s Working Group on Gender Diversity. Professor McNamara is also Clinical Lead for the Transforming Theatre Programme established by RCSI and, as the initial two-year pilot with the South/South West Hospital Group (SSWHG) draws to a close, she is currently seeking a second hospital group to participate in the programme. “RCSI has been working in the area for some time,” explains Professor McNamara. “Our focus from the outset has been to make the patient’s journey in the operating theatre department the focus of standardised measurement and quality improvement.” Professor McNamara has worked closely with Programme Manager, Charlie Dineen of RCSI, a process improvement expert, to develop and deliver the Programme using the principles of lean methodology – a way of optimising the people, resources, effort, and energy of organisations toward creating value for the customer. 16
“The Transforming Theatre Programme design is a result of carefully constructed elements of lean methodology and principles, steeped in clinical knowledge and expertise,” says Dineen. “It is this coming together of lean experience coupled with clinical insights and awareness which has created a model specifically applicable to a healthcare environment.” Dineen explains that some of the lean principles paramount in the Transforming Theatre Programme are Value, Flow and Respect for People. “Value is to the fore in relation to people’s time,” he says. “For instance, we try to maximise the time surgical teams are engaged in surgical activity as opposed to waiting and other non-value activities, and likewise, from a patient’s perspective, prioritise timely access to the surgical care they require. “Patient flow through theatre is captured using five standardised key milestones which in turn generate a balanced suite of theatre metrics in a cascading tiered structure designed for frontline theatre teams, hospital managers and Hospital Group leaders. The measurement system also identifies the impact upstream and downstream processes have on the smooth transition of patients through theatre. “To demonstrate respect for people, it is critical to engage and empower people closest to the work – in this situation, the operating theatre staff. The Transforming Theatre Core Team at each site includes a surgical lead, anaesthetic lead and nurse lead, and together they determine locally the overall direction of the programme, while aligning with the suite of metrics provided. Lean tools are deployed as appropriate during Quality Improvement projects which are captured within an overall Theatre Management System providing effective action-based reviews and support.” At the outset of the pilot, Professor McNamara was delighted when Professor Mark Corrigan, FRCSI, Clinical Lead within the SSWHG and Consultant Breast Surgeon in Cork University Hospital (CUH), volunteered to be the local surgical leader of the Programme. “Surgeons hate waiting lists,” says Professor Corrigan, explaining his motivation for taking on the role. “We all want to work and our reward is seeing patients progress. If the service is to make the case for additional theatres, we need improved patient flow using the resources we have. What appealed to me about Transforming Theatre is that it is one of the few initiatives that empowers clinical staff from the frontline rather than from management down. “Often when management talks about efficiencies without providing the tools to achieve them, it can mean working people who are already stretched thin even harder. They lose the locker room. The beauty of Transforming Theatre is that it provides hospital sites locally with their own data from within. It’s a truism that what you measure, you improve, but once you start
