Nottingham University Hospitals NHS Trust is a large teaching hospital in the East of England that was looking for a change is performance of its operating theatres. The Trust provides acute health services to 2.5 million people within Nottinghamshire and beyond, and specialist services to a further 3.4 million people from neighbouring counties each year. The Trust also provides education and training for doctors, nurses and other health care professionals. The Trust is based over 3 sites throughout the city and is one of the country’s largest acute teaching Trusts with:
- An annual income of £824 million
- 1,700 beds, 87 wards and 48 Theatres
- 14,500 staff and in excess of 1,000 volunteers
The Trust has a vision of ‘Working together to be the best for patients’
One significant goal for NUH was to improve theatre efficiency by
- Starting on time
- Improving theatre utilisation.
The Trust’s operating theatres needed to increase efficiency by improving the number of operations undertaken in the planned theatre time available. A plan was developed to enable the Trust to make a significant improvement in how it used its theatre capacity. It had the key objectives of improving:
- Session Utilisation – a measure of whether timetabled operating sessions are used by surgical specialties (from 92% to 96%), and
- In-Session Utilisation – a measure of when timetabled sessions are used how well they are used (from 76% to 85%)
With improvements in both these measures the Trust aimed for an increase in the number of surgical cases being undertaken in the available theatre time improving the income position of the Trust with minimal additional cost
These objectives needed to be achieved at the same time as improving surgical safety and reducing cancelled operations.
Through support and several interventions with Surgeons, Anaesthetists and theatre team leaders using the Beffective Team Effectiveness Strategy we were able to build foundation of Trust in the leaders. A recent research paper has been able to show that Trust in your leader had the biggest impact on engagement in an organization, by as much as a factor of 5. By empowering these leaders, some of whom have informal leadership roles, to share the future outcomes and expectations of the team and hold others accountable in an appropriate manner, we are able to see the significant changes listed below. Changing the paradigm of how leadership is applied within the team and giving members new tools to aid in the execution of the strategy has a profound effect.
These changes and the ongoing support supplied by the leaders and Beffective result in changes of behaviour that sustain. As the behaviours begin to become habitual, the team can take ownership to make the necessary changes to processes and achieve the change in performance required.
Regular coaching/implementation support visits were made across all theatres which contributed to the following results:
- A step change improvement in in-session utilisation with specialties meeting the 96% session utilisation target.
- The scale of work across the 48 Trust theatres means that a small percentage change produced a large increase in additional cases.The specialties with improved performance have undertaken more than 1,000 additional cases in equivalent planned theatre time (data 2013-14). Financial impact of £2.4 million.
- A 27% reduction in time lost to late starts equivalent to 810 hours a week with a value in theatre time of £655k per annum
The programme has supported other initiatives in the Trust and has helped support
- A reduction in on the day cancelled operations
- A Safer Surgery model that has resulted in no ‘never’ events in NUH theatres since 2012
- A reduction of monthly Waste Disposal Cost overspent pressure from an average of £13,500 to £8,000
The program continues to make an impact throughout the hospital. We have now seen approximately 450 people attend of which 70/80 are Clinicians.
In conclusion, engagement is a challenge that faces many hospitals, but improving processes is not the start point. Helping leaders, whether they are formal or informal, to build their credibility and exhibit behaviours that enable others to share the burden of achieving the key outcomes in an empowering environment is the start. Continuing to challenge beliefs and paradigms and reinforce the appropriate responses is key to the conclusion which must be a better patient experience.
With coaching and support leaders can increase engagement, which to others may appear to be obvious, but if it were obvious everyone would be doing it and engagement would not be an issue.
Interview with Jason Neil-Dwyer