Why It Matters
By showing staff their data, and letting them explore how to make improvement, an improvement effort "found the solutions we had been talking about for years, but no one had implemented because no one was owning them [before].”
It sounds counter-intuitive, but a recent initiative to improve elective surgery start times did not focus directly on increasing punctuality and efficiency. Instead, it emphasized improving staff experience and ensuring that they had what they needed to flourish.
The project was led by Eva Fiz, Deputy Director, Improvement and Transformation at Barts Health NHS Trust (London, UK), a member of the IHI Health Improvement Alliance Europe. Fiz had run elective surgery improvement efforts before “where the focus was on the finances, inefficiencies, hard numbers,” she recalled. But those goals were not inspiring and did not resonate with most staff. The results ended up being disappointing. “This time, we’ve taken the IHI QI approach to get the staff involved and put them at the center of the changes,” Fiz said.
The initiative grew out of the pandemic. When it struck, in early 2020, the Trust had seven people on their list who had been waiting for more than a year for elective surgery. A year later, that number had ballooned to 7,000. “We needed to do something to optimize the resources that we had,” Fiz noted. “Looking at how effectively we use our theater’s capacity was one of the most obvious places to go.”
In approaching the challenge, it was crucial to Fiz and her team to shift the focus from inefficiencies to listening to staff and patients and learning what mattered most to them. “We are not numbers,” she said. “We are people and patients. We want to make sure that the time we spend in [surgical] theaters is as good as it can be.”
To start off, the leaders pursued deep diagnostics to understand the current system and why they were not starting on time. Through that process, they identified workstreams. “By having those conversations, showing them the data, and letting them explore the issues they face and how can they fix them,” Fiz recounted, “we found the solutions we had been talking about for years, but no one had implemented because no one was owning them [before].” These discussions helped everyone understand they had to change that.
The work focused on three primary areas. One was to improve the experience of the staff and keep them informed and engaged in improvement efforts. As part of this priority, the divisional manager at the hospital went to all the audit days (when surgeries are not occurring) and everyone participated in engagement sessions. The second area involved fine-tuning processes and ensuring a smooth patient journey, from the moment they arrive at the hospital to the moment they go home. The third area was scheduling. “It’s all about planning, planning, planning, planning,” said Fiz. “No matter how well you plan, you still have to plan a bit better.”
One of the most illuminating parts of the work involved engaging their scheduling team in the improvement project. Despite their importance, the schedulers had typically not received the recognition they deserved or been involved in work of this kind. “They are often people sitting in the corner or in a dark office,” Fiz said. “Everyone blamed them for everything, and they hadn’t been supported.”
That changed with this project. Fiz’s team included the schedulers as part of the improvement journey. This effort started with a what matters to you joy in work session. Through this process, the scheduling team made modest requests for items that would contribute to their joy in work and well-being: An extra printer and a water-filling station. Asking what mattered to them had two key results: the schedulers got simple items to help them do their jobs and they felt like the valuable team members they are. The discussions also gave the schedulers, surgical staff, and other clinicians the chance to get to know one another and understand they were working toward the same goals.
Over the course of the initiative, the team has seen significant improvement in start times. At the outset, they were starting 50 percent of elective surgeries within 30 minutes of their scheduled start time. Now that number has risen to 70-75 percent.
Fiz cannot stress enough the importance of staff engagement. “Staff are the change, and they have the ideas,” she emphasized. “[Our improvement team] just help them to get the ideas out of their heads, articulate them, and then support them to deliver results.”
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