Operating Room Design - Mayo Case Study

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Presentation delivered during a Hospital Efficiency Seminar hosted by Institute for Healthcare Optimization on July 25, 2013. Reviews Mayo Clinic experience and outcomes with using variability theory to re-design the management of the operating rooms at Mayo Clinic Florida.

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  • Our goals when deliver healthcare should be to provide the right care, to the right patient, at the right time. It is critical that we do that will maintaining or increasing the value of the healthcare we deliver. In doing this variability is the enemy.
  • Our goals when deliver healthcare should be to provide the right care, to the right patient, at the right time. It is critical that we do that will maintaining or increasing the value of the healthcare we deliver. In doing this variability is the enemy.
  • Our goals when deliver healthcare should be to provide the right care, to the right patient, at the right time. It is critical that we do that will maintaining or increasing the value of the healthcare we deliver. In doing this variability is the enemy.
  • While we are all familiar with variability in clinical care (every case is unique and requires a tailored solution), professional variability (each clinician approaches things differently), and flow variability (we can’t control when the patients need care), applying variability theory provides us with a different way to look at and manage variability in healthcare. Natural…….and Artificial. We embarked on our MVP intiative to apply variability theory and operations management to our surgical practice in an attempt to improve the value of our surgical care.
  • While we are all familiar with variability in clinical care (every case is unique and requires a tailored solution), professional variability (each clinician approaches things differently), and flow variability (we can’t control when the patients need care), applying variability theory provides us with a different way to look at and manage variability in healthcare. Natural…….and Artificial. We embarked on our MVP intiative to apply variability theory and operations management to our surgical practice in an attempt to improve the value of our surgical care.
  • While we are all familiar with variability in clinical care (every case is unique and requires a tailored solution), professional variability (each clinician approaches things differently), and flow variability (we can’t control when the patients need care), applying variability theory provides us with a different way to look at and manage variability in healthcare. Natural…….and Artificial. We embarked on our MVP intiative to apply variability theory and operations management to our surgical practice in an attempt to improve the value of our surgical care.
  • With this understanding, there have been several key principles that have guided our efforts. These include isolating the unpredicatble variation of the urgent/emergent practice, Natural Variation, from the manageable and modifiably variation of the elective practice, Artificial Variation. Design a process to create a predictable and more consistent surgical schedule, Limit the number of changes we make to the elective schedule on the day of surgery, and maintain the integrtity of our surgical teams so that patients can benefit fomr the expertise and quaity we deliver through our team-based care.
  • With this understanding, there have been several key principles that have guided our efforts. These include isolating the unpredicatble variation of the urgent/emergent practice, Natural Variation, from the manageable and modifiably variation of the elective practice, Artificial Variation. Design a process to create a predictable and more consistent surgical schedule, Limit the number of changes we make to the elective schedule on the day of surgery, and maintain the integrtity of our surgical teams so that patients can benefit fomr the expertise and quaity we deliver through our team-based care.
  • With this understanding, there have been several key principles that have guided our efforts. These include isolating the unpredicatble variation of the urgent/emergent practice, Natural Variation, from the manageable and modifiably variation of the elective practice, Artificial Variation. Design a process to create a predictable and more consistent surgical schedule, Limit the number of changes we make to the elective schedule on the day of surgery, and maintain the integrtity of our surgical teams so that patients can benefit fomr the expertise and quaity we deliver through our team-based care.
  • Specific to our surgical practice we identified two drivers of significant variability. First, day-today variability. AS you can see here, our surgical volumes can vary from 35 cases on one day, to over 60 cases a few days later. This degree of day-to-day variability has a significant negative impact on staffing, planning for hospital placement and flow, supply chain and many other aspects of running a safe, efficient and value driven operating room.
  • Specific to our surgical practice we identified two drivers of significant variability. First, day-today variability. AS you can see here, our surgical volumes can vary from 35 cases on one day, to over 60 cases a few days later. This degree of day-to-day variability has a significant negative impact on staffing, planning for hospital placement and flow, supply chain and many other aspects of running a safe, efficient and value driven operating room.
  • Another type of variability is within day variability. This is the changes that we make in the elective schedule on the day of surgery. These changes most often are the result of a poorly crafted schedule for the day that needs to then be remedied on the day of surgery. This graph represents the number of changes to the elective schedule that were made on the day of surgery. Almost 10% of our elective cases are moved on the day of surgery, or around 5 cases each day. Remember, these are cases that are scheduled into a particular room with a particular team to support that case. You can see that these cahnges have a significant impact on safety, teamwork, patient satisfaction, to name a few.
  • Another type of variability is within day variability. This is the changes that we make in the elective schedule on the day of surgery. These changes most often are the result of a poorly crafted schedule for the day that needs to then be remedied on the day of surgery. This graph represents the number of changes to the elective schedule that were made on the day of surgery. Almost 10% of our elective cases are moved on the day of surgery, or around 5 cases each day. Remember, these are cases that are scheduled into a particular room with a particular team to support that case. You can see that these cahnges have a significant impact on safety, teamwork, patient satisfaction, to name a few.
  • Managing this variability has significant benefits for our patients, Mayo, each surgical department, and the individuals who provide surgical care to our patients.
  • With this understanding, there have been several key principles that have guided our efforts. These include isolating the unpredicatble variation of the urgent/emergent practice, Natural Variation, from the manageable and modifiably variation of the elective practice, Artificial Variation. Design a process to create a predictable and more consistent surgical schedule, Limit the number of changes we make to the elective schedule on the day of surgery, and maintain the integrtity of our surgical teams so that patients can benefit fomr the expertise and quaity we deliver through our team-based care.
  • This represent the OR allocation to support these principles and design. Notice the explicitly defined and isolated resource for the urgent emergent cases.
  • Overall Summary
  • Lessons learned
  • Operating Room Design - Mayo Case Study

    1. 1. Re-engineering Operating Room Flow to Improve Operational Performance Institute for Healthcare Optimization Hospital Efficiency Seminar July 25, 2013 C. Daniel Smith, MD 1
    2. 2. Conflict of Interest / Disclosure • No financial or other relationship with any product or treatment discussed in this talk
    3. 3. Today’s Goals/Objectives • Case study on variability management • Results – objective & subjective • Personal reflections on do’s and don’ts • Q&A 3
    4. 4. Case Study Setting 4
    5. 5. Mayo Clinic Culture • Fully integrated healthcare practice • Physician lead, consensus based, committee structured • All physicians salaried* • No productivity-based financial compensation adjustment* • Academic practice with expectations of productivity in all “three shields”* 5
    6. 6. Mayo Clinic Florida • 214 bed hospital (21 ORs, 28 ICUs) and outpatient practice within a single complex/campus – opened in 2008 • 11,900 admissions/ year: 55% surgical • 12,000 operations/year – complex case mix (e.g., 150 liver transplants, 1,200 NS, 900 GISurg) • 443,500 outpatient visits annually 6
    7. 7. Mayo Clinic Florida - Demographics Four surrounding counties Rest of Florida 47,000 23,000 Southeastern USA 11,000 Rest of USA 7,000 International 1,000 Total Average age - 59 89,000 55% Medicare 2010 OM – 6.7% 7
    8. 8. Mayo Clinic Florida - Staff Patient Care Research Total Staff physicians and scientists 307 41 348 Residents, fellows, students 239 85 324 Administrative and allied health 2,918 146 3,064 Total 3,464 272 3,736 8
    9. 9. CEO Imperatives • Aggressive growth and expansion (“30% increase in volume by 2012”) • Focus on optimization • “Just do it” • Rapid cycle change • Increase capacity with existing resources • Leverage organization’s core values (needs of patient come first, teamwork) 9
    10. 10. Healthcare Delivery Goals To provide the right care To the right patient At the right time 10
    11. 11. Healthcare Delivery Goals To provide the right care To the right patient At the right time Quality * Value = Cost *Outcomes, Safety, Service 11
    12. 12. Healthcare Delivery Goals To provide the right care To the right patient At the right time Quality * Value = Cost *Outcomes, Safety, Service VARIABILITY IS THE ENEMY 12
    13. 13. Variability in Healthcare Clinical Variability Professional Variability Flow Variability 13
    14. 14. Variability in Healthcare Clinical Variability Natural Variability – a result of naturally occurring processes; uncontrollable Professional Variability Flow Variability 14
    15. 15. Variability in Healthcare Clinical Variability Natural Variability – a result of naturally occurring processes; uncontrollable Professional Variability Flow Variability Artificial Variability – a function of man made decisions; controllable 15
    16. 16. Variability Management in Our ORs 16
    17. 17. Variability in Operating Rooms Day-to-Day Within-Day 17
    18. 18. Variability in Operating Rooms Day-to-Day • Peaks and valleys in day-to-day volume of surgical cases • “No one wants to operate on Monday or Friday” Within-Day 18
    19. 19. Variability in Operating Rooms Day-to-Day • Peaks and valleys in day-to-day volume of surgical cases • “No one wants to operate on Monday or Friday” Within-Day • On the day of surgery, changes to the OR schedule and resource allocation • Emergencies, add-ons, delays, etc. 19
    20. 20. Day-to-Day Variability
    21. 21. Day-to-Day Variability Staffing Hospital census Supply chain …..
    22. 22. Within-Day Variability – Light Day
    23. 23. Within-Day Variability – Busy Day
    24. 24. Within-Day Variability Elective Rooms on Day of Surgery 2009-2010 No. Room Changes 8%
    25. 25. Within-Day Variability Elective Rooms on Day of Surgery 2009-2010 No. Room Changes 8% Safety Patient satisfaction Teamwork ….
    26. 26. “Our ORs Are A Mess” • Prime time OR utilization <65% • 15 FTEs of overtime every pay period • Low surgeon and staff satisfaction with OR management and efficiencies • Concern about absence of specialty specific teams • Frequent disruptions of elective cases by transplants and urgent cases • “Whatever / Whenever” culture
    27. 27. Benefit of Managing Variability Benefits Patient – predictability, reliability, safety Organization – optimize resources & throughput Departments – collaboration, more resources Individuals – predictable lives, teams, “flow” 27
    28. 28. Operating Room Redesign Collaboration with IHO 28
    29. 29. OR Variability Management Team • Chair, Surgical Committee & Chair, Department of Surgery • Vice Chair, Surgical Committee & Chair, Department of Anesthesiology • Chair, Department of Ophthalmology • Administrator, Surgery & Procedural Operations • Director, Surgical Services • Director, Systems and Procedures • Financial Analyst MVP Managing Variability Program November 2009 meets 2X weekly Consulting with Institute for Healthcare Optimization (IHO)
    30. 30. MVP – Key Principles • Separate and isolate Urgent/Emergent (Natural Variation) from Elective (Artificial Variation) surgical cases • Effect a predictable and consistent daily elective surgical schedule • Minimize the number of changes to the elective surgical schedule on the day of surgery • Optimize the ability for teams to remain intact and surgeons to work with their primary teams 30
    31. 31. Goals for MVP • Increase throughput / utilization • Decrease overtime • Assure access for urgent/emergent cases • Assure predictable and reliable elective schedule • Optimize room flow and efficiencies • Reduce and limit the number of same-day changes to the elective surgical schedule 31
    32. 32. Re-Engineered ORs – Initial Plan Urgent/Emergent Work-Ins Elective No of Rooms: 2 No of Rooms: 2 No of Rooms: 15 Includes: Unscheduled A-E + H/L Tx Cases + prior night Es Ave Room Utilization: 33.5% Includes: NS, CTS, GS, Ortho C&A Work-Ins + Abdominal Tx Ave Room Utilization: 64.9% Target Utilization: 80.0% A Ave Waiting Time 11 minutes B 12 minutes C 13 minutes D 15 minutes E 18 minutes Case Type “Opportunity”: + 1,370 Cases Elective Rooms 7:30-5:00 Work-in Rooms 7:30-7:00 Staffing Model Approved
    33. 33. Elective (16) Urgent / Emergent (3) Scheduled Within 48 hours 2000 1900 1800 Artificial Variability Natural Variability 1700 E 1600 E 1500 1400 E E E E 1200 E 1000 0900 0800 0700 E E E 1300 1100 E E E E E E E E E E E E E E E 401 402 403 404 102 103 104 105 405 406 407 408 409 410 411 412 414 415 404 102 103 104 105 403 405 406 407 408 409 410 411 412 414 415 E E E E E E E E E E E E E E E
    34. 34. MVP Results – Time Frame Pre-MVP MVP 1 MVP II MVP III Nov 1, 2009 – Oct 31, 2010 Nov 1, 2010 – Oct 31, 2011 Nov 1, 2011 – Jul 31, 2012 Aug 1, 2012 – Present • Baseline Data Whatever, Whenever • Full implementation Highest compliance 34
    35. 35. Journal of the American College of Surgeons Volume 216, Issue 4 , Pages 559-568, April 2013 35
    36. 36. Surgical Cases Surgical Minutes OR Utilization (19 Room Model) Number of Overtime FTE's (average) Staff Turnover (highest to most recent) Daily Case Volume Variation Daily Surgery Minutes Variation Elective Room Changes (Average/Mon) Elective Room Changes (%) Pre- MVP 11,874 1,757,008 61% 7.4 20.3% 55.24 6,531 80 8% Salary Dollars (Adjusted for Salary Increases) Total Monthly $12,607,061 $1,045,942 $13,395,997 $1,115,646 6% 7% $1,062 $7.18 $1,070 $7.26 0% 1% $2.47 $1.40 $111,488 -43% $93,929,569 $98,686,963 5% Cost/Case Cost/Minute of Surgery Staff Turnover Cost (millions) Overtime Cost Savings Total OR Net Revenue (Fee Increase adjusted) MVP I % Change 12,367 4% 1,844,479 5% 64% 5% 5.4 -27% 11.5% -43% 44.06 -20% 5,124 -22% 25 -69% 2% -70% 36
    37. 37. Surgical Cases Surgical Minutes OR Utilization (19 Room Model) Number of Overtime FTE's (average) Staff Turnover (highest to most recent) Daily Case Volume Variation Daily Surgery Minutes Variation Elective Room Changes (Average/Mon) Elective Room Changes (%) Pre- MVP 11,874 1,757,008 61% 7.4 20.3% 55.24 6,531 80 8% Salary Dollars (Adjusted for Salary Increases) Total Monthly $12,607,061 $1,045,942 $13,395,997 $1,115,646 6% 7% $1,062 $7.18 $1,070 $7.26 0% 1% $2.47 $1.40 $111,488 -43% $93,929,569 $98,686,963 5% Cost/Case Cost/Minute of Surgery Staff Turnover Cost (millions) Overtime Cost Savings Total OR Net Revenue (Fee Increase adjusted) MVP I % Change 12,367 4% 1,844,479 5% 64% 5% 5.4 -27% 11.5% -43% 44.06 -20% 5,124 -22% 25 -69% 2% -70% 37
    38. 38. Surgical Cases Surgical Minutes OR Utilization (19 Room Model) Number of Overtime FTE's (average) Staff Turnover (highest to most recent) Daily Case Volume Variation Daily Surgery Minutes Variation Elective Room Changes (Average/Mon) Elective Room Changes (%) Pre- MVP 11,874 1,757,008 61% 7.4 20.3% 55.24 6,531 80 8% Salary Dollars (Adjusted for Salary Increases) Total Monthly $12,607,061 $1,045,942 $13,395,997 $1,115,646 6% 7% $1,062 $7.18 $1,070 $7.26 0% 1% $2.47 $1.40 $111,488 -43% $93,929,569 $98,686,963 5% Cost/Case Cost/Minute of Surgery Staff Turnover Cost (millions) Overtime Cost Savings Total OR Net Revenue (Fee Increase adjusted) MVP I % Change 12,367 4% 1,844,479 5% 64% 5% 5.4 -27% 11.5% -43% 44.06 -20% 5,124 -22% 25 -69% 2% -70% 38
    39. 39. Surgical Cases Surgical Minutes OR Utilization (19 Room Model) Number of Overtime FTE's (average) Staff Turnover (highest to most recent) Daily Case Volume Variation Daily Surgery Minutes Variation Elective Room Changes (Average/Mon) Elective Room Changes (%) Pre- MVP 11,874 1,757,008 61% 7.4 20.3% 55.24 6,531 80 8% Salary Dollars (Adjusted for Salary Increases) Total Monthly $12,607,061 $1,045,942 $13,395,997 $1,115,646 6% 7% $1,062 $7.18 $1,070 $7.26 0% 1% $2.47 $1.40 $111,488 -43% $93,929,569 $98,686,963 5% Cost/Case Cost/Minute of Surgery Staff Turnover Cost (millions) Overtime Cost Savings Total OR Net Revenue (Fee Increase adjusted) MVP I % Change 12,367 4% 1,844,479 5% 64% 5% 5.4 -27% 11.5% -43% 44.06 -20% 5,124 -22% 25 -69% 2% -70% 39
    40. 40. Surgical Cases Surgical Minutes OR Utilization (19 Room Model) Number of Overtime FTE's (average) Staff Turnover (highest to most recent) Daily Case Volume Variation Daily Surgery Minutes Variation Elective Room Changes (Average/Mon) Elective Room Changes (%) Pre- MVP 11,874 1,757,008 61% 7.4 20.3% 55.24 6,531 80 8% Salary Dollars (Adjusted for Salary Increases) Total Monthly $12,607,061 $1,045,942 $13,395,997 $1,115,646 6% 7% $1,062 $7.18 $1,070 $7.26 0% 1% $2.47 $1.40 $111,488 -43% $93,929,569 $98,686,963 5% Cost/Case Cost/Minute of Surgery Staff Turnover Cost (millions) Overtime Cost Savings Total OR Net Revenue (Fee Increase adjusted) MVP I % Change 12,367 4% 1,844,479 5% 64% 5% 5.4 -27% 11.5% -43% 44.06 -20% 5,124 -22% 25 -69% 2% -70% 40
    41. 41. Surgical Cases Surgical Minutes OR Utilization (19 Room Model) Number of Overtime FTE's (average) Staff Turnover (highest to most recent) Daily Case Volume Variation Daily Surgery Minutes Variation Elective Room Changes (Average/Mon) Elective Room Changes (%) Pre- MVP 11,874 1,757,008 61% 7.4 20.3% 55.24 6,531 80 8% Salary Dollars (Adjusted for Salary Increases) Total Monthly $12,607,061 $1,045,942 $13,395,997 $1,115,646 6% 7% $1,062 $7.18 $1,070 $7.26 0% 1% $2.47 $1.40 $111,488 -43% $93,929,569 $98,686,963 5% Cost/Case Cost/Minute of Surgery Staff Turnover Cost (millions) Overtime Cost Savings Total OR Net Revenue (Fee Increase adjusted) MVP I % Change 12,367 4% 1,844,479 5% 64% 5% 5.4 -27% 11.5% -43% 44.06 -20% 5,124 -22% 25 -69% 2% -70% 41
    42. 42. Cases per Day by MVP St agi ng ( Wor k -I n & El ect i v e) Pre-MVP 1 70 MVP UCL= 70.60 Daily Case Volume Variation UCL= 65.36 60 2 2 2 50 40 _ X= 42.98 ↓ 20% _ X= 43.33 2 2 2 30 2 20 LCL= 21.30 LCL= 15.36 10 1 50 99 148 197 246 295 Obser v at ion 344 393 442 Tot al Pat i ent I n Room Mi nut es per Day ( Wor k -I n & El ect i v e) Pre-MVP 11000 Daily Surgery Minutes Variation ↓ 22% MVP 1 1 10000 11 UCL= 9397 UCL= 8806 9000 Individual Value Individual Value 1 8000 2 7000 2 2 2 6000 _ X= 6244 2 _ X= 6132 2 2 5000 2 2 4000 LCL= 3682 1 3000 LCL= 2866 1 1 2000 1 50 99 148 197 246 295 Obser v at ion 344 393 42 442
    43. 43. #3 GOAL: Assure predictable and reliable elective schedule #6 GOAL: Reduce and limit the number of same-day changes to the elective schedule No. Room Changes Number of Changed Elective Rooms on Day of Surgery ↓ 69% 43
    44. 44. #3 GOAL: Assure predictable and reliable elective schedule #6 GOAL: Reduce and limit the number of same-day changes to the elective schedule No. Room Changes Number of Changed Elective Rooms on Day of Surgery ↓ 69% 44
    45. 45. 210 190 12 month Turnover $2.47 $2.33 30.0% 19.4% ↓ 43% $2.08 $1.70 25.0% $3.00 $2.43 35.0% 20.0% Excl Temps and Supps- Assigned FTE Turnover & Cost of Turnover 45.0% 40.0% Excl Temps and Supps-Headcount 20.3% $1.84 $1.69 $1.65 $2.50 $2.00 $1.54 $1.40 19.8% 17.8% 16.2% 15.0% 15.6% 14.9% 13.5% 12.7% $1.50 11.5% $1.00 10.0% $0.50 5.0% 0.0% 0.0% Retirements / Deaths Inv, 2+ yrs Inv, < 2 yrs Vol, 2+yrs Vol, < 2 yrs 0.0% 0.0% Cost of Turnover Page 1 of 4 45 $0.00 Cost of Turnover (Millions) Incl Temps and Supps-Headcount
    46. 46. I nt er val Plot of WO-WI same special t y -Oct ober 2010 95% CI for the Mean 1:30 1:24 1:18 1:12 W O- W I 1:06 1:00 0:54 0:48 0:42 0:36 0:30 0:24 0:18 102 103 104 105 106 401 402 403 404 405 406 407 408 409 410 411 412 414 415 Room
    47. 47. I nt er val Plot of WO-WI same specialt y-Jan 2011 95% CI for the Mean 1:40 1:30 1:20 W O-W I 1:10 1:00 0:50 0:40 0:30 0:20 102 103 104 105 106 402 403 404 405 406 407 408 409 410 411 412 414 415 Room
    48. 48. OR Redesign - Summary • Resulted in more cases and more minutes of surgery • More of the surgical volume done during prime time • Added staff without increasing cost/case • Access to OR for transplants and other urgent/emergent cases not compromised • The number of same day changes to the elective schedule decreased significantly • Substantial cost savings without compromise in outcomes 48
    49. 49. OR Redesign - Concerns/Barriers • Too restrictive • Hurts the high volume, two-room surgeon • Decisions not transparent • Clinic was negatively impacted • Small groups couldn’t be immediately available for urgent / emergent cases • Doing cases at the end of clinic and before 7:00 was not very appealing • Open prime time availability was being wasted 49
    50. 50. MVP Concerns/Barriers The Divine Barrier “I say a prayer everyday that I don’t have to finish my career working under MVP” Anonymous Surgical Chair 50
    51. 51. MVP Results – Time Frame Pre-MVP MVP 1 MVP II MVP III Nov 1, 2009 – Oct 31, 2010 Nov 1, 2010 – Oct 31, 2011 Nov 1, 2011 – Jul 31, 2012 Aug 1, 2012 – Present • Baseline Data Whatever, Whenever • Full implementation Highest compliance 51
    52. 52. MVP Results – Time Frame Pre-MVP MVP 1 MVP II MVP III Nov 1, 2009 – Oct 31, 2010 Nov 1, 2010 – Oct 31, 2011 Nov 1, 2011 – Jul 31, 2012 Aug 1, 2012 – Present • Baseline Data • Full implementation • Opened rooms • Over allocated Block Time Whatever, Whenever Highest compliance Minimal compliance 52
    53. 53. MVP Results – Time Frame Pre-MVP MVP 1 MVP II MVP III Nov 1, 2009 – Oct 31, 2010 Nov 1, 2010 – Oct 31, 2011 Nov 1, 2011 – Jul 31, 2012 Aug 1, 2012 – Present • Baseline Data • Full implementation • Opened rooms • Over allocated Block Time Whatever, Whenever Highest compliance Minimal compliance • Lifted overtime pre-approval • Block sharing • Block give back Urgent/emergent isolation only 53
    54. 54. MVP – Engagement &Sustainability Variability Not Gener al Sur ger y MVP I MVP II MVP III UCL= 12.67 I ndiv idual Value 12 1 UCL= 11.11 UCL= 12.53 _ X= 8.85 UCL= 10.61 _ X= 7.48 _ X= 6.43 6 4 LCL= 4.35 1 5 LCL= 1.75 9 13 17 MVP II UCL= 24.31 _ X= 10.78 10 UCL= 25.72 UCL= 20.50 _ X= 16.64 20 MVP III _ X= 14.13 _ X= 11.16 LCL= 5.03 LCL= 3.24 2 UCL= 37.84 MVP I 30 _ X= 7.89 10 8 Pre-MVP 40 Indiv idual Value Pre-MVP 14 Gener al Sur ger y 21 25 Obser v at ion 29 33 37 41 LCL= 2.53 0 1 LCL= -4.56 5 9 13 LCL= 1.81 LCL= -2.76 17 21 25 Obser v at ion 29 33 37 41
    55. 55. MVP – Engagement &Sustainability Overtime Not General Surgery General Surgery (maintained MVP)
    56. 56. OR Redesign – Lessons Learned • Separating surgical patient flows makes sense – decrease cost / increase quality • Fully understand and appreciate the culture and model of your practice • Ensure proper resources are in place and functional prior to redesign implementation • Accurate data collection is vital • Redesign efforts should become part of your “existence”….not simply a project with a defined beginning and ending 56
    57. 57. OR Redesign – Lessons Learned • Establish reporting metrics/tools and management metrics/tools • Communicate, communicate, communicate – identify the key stakeholders early and at a minimum establish neutrality regarding redesign • Plan to change the program – be careful to not change too early and don’t be too rigid (yes I mean this) • You CAN NOT over-estimate the potential disruptive behavior this might stimulate – leaders need to create a safe place and way to support each other
    58. 58. Hazards of Leading of Change “And one should bear in mind that there is nothing more difficult to execute, nor more dubious of success, nor more dangerous to administer than to introduce a new order to things; for he who introduces it has all those who profit from the old order as his enemies; and he has only lukewarm allies in all those who might profit from the new. ” from Niccolo Machiavelli's "The Prince" 58

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