Q Exchange
Using Overall Equipment Effectiveness to improve theatre utilisation
- Idea
- 2023
Meet the team
What is the challenge your project is going to address and how does it connect to the theme of 'How can improvement be used to reduce delays accessing health and care services'?
The first challenge is to use a measure that does not appear to have been used in any study in the NHS before according to a literature search. Using overall equipment effectiveness as an indicator broadens the focus to include not only productivity but also quality to show the different types of waste. Effectively identifying losses relating to planning, performance and quality will provide a challenge as in a number of ways –
- Any increase in productivity must not come at the expense of patient and staff safety as well as the impact on the quality of patient experience.
2. This will involve breaking down divisional silos, forming a working group and highlighting the importance of working across the system.
3. The final challenge will be the duration as quality of intervention would need to be measured over a 12 month period.
Evidence shows taking this approach can lead to 12% efficiency gains in theatre.
What does your project aim to achieve?
In this pilot we aim to introduce this new measure of effectiveness to our theatre productivity group. Looking at theatre utilisation through a different lens that provides a 360 degree view on what is happening should lead to improvement in theatre utilisation. This improvement piece falls under – Redesigning care to best use the time and skills of those using and providing services’. It will do this by assessing the total time used so we make the best use and skills of our surgeons, anaesthetists and nursing staff.
How will the project be delivered?
We aim to complete a pilot with one area that is showing the least theatre utilisation, working with them for an initial period of 3 months and supporting from a distance for the full 12 month period to ascertain the quality of surgical intervention. Taking learning from this pilot, we would then work with further specialities on a 3 month cycle sharing the learning with our theatre productivity group.
How is your project going to share learning?
QI work at Mid Yorks NHS Trust is captured as a case study with a front A3 sheet and this will be shared across different specialities across the Trust and local ICB.
The learning from this work will be transferrable to other trusts to help them improve their theatre effectiveness looking trough a different lens to make best use of the time of surgeons, anaesthetists and nursing staff.
How you can contribute
- Advise if your Trust is doing similar work.
- Advise on opportunities to share learning across the Q community.
- Contribute previous waste identification in this field of work.
Comments
Joy Furnival 18 Mar 2023
I like this Bradley… I say that as an engineer who specialised in OEE improvement in the chemicals sector over 20 years ago. It’s hard to do tho with batch plant (rather like theatres) imho only having a typical OEE of c25%. I remember reading in HSJ about 2006 somewhere else that tried to do this and it might be worth seeing if that is still on record somewhere.
im curious about the following:
1. How will you set out your product/performance rate standard to measure against given the variability within patient care
2. quality defects are not always immediately apparent, indeed they may not show up immediately post up, but in a re admission or in a 6 week FU clinic, how do you propose to measure quality rates?
3. What base are you going to use for total time, esp as weekends/evenings are increasingly used for additional waiting lists… seems difficult to justify exclusion given this, however may overall lead to challenging availability/planning numbers
4. how will you communicate the difference in OEE as a metric vs theatre utilisation and challenge the myths
5. How will you collect production loss data, without significantly increasing data collection burden or having poor data quality?
6. How might you capture the impact of external losses, eg in pre-op or in bed availability?
well done, good submission, happy to help if I can
Bradley Mellor 21 Mar 2023
Thanks for the heads up on the HSJ article as I only searched for the past decade.
1. How will you set out your product/performance rate standard to measure against given the variability within patient care
This would be agreed with the theatre team, focusing on areas which can benefit the most from improvement.
2. quality defects are not always immediately apparent, indeed they may not show up immediately post up, but in a re admission or in a 6 week FU clinic, how do you propose to measure quality rates?
Initially, quality rates will be set as 100% and the starting point would be as you say in the 6 week FU clinics with patients tracked for a 12 month period following surgery.
3. What base are you going to use for total time, esp as weekends/evenings are increasingly used for additional waiting lists… seems difficult to justify exclusion given this, however may overall lead to challenging availability/planning numbers
The key here is planned production time, focusing on normal operating times as the additional capacity you mentioned could be seen as distorting the figures.
4. how will you communicate the difference in OEE as a metric vs theatre utilisation and challenge the myths.
That is a great question, the best way to communicate this would be through evidence from a previous case study in a Brazilian hospital.
5. How will you collect production loss data, without significantly increasing data collection burden or having poor data quality?
This would need a different data extraction from existing data, having recently observed the theatre process and compared the observations against system data we have a firm understanding on our data quality.
6. How might you capture the impact of external losses, eg in pre-op or in bed availability
This is something we have recently looked at as part of an initial look at theatre utilisation using the input - process - output model. What we aim to do with this new piece is to do a more comprehensive piece of work tying all of these elements together over a longer period using OEE as the means to identify areas for improvement.
Thomas John Rose 14 Mar 2023
Can you add a bit more detail to what it is you intend to measure in your 360 deg. view that will provide an overall equipment effectiveness value? For example how will you measure losses due to planning, performance and quality and relate these to overall equipment effectiveness? For example how will you ascertain and measure the quality of surgical interventions?
Bradley Mellor 21 Mar 2023
The 360 degree would be from the OEE equation -
Availability, Performance and Quality.
The initial look at availability would be to assess current performance based on what happens within our current systems for the past 12 months using the OOE calculation to provide a baseline indicator. This would include an initial quality indicator of 100% until we have a cohort of patients to track over a 12 month period. The quality of surgical intervention would be based on the patient returning through the system and utilising the same resource for the same purpose, this assessment would be agreed with clinicians. Once past the 'first stage' of the project, we would look at the planning and booking process and its impact on performance.
Beckie Burn 1 Mar 2023
This is interesting, does this also have a link to your Trust's Green Plan?
Bradley Mellor 21 Mar 2023
At present it doesn't, however this is a great idea and I will liaise with our head of sustainability.
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