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Use of multidisciplinary positive deviance seminars to improve efficiency in a high-volume arthroplasty practice: a pilot study
Canadian Journal of Surgery ; 66(1):E1-E7, 2023.
Article in English | ProQuest Central | ID: covidwho-2260837
ABSTRACT
Delivery of health care is coming to an inflection point in regard to supply and demand, with joint replacement demand in Canada increasing from 2014 to 2019 by 20.1% for hip replacement and 22.5% for knee replacement.1 Increasing demand, combined with delays related to the COVID-19 pandemic, has created a large backlog of surgical procedures, especially in countries with universal health care like Canada and the United Kingdom, where efficient delivery of health care is even more critical.2-4 Prolonged surgical wait-lists are further compounded by systemic inefficiencies in North America, health care functions at a productivity level of about 43%;in the surgical care setting, inefficient use of time and space accounts for 30% of costs.5 To address this, various initiatives to increase throughput, such as high-efficiency operating rooms (ORs) and parallel processing with anesthesia block rooms, have been suggested.6 At our institution, to address wait times and increasing demands, 4-joint rooms were instituted in 2004, but successful completion of 4 joint replacement procedures within the assigned OR time (i.e., 4 joints between 0730 and 1530) has been inconsistent.7 This lack of efficiency, with overtime and lack of improvement, can lead to staff disengagement, fatigue and a sense of impossibility of the task at hand.8 To foster self-improvement and staff engagement to work as a team, various models of team efficiency have been developed using the Lean method, Six Sigma and process mapping, which can be quite effective but very resource intensive.9,10 An alternative approach that has shown excellent results in improving the quality of individual surgeon practices is positive deviance (PD) seminars,11,12 which use individual performance feedback to identify team members who outperform their peers. Positive deviance has been effectively used in health care, public health, education and the private sector.13 Positive deviance seminars focus on individual strengths and resources already present, instead of negatives that require improvement. Measures The time interval data were recorded by the circulating nurse using the Surgical Information Systems. The time intervals used to determine OR efficiency were a modified version of those defined by the Association of Anesthesia Clinical Directors14 anesthesia preparation time;patient in room to anesthesia ready, surgical preparation time;anesthesia ready to procedure start, procedure duration;(procedure start time to procedure finish), anesthesia finish time;procedure finish to patient out of room, and turnover time;start of room cleanup to patient in room.
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Collection: Databases of international organizations Database: ProQuest Central Language: English Journal: Canadian Journal of Surgery Year: 2023 Document Type: Article

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Collection: Databases of international organizations Database: ProQuest Central Language: English Journal: Canadian Journal of Surgery Year: 2023 Document Type: Article