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NUR 630 Topic 4 DQ 1

Sample Answer for NUR 630 Topic 4 DQ 1 Included After Question

You are a member of an operating room team. The hospital is reporting an increase in complication rates from your team. Choose one of the quality models and explain how you would use it to address the causes or the adverse events. 

A Sample Answer For the Assignment: NUR 630 Topic 4 DQ 1

Title: NUR 630 Topic 4 DQ 1

TANYA 

A hospital’s operating room just as a surgery center can place process improvement plans in place that are reliable. However, the right tools must be used by leaders to ensure the desired outcome improvements are achieved. To decrease the number of complications in the OR associated with my team is by a team collaborative approach. The Lean method and its philosophy of “5S” is a quality model of choice. The five S’s are: Sort (separate items in the space, eliminating whatever is not needed); Set in order (organize remaining tools, equipment, and supplies, arranging and identifying them for easier use); Shine (keep the workplace clean); Standardize (schedule regular cleaning and maintenance so the workplace looks the same each day and over time); and Sustain (Make the five S’s a way of life and a habit for employees). The foundational philosophy of 5S pertains to a workplace making equipment and supplies available at the precise place where they are needed (Selig, 2020). By following this Lean process, the desired goal of a significant reduction in OR complication rates are achievable according to Selig, 2020. It is believed that by following the Lean and 5S process, we can make operating room workflows more efficiently. 

The first step would be an OR inventory. After taking an inventory the OR would be emptied and only the equipment needed with the highest efficiency rating is placed back. For example, if the operating room only needs a certain number of items, then that exact number should be stocked and no more or no less. According to Selig, 202 the 5S process can be time-consuming. Going through the initial clean-up process with one room can take a couple of days. Taking the time to know where everything is at all times can lead to better productivity. When the OR is reorganized and all team members agree it is arranged appropriately, then all other ORs (Operating Rooms) will go through the 5S process. The process is to ensure there is no waste or expired products or items that are not used or needed in the OR space (Selig, 2020).   

The process also makes OR staff efficient in their work, giving them more time to spend with their patients. To sustain the reorganized ORs, the 5S process is followed through daily observations. A walk-through observation is done at the end of every shift. Someone observes the operating room, using a map of where everything should be and how it looks to make certain all items are returned to their proper place. Employees are also given hands-on, written, and visual instructions on how to conduct these daily observations(Selig, 2020).   

Reference 

Selig, B. (2020). Following Lean and the 5S philosophy can make quality improvement sustainable. Trade Journal, 44(3), 1. https://www.proquest.com/docview/2507126753/fulltext/FAC2B0EA0C6046C8PQ/1?accountid=7374  

Respond here 

Tanya, I agree with you that process improvement plans that be reliable in addressing the increasing complication rates. The process improvement defines the problem and suggests suitable intervention mechanisms (Ulrych, 2019). Therefore, healthcare leadership understands the best respond to adverse events. However, attempts to restore perfect conditions should have a collaborative approach. The Lean method and its philosophy of “5S” is a suitable model that can be used to handle adverse events. Adhering to the 5S of the model will make the model more efficient in handling the occurrences. The 5S of the model includes sorting, setting in order, shining, standardizing, and sustaining (Chandrayan et al., 2019). Through sorting the hospital management internalize the adverse event.  The sorting process is the first step of the model. Therefore, adequate information about the condition at the beginning benefits the other process. Success in all the steps is important in addressing the complication.  The procedural process in the lean method increases the chances of the best intervention outcomes.  

References 

Chandrayan, B., Solanki, A. K., & Sharma, R. (2019). Study of 5S lean technique: a review paper. International Journal of Productivity and Quality Management, 26(4), 469-491. 

Ulrych, W. (2019). The 5s Method and its Influence on Employee Work Requirement Practices which Can Hamper Lean Service Introduction. Journal of Positive Management, 10(2), 30-41. 

DOI: https://doi.org/10.12775/JPM.2019.005 

ANGELA 

In health care, clinicians function under the philosophy of “first, do no harm.”  Because patient safety is priority, the principles and concepts in Six Sigma are in alignment with the objectives and goals in health care and therefore would be the most appropriate quality model to apply. According to Fondahn et al. (2016, p. 81), the goal of Six Sigma is to continuously improve quality by identifying and eliminating the causes of defects (errors) and reducing variability in processes. To achieve this goal, Six Sigma utilizes a five-step, data-driven process improvement methodology, define, measure, analyze, improve, and control or the acronym DMAIC. The DMAIC method seeks to improve existing processes by defining the problem or issue for improvement, measuring the performance of the process by collecting relevant data, analyzing the data to determine the root causes of poor performance, improving the process by eradicating the root causes, and controlling improved processes through monitoring to ensure the better results are sustained (Fondahn et al., 2016, p. 81). Six Sigma is a beneficial and practical tool to use when seeking opportunities to optimize processes and enhance quality.  

References  

Fondahn, E., Fer, T. M., Lane, M., & Vannucci, A. (2016). Washington manual of patient safety and quality improvement. Lippincott Williams & Wilkins.  

RESPOND HERE 

Angela, I agree with you that clinicians prioritize patient safety. As a result, nurses may not engage in activities that expose patients to any form of risk. Clinicians either with or without their knowledge function under the philosophy of “first, do no harm.” Unfortunately, some mistakes may be unpredictable. Hence, clinicians are trained to be flexible in handling multiple roles within healthcare settings. The principles and concepts in Six Sigma is the right model to handle the diverse situation. The model’s alignment with the objectives and goals of healthcare makes the model more suitable (Honda et al., 2018).  Six Sigma aims at improving quality. However, as they improve the quality chances of mistakes are identified and the right reactions generated. Data-driven process improvement methodology, define, measure, analyze, improve, and control are the six-step of the model (Improta et al., 2018). Therefore, to achieve the admired outcome when the model is used in this scenario adhering to all the six steps is important.  

References 

Honda, A. C., Bernardo, V. Z., Gerolamo, M. C., & Davis, M. M. (2018). How lean six sigma principles improve hospital performance. Quality Management Journal, 25(2), 70-82. 

Improta, G., Cesarelli, M., Montuori, P., Santillo, L. C., & Triassi, M. (2018). Reducing the risk of healthcare‐associated infections through Lean Six Sigma: The case of the medicine areas at the Federico II University Hospital in Naples (Italy). Journal of evaluation in clinical practice, 24(2), 338-346. https://doi.org/10.1111/jep.12844 

Latrice Hatch 

Posted Date 

Mar 5, 2022, 7:46 PM 

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Replies to Latrice Hatch 

Lean Six Sigma model would be very useful in eliminating complication rates in an operating room. Lean can help to reduce the number of medical errors in healthcare. “Lean in healthcare is about creating value and reducing burdens that patients and staff experience every day.” (Virginia Mason Institute, 2021) Six sigma is used to improve patient quality and safety. It is imperative that healthcare teams use the Six Sigma model because it improves medical procedures and ensures efficiency because the commission of errors may seriously harm patients. The main focus of the Lean Six Sigma model is to reduce time. costs, and errors, for the improvement of the quality and satisfaction of the patients. “By implementing Lean Methodology in healthcare organizations can reduce wait times, minimize inventory, reduce errors, and prevent injuries.” (John Hopkins Medicine, 2017) 

I would use the Six Sigma model by reviewing the statistical data. I would identify areas where mistakes have been made and analyze them. I would also use the other stages like defining the problems, measuring them, analyzation, design, and verify. Performing the six principles of Six Sigma Model allows for improvement of the operating team. Modifying and identifying areas of need in the process reduces errors and improves patient care. 

What is lean Healthcare. (2021). Virginia Mason Institute. http://virginiamasoninstitute.org 

Quality Improvement. (2017). John Hopkins Medicine. http://johnhopkinsmedicine.org 

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DH 

Deanna Higgins 

replied toLatrice Hatch 

Mar 5, 2022, 10:11 PM 

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Replies to Latrice Hatch 

 Hello Latrice, 

Thank you for your post and explaining the Six Sigma use in the OR. The Operating room is a high-risk high-cost area, and it is an area that has a high potential for errors. High quality in the operation room is necessary for the quality of care as well the need to be efficient. Six Sigma is defined as a standard deviation from the mean thus use of the Six Sigma in the operating room can be successfully implemented in streamlining the clinical excellence of the OR. (Fondahn et al., 2016). The Key concept of Six Sigma in health care is recognizing the customers can be impacted during any particular process of the care and to identify areas that lack efficacy or quality. As you state using Six Sigma can be helpful to identify and define problems then use statistical l data to analyze and design a solution.  Successful implementation of Six Sigma in health care requires a culture shift in sound operational strategies to implement the change (Fondahn et al., 2016). Changing a culture is not easy yet with a steady useful consistent tool such as Six Sigma helps to easy the change process along.  Thanks for the explanation of Six Sigma, I have not studied this area much, it is very interesting and useful. 

Deanna          

Fondahn, E., Lane, M., & Vannucci, A. (2016). The Washington manual of patient safety and quality improvement [e-book]. Wolters Kluwer . 

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LH 

Latrice Hatch 

replied toDeanna Higgins 

Mar 5, 2022, 11:55 PM(edited) 

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Replies to Deanna Higgins 

Hello Deanna, 

I agree that high quality care is especially important in the OR. Medical errors are a serious problem in the OR and can be not only detrimental to patient’s health but more importantly, deadly. “Part of the solution is to maintain a culture that works toward recognizing safety challenges and implementing viable solutions rather than harboring a culture of blame, shame, and punishment.” (Rodziewicaz, Houseman, & Hipskind, 2022) Not addressing issues problems can increase the potential for more adverse events and put more patients at risk. It is important to move away from placing blame and move toward prevention and education structure. Implementation of quality models in healthcare facilities is a must and should be evaluated on a continuous basis. 

Rodziewicz, TL., Houseman, B., & Hipskind, JE. (2022). Medical Error Reduction and Prevention. http://ncbi.nlm.nih.gov 

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CM 

Carolee McPherson 

Posted Date 

Mar 5, 2022, 6:31 PM 

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A destructive occasion is described as an occasion that results in accidental damage to the affected person with the aid of using an act of fee or omission in place of with the aid of using the underlying ailment or circumstance of the affected person. The know-how that destructive occasions are each day and frequently end result from the terrible layout of fitness care transport structures has brought about the improvement of institutional destructive occasion structures. These structures gather statistics on destructive occasions that make it viable to analyze from such occasions and pick out tendencies which can screen organizational, systemic, and environmental problems. Most destructive occasions are undetected (Hudson & Guthrie, 2020). The great version used for this example is the statistics-pushed great development in number one care (DQIP), the usage of informatics to put in force new prescribing great measures included with instructional interventions and current great development mechanisms. 

  The purpose is to outline and validate express medicine use great and protection requirements in a number one. DQIP represents a version for the usage of phrases and the standardization of statistics collection. Each degree encompasses inclusion and exclusion definitions, confounding affected person demographic or different statistics, the purpose for the significance of the degree, and a method with the aid of which the degree has to be obtained (Institute of Medicine (US) Committee on Data Standards for Patient Safety et al., 2019). The cause is that maximum fitness care agencies rely upon voluntary reporting to locate destructive occasions, and spontaneous reporting has been tested to be a minimally powerful manner of detecting such occasions. The great version used for this example is the statistics-pushed great development in number one care DQIP the usage of informatics to put in force new prescribing great measures included with instructional interventions and current great development mechanisms. The purpose is to outline and validate express medicine use great and protection requirements in a number one. 

Hudson, S., & Guthrie, B. (2020). Evaluating pharmaceutical care: A generic algorithm to operationalise “adherence to standards” as an intermediate outcome measure. https://www.pcne.org/upload/ws2009/MR%20Dreischulte%20Pres.pdf 

Institute of Medicine (US) Committee on Data Standards for Patient Safety, Aspden, P., Corrigan, J. M., Wolcott, J., & Erickson, S. M. (2019). Adverse event analysis. Nih.gov; National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK216102/ 

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CN 

Charles Nderu 

Posted Date 

Mar 5, 2022, 3:16 PM 

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The existing problem shows an inherent system failure in their work system they have in place or team members due to the increasing number of complications. The first step would be to conduct QA in order to conduct an investigation and determine what is wrong with the process the OR is using to conduct procedures. I would probably use the lean model to rectify the problem. The lean model is composed of muda, muri and mura. Muda – which is wastage due to non-value-added activities. It helps to identify unwanted procedures, processes that may result in near miss events which may result in error. Muri which is wastage due to overburdening staff with process or procedures that are not necessary. The goal being to shorten, or to eliminate unnecessary procedures so that they are short and effective. Mura- having a work flow that would enable everyone who works in the OR to know their responsibilities, and know what is expected of them. The lean model also gives an opportunity for the whole team to come together and brainstorm how to find solutions to the problems that exist. The model also uses the four-point model where continuous problem solving by all staff is greatly encouraged, staff are encouraged to engage and respect each other, team members are encouraged to continuously improve on processes and procedures that they use, and finally the team is always encouraged to remain focused on achieving their goals (Morell-Santandreu, 2021). 

Reference: 

Morell-Santandreu, O., Santandreu-Mascarell, C., & Garcia-Sabater, J. J. (2021). A Model for the Implementation of Lean Improvements in Healthcare Environments as Applied in a Primary Care Center. International Journal of Environmental Research and Public Health, 18(6). https://doi.org/10.3390/ijerph18062876 

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MR 

Magela Rodriguez 

Posted Date 

Mar 5, 2022, 3:02 PM 

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One of the quality models I would use to address the increased complication rates from my team is the Lean model. The application of the Lean model will be targeted at eliminating any waste and improving the processes around patient care, decreasing errors, and improving overall safety. The application of Lean principles allows surgical processes to attain high levels of efficiency and performance. It also leads to enhanced patient safety and satisfaction. The lean model will facilitate improved sharing of surgical resources and criteria for operating room scheduling. Lean tools can help optimize operating room nurse scheduling help identify waste and areas for improvement (Sales-Coll et al., 2021). The application of lean tools has been shown to reduce outcome errors by 90 percent and waste in the operational process by 41 percent (Simon & Canacari, 2014). They can visualize waste and eliminate it.  In addition, it aids in evolving current processes used in operating room nurses scheduling while paying specific attention to the processes and system design.   

Lean principles and tools will also be essential in assisting the selected team better understand and identify those responsible for doing what works within the scheduling process. This insight will enable the team to review this process and substantially improve it (Sales-Coll et al., 2021). Lean principles and techniques also emphasize the significance of a multidisciplinary approach in caring for patients. The multidisciplinary team will allow for proper treatment of the entire patient and provision of comprehensive care focused on meeting patients’ needs, ensuring minimal errors.   

References 

Sales-Coll, M., de Castro Vila, R., & Madrid, J. A. H. (2021). Improving Operating Room Efficiency Using Lean Management Tools. Production Planning and Control. https://doi.org/10.1080/09537287.2021.1998932  

Simon, R., & Canacari, E. G. (2014). Surgical Scheduling: A Lean Approach to Process Improvement. AORN Journal, 99(1), 147-159. https://doi.org/10.1016/j.aorn.2013.10.008 

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CS 

Carin Schmidt 

Posted Date 

Mar 5, 2022, 2:37 PM 

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Patients in an operating room are a vulnerable population and all steps need to be taken to ensure quality treatment and safe care. When there is an increase in complication rates in the operating room space it is imperative to act swiftly to protect the safety of current and future patients. Once the different types of complications are identified the team will need to determine an approach to address the quality deficits. One approach to address quality concerns in this space is to use the Lean Six Sigma model. Lavin & Vetter (2022) define Lean as eliminating non-value added steps to improve processes and Six Sigma as a means to reduce variation through process improvement. Using the Lean Six Sigma approach will allow the team to determine what is of value to customers and standardize processes to reduce potential harm to patients. 

Initially it will need to be determined what is of value to customers, internal and external. Vollman et al. (2016) identify the three criteria that need to present for a customer to believe it is value-added: a willingness by the customer to pay for the item/service, the action taken must transform some aspect of the product/service provided, and, from the initial use, the work must be performed correctly. Once value is determined, the DMAIC (Define, Measure, Analyze, Improve, and Control) method of Six Sigma can be applied. The value will help define the goal of the process improvement. It is important to then measure by collecting baseline data around the problem and analyze the data and the process to identify the root causes. Next, improvement includes solutioning, planning, and implementing the change process. Designing controls to start behavioral changes in staff and, after validating the new processes, advance the changes to other areas that would benefit, is the final step (Vollman et al., 2016). Being centered in the quality improvement model steps the team would be able to realize a reduction in complications in the operating room processes. 

References: 

Lavin, P., & Vetter, M. J. (2022). Using Lean Six Sigma to Increase the Effectiveness of an Evidence-Based Quality Improvement Program. Journal of Nursing Care Quality, 37(1), 81–86. https://doi-org.lopes.idm.oclc.org/10.1097/NCQ.0000000000000567 

Vollman, D. Kumar, G. & Stock, M. (2016). The Washington Manual of Patient Safety and Quality Improvement (E. Fondahn, M. Lane, & A. Vannucci Eds.). Wolters Kluwer. 

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JA 

Jessica Albracht 

Posted Date 

Mar 5, 2022, 12:56 PM 

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Topic 4 DQ 1 

Complications in the operating room would need to be addressed in a timely manner to prevent any adverse events to the patients. The Six Sigma Model would be the best model I would choose to incorporate in order to address the issue of the increase in surgical complications. A goal of the Six Sigma is to continuously improve operations (Fondahn et al., 2016). The project method that would be best utilized in this situation is the DMAIC (Define, Measure, Analyze, Improve, and Control).  

The first step to this project would be to define the issue at hand and look at the different processes involved currently (Fondahn et al., 2016). In this case the issue is the increase of surgical complications in the hospital. Next we would need to analyze the potential issue and to identify the problem (Fondahn et al., 2016). In this case I would look at the process of setting up the sterile field or the process of how the surgeon and the surgical techs scrub in. There may be better evidence on how to improve those processes. When the issue is identified then it would need to be further categorized into controllable or uncontrollable (Fondahn et al., 2016). With controllable factors, implementation strategies can be implemented to control the factor causing the issue (Fondahn et al., 2016). Then finally the organization would need to improve and control the issue. In this phase implementations are introduced to improve the issues, aden then the control phase is where the behavior changes and translation of the project are implemented (Fondahn et al., 2016). Once all steps are completed then the leadership would evaluate the effects of the change. If there is no improvement then there would be a continued need to reevaluate the issues.  

References 

Fondahn, E., Lane, M., & Vannucci, A. (2016). The Washington Manual of Patient Safety and Quality Improvement. Wolters Kluwer. https://doi.org/ISBN-13: 9781451193558 

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KM 

Katherine Martin 

Posted Date 

Mar 5, 2022, 10:22 AM 

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An increase in complication rates in the operating room (OR) warrants timely action to prevent Serious Safety Events (SSEs), Serious Reportable Events (SREs), and Sentinel Events (SEs) from occurring and reaching the patient. According to the Press Ganey (2022) HPI Cause Analysis Field Guide, ideally, a quality improvement (QI) intervention would be implemented when the (OR) team begins reporting Precursor Safety Events (PSEs). Press Ganey (2022) indicates that PSEs result in either no harm (PSE-4), no detectable harm (PSE-3), minimal temporary harm (PSE-2), or minimal permanent harm (PSE-1). Any preventable event resulting in moderate or greater harm is considered an SSE (Press Ganey, 2022). It is vital to mitigate complications before they cause patient harm. After Root Cause Analyses (RCAs) are performed to determine failure mechanisms and addressable action items, a QI tool should be chosen (Beyranvand et al., 2019).  

The Lean-Six Sigma Model and Green Belt certification process, including the “Define,” “Measure,” “Analyze,” “Improve,” and “Control” (DMAIC) Methodology would involve a comprehensive approach to addressing broken processes resulting in OR complications (Beyranvand et al., 2019).  

In the “Define” phase, a project charter would be utilized to outline the OR problem to be addressed. The project charter is also used to determine a goal and form a green belt team. A stakeholder analysis tool is used to identify key stakeholders and potential barriers. The team would also disseminate a survey to staff and create a process map to outline the current OR processes in the “Define” phase (Purdue University, 2021).  

The “Measure” phase would involve retrieving analysts’ or Risk Management’s data to determine a baseline number of OR complications. The data would need to be displayed graphically, and the sigma level would be calculated (Purdue University, 2021).  

“Analyze” involves outlining current OR processes and quantifying risks associated with the processes through a Failure Modes and Effects Analysis (FMEA). The FMEA would be performed again in the “Improvement” phase after determined improvement interventions are implemented. The “Control” phase involves developing a control plan and reporting results to pertinent committees for approval of continued use (Purdue University, 2021).  

References:  

Beyranvand, T., Aryankhesal, A., & Aghaei Hashjin, A. (2019). Quality improvement in hospitals’ surgery-related processes: A systematic review. Medical journal of the Islamic Republic of Iran, 33, 129. https://doi.org/10.34171/mjiri.33.129 

Press Ganey. (2022). Patient safety and high reliability platform. Pressganey.Com. https://www.pressganey.com/products/safety-high-reliability 

Purdue University. (2021). DMAIC vs. DMADV. Purdue.Edu. https://www.purdue.edu/leansixsigmaonline/blog/dmaic-vs-dmadv/#:~:text=DMAIC%20(Define%E2%80%94Measure%E2%80%94Analyze%E2%80%94Improve%E2%80%94Control),-DMAIC%20is%20the&text=Collect%20data%20from%20the%20process,solutions%20to%20improve%20the%20process. 

Word count: 346 

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CD 

Constantine Dapilma 

Posted Date 

Mar 5, 2022, 3:06 AM 

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Replies to Latrice Hatch 

Health care providers should remain committed to improving health care quality in their various work environments. Achieving this requires health care providers to identify areas of inefficiency and apply a suitable quality model to guide quality improvement. The six sigma quality model would be the best to address increased complication rates. 

Complication rates depict poor quality care. An increase in complication rates implies more defects in the health care processes and the need to use more efficient tools and techniques. The six sigma quality model seeks to remove defects from processes involved in delivering care (Ponsiglione et al., 2021). Its basic tenet is that decreasing defects reduces variation between the current and desired outcomes. The metrics-driven system applies a structured approach to finding a problem’s root cause. As Ahmed (2019) explained, the approach (DMAIC) consists of five interrelated steps: define, measure, analyze, improve, and control. In this case, the whole process starts with defining the problem, followed by measuring the defect and analyzing the causes. Next, the process is improved by removing major causes and control measures adopted to prevent the recurrence of the defects (Fazaeli et al., 2021). A multidisciplinary team is necessary since most defects are system-wide such as delays in patient transition across units. 

Applying the six sigma model to address the causes of high complication rates would start with defining the scope of the problem in terms of a statistical increase. Such quantification implies that the problem is already measured. Next, a multidisciplinary team would analyze the causes of the rising complication rates to determine the defects that should be removed to fix the problem. For instance, the rise can be due to increased medication errors, implying that the process could be improved by reducing medication errors. The final step is control measures to prevent the recurrence of the problem. For instance, nurses causing medication errors would be educated n safe practices and error prevention by confirming medications electronically. 

References 

Ahmed, S. (2019). Integrating DMAIC approach of Lean Six Sigma and theory of constraints toward quality improvement in healthcare. Reviews on Environmental Health, 34(4), 427-434. https://doi.org/10.1515/reveh-2019-0003 

Fazaeli, S., Yousefi, M., Dokht, M. S., & Heidarian, H. (2021). Implementation of Six Sigma method to improve hospital discharge process: A before-and-after study with the control group in a large hospital. Research Square. https://doi.org/10.21203/rs.3.rs-731820/v1 

Ponsiglione, A. M., Ricciardi, C., Improta, G., Orabona, G. D. A., Sorrentino, A., Amato, F., & Romano, M. (2021). A Six Sigma DMAIC methodology as a support tool for Health Technology Assessment of two antibiotics. Math. Biosci. Eng, 18(4), 3469-3490. doi: 10.3934/mbe.2021174 

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RL 

Rebecca Luetke 

replied toConstantine Dapilma 

Mar 5, 2022, 9:56 AM 

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Replies to Constantine Dapilma 

Historical Shift 

Hi Everyone,  

Constantine has a great insights post in answer to this question. In learning about quality models I want to provide you an understanding of the historical shift from quality assurance to quality improvement. We used to focus on quality assurance or ensuring that we were providing quality care…this also meant we assumed as long as we were doing good…we were doing good. In quality assurance we focused more on the historical model of the physician directing care and nurses taking orders. In the transition to a collaborative care environment and a focus on evidence we have transitioned to quality improvement. Here is a great article about it: https://www.ahrq.gov/ncepcr/tools/pf-handbook/mod4.html 

Why is quality improvement so much better than quality assurance? 

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TP 

Tanya Perkins 

Posted Date 

Mar 4, 2022, 6:54 PM(edited) 

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A hospital’s operating room just as a surgery center can place process improvement plans in place that are reliable. However, the right tools must be used by leaders to ensure the desired outcome improvements are achieved. To decrease the number of complications in the OR associated with my team is by a team collaborative approach. The Lean method and its philosophy of “5S” is a quality model of choice. The five S’s are: Sort (separate items in the space, eliminating whatever is not needed); Set in order (organize remaining tools, equipment, and supplies, arranging and identifying them for easier use); Shine (keep the workplace clean); Standardize (schedule regular cleaning and maintenance so the workplace looks the same each day and over time); and Sustain (Make the five S’s a way of life and a habit for employees). The foundational philosophy of 5S pertains to a workplace making equipment and supplies available at the precise place where they are needed (Selig, 2020). By following this Lean process, the desired goal of a significant reduction in OR complication rates are achievable according to Selig, 2020. It is believed that by following the Lean and 5S process, we can make operating room workflows more efficiently. 

The first step would be an OR inventory. After taking an inventory the OR would be emptied and only the equipment needed with the highest efficiency rating is placed back. For example, if the operating room only needs a certain number of items, then that exact number should be stocked and no more or no less. According to Selig, 202 the 5S process can be time-consuming. Going through the initial clean-up process with one room can take a couple of days. Taking the time to know where everything is at all times can lead to better productivity. When the OR is reorganized and all team members agree it is arranged appropriately, then all other ORs (Operating Rooms) will go through the 5S process. The process is to ensure there is no waste or expired products or items that are not used or needed in the OR space (Selig, 2020).   

The process also makes OR staff efficient in their work, giving them more time to spend with their patients. To sustain the reorganized ORs, the 5S process is followed through daily observations. A walk-through observation is done at the end of every shift. Someone observes the operating room, using a map of where everything should be and how it looks to make certain all items are returned to their proper place. Employees are also given hands-on, written, and visual instructions on how to conduct these daily observations(Selig, 2020).   

Reference 

Selig, B. (2020). Following Lean and the 5S philosophy can make quality improvement sustainable. Trade Journal, 44(3), 1. https://www.proquest.com/docview/2507126753/fulltext/FAC2B0EA0C6046C8PQ/1?accountid=7374  

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DH 

Deanna Higgins 

replied toTanya Perkins 

Mar 4, 2022, 7:12 PM 

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Replies to Tanya Perkins 

Hello Tanya  

Thank you for your post and for explain the 5S process thoroughly, as you stated the 5S process can be useful in the OR setting utilizing the 5S process and is a common place for a Lean project. The Lean process is adapted for manufacturing and has transformed to the health care field in the process of reduction of waste (Johnson & Sollecito, 2020). One would think the Lean process would not be useful in an OR setting attempting to decrease adverse outcomes. The OR setting can be very similar to a manufacturing facility where the process of the OR must be a “well-oiled machine” to run efficiently.  If an OR used the 5S process of having a clean, organized and standardized process it can be useful in maintaining the order of proper processed, organized equipment and standard routines to keep the OR consistent. A consistent standardized practice has decreased incidence of error due to the consistency.  As you stated and efficient OR leaves more time for patient care and I would venture to say more time to ensure all the processes of the surgery are done correctly such as a full time out to identify the patient and procedure. The adoption of national based QI processes can be adopted to decrease inefficacies and improve patient outcomes (Johnson & Sollecito, 2020).   

Johnson, J. K., & Sollecito, W. A. (2020). Continuous quality improvement in health care (5th ed.) [e-book]. Jones &Bartlett Learning . 

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CD 

Constantine Dapilma 

replied toTanya Perkins 

Mar 6, 2022, 5:48 AM 

Replies to Tanya Perkins 

Tanya, I agree with you that process improvement plans that be reliable in addressing the increasing complication rates. The process improvement defines the problem and suggests suitable intervention mechanisms (Ulrych, 2019). Therefore, healthcare leadership understands the best respond to adverse events. However, attempts to restore perfect conditions should have a collaborative approach. The Lean method and its philosophy of “5S” is a suitable model that can be used to handle adverse events. Adhering to the 5S of the model will make the model more efficient in handling the occurrences. The 5S of the model includes sorting, setting in order, shining, standardizing, and sustaining (Chandrayan et al., 2019). Through sorting the hospital management internalize the adverse event. The sorting process is the first step of the model. Therefore, adequate information about the condition at the beginning benefits the other process. Success in all the steps is important in addressing the complication. The procedural process in the lean method increases the chances of the best intervention outcomes. 

References 

Chandrayan, B., Solanki, A. K., & Sharma, R. (2019). Study of 5S lean technique: a review paper. International Journal of Productivity and Quality Management, 26(4), 469-491. 

Ulrych, W. (2019). The 5s Method and its Influence on Employee Work Requirement Practices which Can Hamper Lean Service Introduction. Journal of Positive Management, 10(2), 30-41. 

DOI: https://doi.org/10.12775/JPM.2019.005 

REPLY 

CD 

Constantine Dapilma 

Posted Date 

Mar 6, 2022, 5:49 AM 

Status 

Ungraded 

Angela, I agree with you that clinicians prioritize patient safety. As a result, nurses may not engage in activities that expose patients to any form of risk. Clinicians either with or without their knowledge function under the philosophy of “first, do no harm.” Unfortunately, some mistakes may be unpredictable. Hence, clinicians are trained to be flexible in handling multiple roles within healthcare settings. The principles and concepts in Six Sigma is the right model to handle the diverse situation. The model’s alignment with the objectives and goals of healthcare makes the model more suitable (Honda et al., 2018). Six Sigma aims at improving quality. However, as they improve the quality chances of mistakes are identified and the right reactions generated. Data-driven process improvement methodology, define, measure, analyze, improve, and control are the six-step of the model (Improta et al., 2018). Therefore, to achieve the admired outcome when the model is used in this scenario adhering to all the six steps is important. 

References 

Honda, A. C., Bernardo, V. Z., Gerolamo, M. C., & Davis, M. M. (2018). How lean six sigma principles improve hospital performance. Quality Management Journal, 25(2), 70-82. 

Improta, G., Cesarelli, M., Montuori, P., Santillo, L. C., & Triassi, M. (2018). Reducing the risk of healthcare‐associated infections through Lean Six Sigma: The case of the medicine areas at the Federico II University Hospital in Naples (Italy). Journal of evaluation in clinical practice, 24(2), 338-346. https://doi.org/10.1111/jep.12844 

REPLY 

DISCARDPOST 

DH 

Deanna Higgins 

Posted Date 

Mar 3, 2022, 8:28 PM 

Unread 

Replies to Latrice Hatch 

The Operating Room is an area of the health care world the is required to run on efficiency and safety. The OR room is an area that requires an incredible about of trust among the team to maintain safety in a high-risk area. The Lean quality tool is one way of directing the team to collaborate and use a team approach to solving a problem (Selig, 2020).  Complications in the OR is an area of high risk for an organization and high risk to the patient as well, to reduce complications or errors first the team must identify the underlying issue causing the complication rate to increase. In an event the complication rate is related to inefficacies, staffing, lack of supplies, the Lean tool can be utilized to reduce time and create efficacies.  A Lean mindset can be used for quick-fixes but in the event the of increased complications, the 5-why tool can be used to solve a problem using Lean thinking (Fondahn et al., 2016).   

The foundation of lean thinking is to identify aspects o the service that provide value to the customer in the most efficient fashion and high value. Complications in the OR not only increase the risk to the patient, but these adverse events are an area that is costly to an organization in relation to poor outcomes leading to decreased reimbursements.  Lean is a process to identify value and decrease waste, in the OR scenario the value is related to improving the quality of care and eliminating wasteful or poor-quality practices (Rundio & Al, 2021). Standardization of a workflow creates consistency, efficacy and safety and is a key principle to the Lean process. When and area is efficient, free from overburden unnecessary workflows the work becomes increasingly efficient and decreased from errors.   

Fondahn, E., Lane, M., & Vannucci, A. (2016). The Washington manual of patient safety and quality improvement [e-book]. Wolters Kluwer . 

Rundio, & Al. (2021). The nurse manager’s guide to budgeting and finance, 3rd edition (3rd ed.) [original]. SIGMA Theta Tau International. 

Selig, B. (2020). Following Lean and the 5S philosophy can make quality improvement sustainable. Trade Journal, 44(3), 1. https://www.proquest.com/docview/2507126753/fulltext/FAC2B0EA0C6046C8PQ/1?accountid=7374 

REPLY 

TP 

Tanya Perkins 

replied toDeanna Higgins 

Mar 4, 2022, 7:53 PM 

Unread 

Replies to Deanna Higgins 

Hi Deanna,  

Your assertion is true that the Operating Room is an area in the health care world that should run on efficiency and safety. Also, the OR is an area that requires an incredible amount of trust and comradery among the team to maintain safety in a high-risk area. I agree that the Lean quality model is one way of directing the team to collaborate and use a partnership approach to problem solving (Selig, 2020). Complications in the OR are an area of substantial risk for an organization and considerable risk to the patient as well. You are correct that to reduce complications or errors, first the team must identify the underlying cause of the complication rate increase. I further agree that in an event the complication rate is related to inefficiencies, staffing, lack of supplies, the Lean tool can be utilized to reduce time and create efficacy. A Lean mindset can be used for quick-fixes but in the event the cause of increased complications is a prolonged cause then I agree that the 5-why tool can be used to solve a problem using Lean thinking (Fondahn et al., 2016).  

The foundation of lean thinking precisely is to identify aspects of the service that provide value to the customer in the most efficient fashion and high value. Complications in the OR not only increase the risk to the patient, but these adverse events are an area that is costly to an organization in relation to poor outcomes leading to decreased reimbursements. Thank you for pointing out that Lean is a process that can be used to identify value and decrease waste, in the OR scenario the value is related to improving the quality of care and eliminating wasteful or poor-quality practices (Rundio & Al, 2021). Also, standardization of a workflow creates consistency, efficacy and safety and is a key principle to the Lean process. When an area is efficient, free from overburden unnecessary workflows the work becomes increasingly efficient and decreased from errors. Thank you for explaining so well the Lean process. Tanya  

References 

Fondahn, E., Lane, M., & Vannucci, A. (2016). The Washington manual of patient safety and quality improvement [e-book]. Wolters Kluwer.  

Rundio, & Al. (2021). The nurse manager’s guide to budgeting and finance, 3rd edition (3rd ed.) [original]. SIGMA Theta Tau International.  

Selig, B. (2020). Following Lean and the 5S philosophy can make quality improvement sustainable. Trade Journal, 44(3), 1. https://www.proquest.com/docview/2507126753/fulltext/FAC2B0EA0C6046C8PQ/1?accountid=7374  

REPLY 

AJ 

Angela Jackson 

replied toDeanna Higgins 

Mar 5, 2022, 6:59 PM 

Unread 

Replies to Deanna Higgins 

Hi Deanna,  

I enjoyed reading your post and agree the OR is a high-risk area which presents many challenges. One of those challenges is surgical site infections (SSIs) which is responsible for 20% of all hospital-acquired infections (Ban et al., 2017). In addition, as noted in Ban et al. (2017), it costs approximately $3.5 to $10 billion annually to treat SSIs. Therefore, it is of the utmost importance that health care organizations establish guidelines to maintain sterility and ensure optimal patient outcomes. At the VA, surgical site infections are tracked by the VA Surgical Quality Improvement Program (VASQIP) which is part of the VA National Surgery Office (NSO). This department is responsible for reviewing and reporting data on all patients who undergo surgery within the VA healthcare system including its significance and implications for patient care as well as the quality of the care provided (Massarweh et al., 2018).   

   

References  

Ban, K. A., Minei, J. P., Laronga, C., Harbrecht, B. G., Jensen, E. H., Fry, D. E., Itani, K. M., Dellinger, E. P., Ko, C. Y., & Duane, T. M. (2017). American College of surgeons and surgical infection society: Surgical site infection guidelines, 2016 update. Journal of the American College of Surgeons, 224(1), 59-74. https://doi.org/10.1016/j.jamcollsurg.2016.10.029  

Massarweh, N. N., Kaji, A. H., & Itani, K. M. (2018). Practical guide to surgical data sets: Veterans affairs surgical quality improvement program (VASQIP). JAMA Surgery, 153(8), 768. https://doi.org/10.1001/jamasurg.2018.0504  

REPLY 

CY 

Crystal Young 

Posted Date 

Mar 3, 2022, 7:13 PM 

Unread 

The quality model that would best address the increase in complication rates from the operating room team is the 5S quality model. The 5S quality model focuses on organization and safety techniques to improve efficiencies within the workspace. These efficiencies are meant to create a better working environment for team members and a safer place to provide care. The operating room team members thrive best in environments with organization, cleanliness, and productivity. The 5S quality model provides techniques that supports efficient workflow practices which increases productivity (Bangert, 2019). 

When applying 5S quality model to the operating room complication rates, it’s important to first sort the equipment that will be used during the procedures. Next, it will be important to set the equipment in order, labeling the equipment, and labeling the cleanliness status. Next, the work environment needs to be maintained, properly cleaned, and prepared for the next procedure. Next, there should be a standardized process for each team member in the operating room. They should all have an assigned role, know what is expected of them and others on the team for clear and consistent expectations. In the operating room team members need to feel comfortable speaking about potential safety events, therefore having a standardized operating procedure supports these efforts. Finally, sustainability of these practices is vital to the overall success and will aid in team member satisfaction and patient safety (Bangert, 2019). 

Reference 

DEANNA 

The Operating Room is an area of the health care world the is required to run on efficiency and safety. The OR room is an area that requires an incredible about of trust among the team to maintain safety in a high-risk area. The Lean quality tool is one way of directing the team to collaborate and use a team approach to solving a problem (Selig, 2020).  Complications in the OR is an area of high risk for an organization and high risk to the patient as well, to reduce complications or errors first the team must identify the underlying issue causing the complication rate to increase. In an event the complication rate is related to inefficacies, staffing, lack of supplies, the Lean tool can be utilized to reduce time and create efficacies.  A Lean mindset can be used for quick-fixes but in the event the of increased complications, the 5-why tool can be used to solve a problem using Lean thinking (Fondahn et al., 2016).   

The foundation of lean thinking is to identify aspects o the service that provide value to the customer in the most efficient fashion and high value. Complications in the OR not only increase the risk to the patient, but these adverse events are an area that is costly to an organization in relation to poor outcomes leading to decreased reimbursements.  Lean is a process to identify value and decrease waste, in the OR scenario the value is related to improving the quality of care and eliminating wasteful or poor-quality practices (Rundio & Al, 2021). Standardization of a workflow creates consistency, efficacy and safety and is a key principle to the Lean process. When and area is efficient, free from overburden unnecessary workflows the work becomes increasingly efficient and decreased from errors.   

Fondahn, E., Lane, M., & Vannucci, A. (2016). The Washington manual of patient safety and quality improvement [e-book]. Wolters Kluwer . 

Rundio, & Al. (2021). The nurse manager’s guide to budgeting and finance, 3rd edition (3rd ed.) [original]. SIGMA Theta Tau International. 

Selig, B. (2020). Following Lean and the 5S philosophy can make quality improvement sustainable. Trade Journal, 44(3), 1. https://www.proquest.com/docview/2507126753/fulltext/FAC2B0EA0C6046C8PQ/1?accountid=7374 

RESPOND 

Deanna, I concur with you that the operating room requires high efficiency and safety levels due to the nature of the cases handled in this space.  The operating team ought to trust one another to avoid committing human faults that may expose patients to various health complications. Frequently, the operating room has clinicians working in teams. Teamwork ensures that there is efficiency and minimal time wastage (Muhammad & Karningsih, 2020). However, working in a team create room for unpredictable mistakes.  The lean quality tool becomes the right strategy for clients encountering diverse events. The tool provides the right protocol for addressing a healthcare problem.  Nurses are experts with adequate information on the lean quality model (Improta et al., 2018).  The foundation of lean thinking focus on customer value. Therefore, the model allows clinicians to think about patients’ safety and well-being.  Supposedly, the OR is occupied by healthcare providers who understand the importance of value patient will be safe.  

References 

Improta, G., Cesarelli, M., Montuori, P., Santillo, L. C., & Triassi, M. (2018). Reducing the risk of healthcare‐associated infections through Lean Six Sigma: The case of the medicine areas at the Federico II University Hospital in Naples (Italy). Journal of evaluation in clinical practice, 24(2), 338-346. https://doi.org/10.1111/jep.12844 

Muhammad, D. N., & Karningsih, P. D. (2020). Development of Lean Assessment Tool for Healthcare Industry. IPTEK Journal of Proceedings Series, (1), 108-115. 

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