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Stanford Hospital's Operating Room

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In each and every community there is one essential aspect each and every individual has to take care of, and this is ones health. And for this reason, we are surrounded by medical institution around us, Stanford Hospital and Clinics is one of them (SHC). Following the poor governance which prevailed at SHC years back before the appointment of Martha Marsh as the new CEO in the year 2002, the institution suffered substantial set-backs, including lack of instrumentation in the operating room, which saw surgeons going through hardships.

Being in a state of high spirit to bring change at SHC, Marsh appointed Seshadri to the position of vice president of Process Excellence, who, primarily was hired due to his work experience and a significant morale for process change. Sashadri saw change through by initializing various criteria for project selection. His plan had the following in content: the project had to make a significant impact toward increasing service excellence in order to draw the attention of the senior management; the project needed to target highly visible and well represented areas of SHC; the project had to a reasonable chance at success and lastly the project had to be in line with the hospital’s mission. From the above criteria Seshadri decided to settle on Operating Room (OR) Improvement Project, the urgency of OR improvement was driven by three factors: local market changes; increasing surgical volumes and decreased physician and staff satisfaction.

After the well selected project, Seshadri went to the drawing board to make the selection a success. He settled for the implementation process, which involved activities such as: time chart completion; outlining of surgery success and efficient room turnover including streamlining the provision of instruments and suppliesto the surgeons before a case. Following these activities there was a significant progress which was experienced. As a reinforcement and assurance of consistency of this progress, Seshadri recruited team leaders who were without a doubt competent and reliable.

To make the selection a success, Seshadri formed the Material Flow Committee (MFC) which was responsible for improvement in the OR instrumentation and supplies process. The MFC saw through valuable projects which were of good returnings to the institution. For instance, the MFC sponsored a pilot project-Early Morning Instrument Prep. The project provided early data into possible sources of accruing problems. Following the above success the SHC hired implementation specialists for healthcare who consisted of individuals of a firm with specialization in sterile processing and surgical service solutions. The firm carried out a critical role of Instrument Captain in the operating room. The Instrument Captain carried out the documentation and tracking down of problems concerning instrumentation errors including identifying the root causes of such errors.

It is seen that through the external consultant’s recommendations in March 2003, the surgical supply channel was centralized under the Material Management Department. For efficiency purpose there was a combination of sterile processing and assembly by the Sterile Processing Department (SPD). This reorganization of duties resulted into a smooth flow of instrumentation in the OR. Following the increasing numbers of cases at SHC in 2004 the instruments required increased and this was a great concern to surgeons. It was evident that instrument sharing was increasing, with the utilization of flash sterilization. But it is seen that through the OR instrumentation project. The SPD discouraged the use of flashing sterillization and as a result is usage dropped and efficiency increased.      

Before the introduction of the OR instrumentation project by Seshadri, the institution had faced various problems in that area due to some significant factors. Due to lack of confidence in the executive staff, change seemed to be a problem to achieve. The diminished communication between the SHC executives and the surgeons became an issue of concern. Surgeons were reporting high levels of frustration over failed and delayed delivery of instruments including the delivery of broken and unusable instruments. Lack of direct interaction between the surgeons and the SPD was an issue since they did not understand the complexity of the SPD’s work. Another significant problem was the heavy reliance of surgeons on nurses to prevent and resolve instrumentation related issues, in which some surgeons blamed the nurses for the instrumentation related problems.

On the other hand nurses at SHC felt that they were going above and beyond their official responsibilities in an effort to prevent instrumentation problems in the operating room. Moreover, some nurses kept some critical instruments in their locker, claiming that by so doing they will decrease the act of missing instruments. The truth is the practice complicated the instrumentation deficiencies even further, since the instruments were counted missing and yet they were needed for cases. Another significant problem accrued as a result of angry calls from the OR nurses to the SPD staff on reporting of the missing instruments. The repeated urgent calls to locate missing instruments interrupted the flow of activities and caused more instruments delayed to the operating room since the SPD staff turned to instrument searching instead of making deliveries to the operating room.

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