Perhaps ‘Thank God it’s Friday’ was a fairly accurate description of the work ethos in the departments associated with the operating theatres at Medisch Spectrum Twente hospital. “When a planning doesn’t run smoothly, you don’t know where you stand exactly. This contributes towards a reactive work attitude,” explains Jan den Boon, member of the board of directors.
Incentive for an efficiency programme
For Medisch Spectrum Twente (MST), the incentive to launch an efficiency programme was not directly related to the planning. It resulted from a financial challenge: the ‘business case for new construction’ anticipated higher returns in the years leading up to building work at the hospital than those eventually realised. As a result, MST was not prepared for the additional nancial burden associated with the construction. “We were therefore faced with a financial deficit at the end of 2015. It was the right moment to initiate an efficiency programme for the operating theatres which also focused on the entire surgical process chain. For years, there had been complaints about the planning and the process,” explains Den Boon.
“Accezz first carried out a very extensive analysis and concluded that staff spent less than half their time on activities that contributed towards the surgical process. The rest of the time involved a lot of waiting and was also spent on repair and rectification because the planning was not functioning properly. Many things were checked twice, for instance, and phone calls went back and forth to organise matters that could have been made clear with a single standard arrangement. An improvement potential of 20-30% was identified,” says Den Boon.
A blood-red room
Feedback from the analysis in a so-called ‘brown paper session’ was very confrontational. During the session, red post-it notes were used to visually identify which processes were not performing optimally. The findings provided sufficient reason to continue with Accezz in order to revise the surgical process and organise care more efficiently throughout the chain. A pilot was therefore initiated with the departments of surgery and neurosurgery.
“One of the first tools implemented by Accezz was the capacity monitor, which provided insight into the extent to which scheduled staffing matched workload demand. This resulted in a considerable reduction in unnecessary staffing because we were able to schedule personnel much more effectively,” explains Den Boon. “The analysis also showed that, by default, the first operations started almost 30 minutes later than the official start time of 8:00 am. These kinds of habits sneak in and are quite stubborn. Thanks to the Accezz programme, employees now start the morning according to a stepped system. Such changes didn’t take place overnight as the works council also has a say in these matters. However, the changes were eventually welcomed by employees who could see the benefits. Their time is now well spent and their input is appreciated.”
Who owns the change?
“Prior to the programme, approximately 80 per cent of patients scheduled for surgery had an operation date moved at least once. Agreements on planning were not clear enough, which meant that schedules could be overruled by people at various points within the organisation. In some areas, personal views took precedence over organisational procedures,” says Den Boon. Fortunately, all this has changed. “The beautiful thing about Accezz is that they not only iden- tify what can be improved but also take responsibility for the result. Not an easy task because when it comes to changes surrounding operating theatres, you can’t just simply press a button as many departments and processes are connected to each other,” adds Den Boon. However, an important turning point occurred when processes and staffing capacities became centrally managed and decided on, which meant that individuals no longer assume ownership of such matters. De Boon concludes: “In turn, employees have taken ownership of all the changes and have adapted to the common goals. Ensuring this level of success is a direct result of Accezz interacting with those on the workfloor. Unlike other parties, Accezz goes out of its way to take that extra step. They really get people moving. Thank God it’s Monday!”