Since 2016, the Women’s Gynecology Surgery unit has been taking part in major LEAN initiatives and working hard to improve their patients’ overall experience. With key unit updates now complete, the gyne surgery team has a lot to be proud of, including their, now ingrained, culture of continuous improvement.
The process has resulted in big improvements, including: clearly stated ‘standard work’ outlines for all areas, highly effective team huddles, significant decreases in median turnover time between surgeries, and zero’ing their long-waiter list.
“I think the biggest thing with LEAN is that it’s not complex,” says Catherine Chung, LEAN consultant with Strategic Change and Performance Improvement. “It’s simple principles and tools that are meant to open up conversations and make work easier.”
For the gyne surgical team, these ‘small’ fixes took shape in improvements such as taking out the need for process discussion between surgeries, clearly understanding everyone’s job, and celebrating quick wins throughout the week. Addressing the root causes of issues directly has positively impacted overall patient experience.
Gyne surgery started their process by taking a comprehensive look at a patient’s path through their unit and creating a visual ‘value stream’. From this initial meeting of over 30 people, including three patients, the gyne surgery team was able to see where they could be doing better.
“This was the first time that we’ve had all of the players in a room,” says Tracy Dryden, manager of Women’s Ambulatory, Perioperative and Breast Health team and lead of the gyne surgery LEAN initiative. “A lot came out of even the initial meetings. It looked at what everyone does and how it all works together.”
From there, the team hit the ground running by working on lowering their turnover time between surgeries. Though consistent auditing, standard processing and an openness to change, the median time between patients is now just 35 minutes, a seven minute decrease. With over 1,500 elective gyne surgeries annually, that adds up to about 175 hours saved per year.
According to Dryden and Rosa Kendall, clinical leader of Adult Surgery Perioperative Program, much of the time improvement can be attributed to the implementation of ‘standard work’ within the unit. “When we asked staff what was important to them, they said that they wanted their work to be trusted and to not have somebody else come behind and do it again,” says Dryden.
The implementation of standard work has made a significant impact to the team in many areas. For example, the process of orienting new staff has been streamlined ensuring that everyone is receiving the same information, and when transferring care from OR to PACU there is a standardized ‘handover’, a process that was given high praise during this year’s accreditation.
“One thing that was really driven home with LEAN is that everybody’s role is equally important. It’s the connection that if one role doesn’t happen then others can’t either,” says Dryden in recalling the overarching outcome of the changes.
The team practices this value three times a week during their ‘new’ team huddles. These huddles are “the way that all huddles should be done,” according to Michael Drake, manager, Strategic Change and Improvement. They begin and end at the same time and in a place that was chosen to be most convenient for staff.
The huddles are structured to provide efficient fixes to meaningful issues and monitor progress within the team. The team’s huddle board clearly guides the flow of the meeting, making sure all boxes are ticked and that follow-up to issues is carried out.
These routine team gatherings have successfully enforced the environment of continuous improvement within the team. The team now carries out their own audits, and anyone can bring forward potential areas of improvement or suggestions of ways that things could be done better.
“We should never think that we’ve got it all figured out, we should always be looking at what we can be doing a little bit better and what is going to make the patients journey a little bit nicer,” states Dryden. “I think LEAN is a process that every area should go through, I really do.”