Team Charter for Schedule to Day of Surgery



SIP 1 – Pre-Op

Schedule to 00:01 on the Day of Surgery

|Leader: Judy Canfield & Laurie Amundsen |Start Date: 2/3/05 |

|Roles: |Suggested Members: |End Date: |

|Clinic Manager |Nancy Eberhardt |Milestones: Dates: |

|Pre-Surgery Clinic |S. Deatrick/S. Mossing |Current State 2/23/05 |

|PCC Manager |Kathy Herigstad |Proposal of Future State |

|PCC |Suzanne Hoehne |Best Practices |

|OR Scheduler |Susan Tracy |Identify and Eliminate Waste |

|Patient Data Services/ORCA |Sally Beahan |Implementation |

|Charge RN OR |Donna Anderson | |

|OR RN3 |Jackie Walker | |

|Surgeon |Ben Greer | |

|Surgeon |Brandt Oelschlager | |

|PL’s & Implants |Bill Anton | |

|Patient Representative |Maria Hall | |

|Anesthesiology |Alan Artru | |

|Materials Management |Sal Ramirez | |

|Financial Counselor |Becky Mounce | |

|Consultant Roles: |Suggested Members: |Support Staff: Kati Koszegvari |

|IT Services |Trina Marsh |206-598-6991 |

|Interpreter Services |Linda Golley |katibell@u.washington.edu |

|Med Consult | | |

|Cardiology Consult |Donna Nyenhuis | |

|Radiology |Bill Shuman/Dawn Vincic | |

|Radiology Tech |Dan Lane/Mario Ramos | |

|Interventional Radiology |Patrick Willis | |

|Lab Medicine |Paul Henderson | |

|Pharmacy |Jim Velez | |

|OR Manager |Mary Claire Cook | |

|Surgeon |Ben Anderson | |

|Stakeholders: Surgeons, PCC, Pre-Anesthesia Clinic, Scheduling, Med Consult, Lab, Radiology, SCCA, Pathology, Patient Registration (Sally Beahan – |

|director), Pharmacy |

|Scope: From patient’s decision of having surgery until 00:01 on the day of surgery. |

|In Scope: |Patient scheduling of surgery; Pre-Anesthesia, Lab – including day of surgery; Discharge Planning; Financial Clearance; patient |

| |packet; interface to: Med Consult, Radiology, Pathology, Cardiology, Lab appointments; Scheduling Systems: scheduling coordination |

| |with PL’s; Communication of special needs – implants, ICU beds, bariatric equipment, etc.; In-patient preparation |

|Out of Scope: |Preparing instruments, supplies, and equipments; |

Methodology:

▪ Lean

o Optimize for Patient Experience

o PASCO

Outcome Characteristics

1. Safe and patient-centered care

2. Scientific modeling for case accuracy

3. Collect accurate patient data once, retain and disseminate

4. Universally accessible patient data

5. Staff, equipment, OR, ready for patient on arrival

6. Patient ready on arrival

7. Scheduling by code or code group that delivers time estimate, equipment, special staffing, and essential service resource needs

8. Robust and flexible yet highly efficient

Outcome Deliverables

1. Document current state process(es)

2. Document best industry practices

3. Value analysis using LEAN methodology

a. Identification of optimal patient flow (patient experience)

b. Identification of optimal information flow

c. Identification of essential variability

4. Design future state process(es)

5. Develop project plan and timeline

a. Identify short and long term projects

6. Develop metrics and key indicators

7. Short and long term project completion

8. Strategy for ongoing Performance Improvement

Essential Metrics

▪ Patient ready upon arrival

▪ All resources ready upon arrival

▪ Block time utilization

▪ Planned schedule same as actual schedule

Project Support

Lean Expert; EPIC Expert

Resources

SIP 2 – First Case

Day of Surgery: 00:02 to Incision First Case

|Leader: Kevin Smith |Start Date: 2/2/05 |

|Roles: |Suggested Members: |End Date: |

|PL’s/Equipment & C-Core |Jason Jio |Milestones: Dates: |

|Anesthesiology |Karen Domino |Current State 2/23/05 |

|Anesthesiology |Karen Souter |Proposal of Future State |

|RN |Susan Grant |Best Practices |

|Pavilion Pre-OP RN |Dori Nelmark |Identify and Eliminate Waste |

|Main Pre-OP RN |Vicki Sandeen |Implementation |

|OR RN3 |Sonja Borthen | |

|Patient Representative |Terry Way | |

|Ambulatory Surgery Manager |Renae Burchiel-Battie | |

|Surgical Tech |Mike Amos | |

|Instrument Room |George Davis | |

|Hospital Assistant E |Abdul Ramzan | |

|Surgeon (Ortho) |Kevin Smith | |

|Surgical Resident (Ortho) |TBD | |

|Consultant Roles: |Suggested Members: |Staff Support: Ruth Oskolkoff |

|Materials Management |Kathy Ritter |206-598-6300 |

|Surgeon (CV) |Gabe Aldea |rosk@u.washington.edu |

|Surgeon (Ophthalmology) |D. Sapperstein | |

|R2 OR Charge Nurse Otolaryngology |Janet Link | |

|Pharmacy |Kevin Kiemele | |

|Admitting |Shabir Somani | |

| |Jason Metcalf | |

|Stakeholders: Pavilion Pre-op, Main Pre-op, Admitting, Anesthesia, Materials Management, Surgeons, Main OR RN, Pavilion OR RN, Registration |

|Scope: All support activities needed to prepare the resources necessary for surgery before the 1st patient enters the OR at 7:25 am. |

|In Scope: |Day ahead prep; Patient check-in; Preparing instruments, supplies, equipments; Room setup; Preparing the 1st patients for |

| |surgery; Transport; Anesthesia; documentation compliance and regulatory issues |

|Out of Scope: |All labs or patient centered activities except patient check-in and flow on the day of surgery |

Methodology:

▪ Lean

o Optimize for Patient Experience

o PASCO

Outcome Characteristics

1. Safe and patient centered care

2. Compliant with all regulatory requirements

3. All cases start on time

a. Zone concept or evolutionary equivalent

4. Minimal unanticipated schedule changes

5. Management plan for schedule changes

6. Plan for transplant and emergent cases

Outcome Deliverables

1. Document current state process(es)

2. Document best industry practices

3. Value analysis using LEAN methodology

a. Identification of optimal patient flow (patient experience)

b. Identification of optimal information flow

c. Identification of essential variability

4. Design future state process(es)

5. Develop project plan and timeline

a. Identify short and long term projects

6. Develop metrics and key indicators

7. Short and long term project completion

8. Strategy for ongoing Performance Improvement

Essential Metrics:

▪ More accurate delay codes

Resource checklist

Project Support:

Lean Expert;

Resources:

SIP 3 – Last Case

Day of Surgery: After Incision for First Case to Midnight

|Leader: Peter Buckley & Mary Claire Cook |Start Date: 2/2/05 |

|Roles |Suggested Members: |End Date: |

|OR Manager |Mary Claire Cook |Milestones: Dates: |

|OR Charge Nurse |Jim Henkleman |Current State 2/23/05 |

|Frontline OR Nurse | |Proposal of Future State |

|PACU Main Charge RN |Mary Mentele |Best Practices |

|R2 PACU RN |Kim Owen |Identify and Eliminate Waste |

|R2 OR MA |Kenneth Marbury |Implementation |

|PACU Manager |Shelley Deatrick | |

|Surgeon (Plastic) |Jana Cole | |

|Surgeon |Al Hillel | |

|Hospital Assistant PACU |Jason Dela Cruz | |

|Pavilion RN3 |Loretta Stesco | |

|Materials Management |Leslie Bahr | |

|Anesthesiology |Karen Domino | |

|Patient Representative |Mike Smith | |

|Main Pre Op RN |Gale Uhlenkott | |

|Consultant Roles: |Suggested Members: |Staff Support: Virginia McClure |

|Radiology |B. Shuman/Dawn Vincic |206-598-4260 |

|Pharmacy |Steve Bird |vmcclure@u.washington.edu |

|IP Unit Manager, 6SE |Judi Hubbard | |

|PCS Director |Sherri Del Bene | |

|Pathology |Melissa Upton | |

|Environmental Services |Craig Saran | |

|Patient Flow Supervisor |Shauna Andrus | |

|Pavilion C-Core | | |

|Stakeholders: Pavilion Pre-op, Main Pre-op, Admitting, Anesthesia, Materials Management, Surgeons, Main OR RN, Pavilion OR RN, Registration, HA, ES, |

|PACU |

|Scope: Logistics for all non-first cases |

|In Scope: |Patient check-in through holding; Documents/results ready; Procedure time; Turnover; Non-black case management (TBA, |

| |Urgent/Emergent); Coordination of rooms, instruments, supplies, and equipments between cases; Bed utilization; |

| |Surgeon/patient availability; Transport of patients; hours of staffing coverage; staffing; Family debriefing; Patient arrival|

| |time; team incentives; |

|Out of Scope: |1st cases |

Methodology:

▪ Lean

o Optimize for Patient Experience

o PASCO

Outcome Characteristics

1. Patient and family centered, safe

a. No rescheduling of elective scheduled cases

2. Scheduled and case time approximate & appropriate

3. Minimal "turnover time"

4. Manage educational experience to maintain efficiency and productivity

5. End of the day plan in place by the end of the first case or 9 am

6. Available resources for throughput from OR to inpatient or DC

7. Optimal strategy for urgent elective and emergent cases

8. Highly efficient use of resources

a. Efficient and consistent performance 24/7

Outcome Deliverables

1. Document current state process(es)

2. Document best industry practices

3. Value analysis using LEAN methodology

a. Identification of optimal patient flow (patient experience)

b. Identification of optimal information flow - staff, patient, AND family

c. Identification of essential variability

4. Design future state process(es)

5. Develop project plan and timeline

a. Identify short and long term projects

6. Develop metrics and key indicators

7. Short and long term project completion

8. Strategy for ongoing Performance Improvement

Essential Metrics:

▪ Number of overhead pages lowered

▪ Patient Satisfaction Survey

Project Support:

Lean Expert;

Resources:

SIP 4 – Leadership/Culture

Leadership and Culture

|Leader: Alan Artru & Dan Kaiser |Start Date: 2/1/05 |

|Roles: |Suggested Members: |End Date: |

|Administration |Lisa Brandenburg |Milestones: Dates: |

|Surgeon |Doug Wood |Current State 2/23/05 |

|Surgeon |Chris Wahl |Proposal of Future State |

|Surgery Resident |Fred Cobey |Best Practices |

|CCE & Anesthesiology |Gene Peterson |Identify and Eliminate Waste |

|Anesthesiology |Peter Buckley/ E Kharasch |Implementation |

|Anesthesiology |Karen Domino | |

|Anesthesia Tech/Hospital Assistant |Joe Fitzgerald/Abdul Ramzan | |

|CRNA |Gail Weiner | |

|RN Management |Susan Grant | |

|Surgical Tech |Neil Kovacs | |

|Frontline OR RN |Melissa Marshburn | |

|Patient Representative |Laura Gerber | |

|PACU |Cindy Riplinger | |

|Inpatient Nursing |Janice Cherin | |

|OD&T |Kurt O’Brien | |

|Consultant Roles: |Suggested Members: |Staff Support: Virginia McClure |

|HR Consultant |Jennifer Petritz |206-598-4260 |

|SOM Representative |Julie Reid |vmcclure@u.washington.edu |

|Stakeholders: Surgeon; RN; Anesthesiologist; HA; ES; CRNA; Anesthesia Tech; C-Core; Surgical Tech; Pre-Op; PACU |

|Scope: Activities within the Surgical Services |

|In Scope: |All cultural & leadership aspects within the walls of Surgical Services; Performance incentives; |

|Out of Scope: |Pre-Anesthesia Clinic; Surgical Clinics; Support Organizations; |

Methodology:

▪ Lean

o Optimize for Patient Experience

o PASCO

Outcome Characteristics

1. Safe and patient and family centered care

2. Specific responsibilities and accountabilities 24x7

3. Inspired, accessible, knowledgeable leadership at all levels

4. Incentives for team development and participation

5. "Can do" attitude - for our patients and ALL of our customers

6. Consistent across all of surgical services, all day, every day

7. Interdisciplinary

8. Transparent

9. Professionalism

Outcome Deliverables

1. Document current leadership and governance structure

2. Document best industry practices

3. Value analysis using LEAN and formal leadership evaluations

4. Design future state. Recommendations regarding future state: effective governance structure and VALUE

a. Front line contributions, interdisciplinary and by consensus

b. Rules, protocols, guidelines for recurring operational/staffing/culture issues

5. Ongoing leadership training

6. Strategy for ongoing optimization of Culture and Leadership - survival and succession strategy

Essential Metrics:

▪ No bumps- every case finds a docking gate

▪ Same answer same question- any leader

▪ Patient Centered

Project Support:

Lean Expert

Resources:

SIP 5 – Strategic Planning

Strategy/Strategic Planning

|Leader: Ed Walker & Ernie Weymuller |Start Date: 1/31/05 |

|Roles: |Suggested Members: |End Date: |

|Administration |Judy Canfield |Milestones: Dates: |

|Surgeon |Dave Flum |Current State 2/23/05 |

|RN |Susanne Loven-Skolnik |Proposal of Future State |

|Anesthesiology |Peter Buckley |Best Practices |

|CRNA |Mark Schierenbeck |Identify and Eliminate Waste |

|Finance |Lisa Brandenburg |Implementation |

|Clinical Oversight |Susan Grant | |

|Transplant |Jorges Reyes | |

|Ambulatory Surgery Mgr |Renae Burchiel-Battie | |

|Electronic Patient Record |Andy Bowdle | |

|PACU RN |Shelley Deatrick | |

|Patient Representative |TBD | |

|Consultant Roles: |Suggested Members: |Staff Support: Kimberly Knight |

|Quality Consultant |Jim Perkins/Dave Flum |206-598-6090 |

|Planning Con |Helen Shawcroft |kknight@u.washington.edu |

|Baldridge Consultant |Preston Simmons | |

|IT Services |Tom Martin | |

|SOM Representative |Julie Reid | |

|Stakeholders: Everyone in Surgical Services; Administration, UW Medicine |

|Scope: All surgical patients through the continuum of the surgical process |

|In Scope: |Core services of the OR, future projections in coordination with or development of the current strategic planning (number of |

| |OR’s, sites, growth of business, business plan development, specialty growth); Capacity planning and impact analysis of all |

| |essential organizations; All evening and weekend cases; Marketing |

|Out of Scope: |Governance; Daily operations |

Methodology:

▪ Lean

o Optimize for Patient Experience

o PASCO

Outcome Characteristics

1. Safe patient and family-centered care

2. Alignment of performance vs. incentives

3. Right sizing of ambulatory and complex case capacity for current and projected UW strategic planning goals

4. Graceful integration with hospital workflow that transcends traditional boundaries

a. Optimal utilization of Pavilion resources

b. IT infrastructure

(e.g.) Electronic patient record in OR

(e.g.) System-wide wireless patient tracking system

5. System for coordination with other UWMC strategic planning around capacity and specific program development

6. Standardized process for transplant cases

7. Standardized process for evening and weekend urgent-elective and emergent cases

8. Policy for allocation and reallocation of block time

9. Sufficient beds for all cases

Outcome Deliverables

1. Environmental Scan, OR capacity, actual delivery of surgical services

a. UW and UW Medicine

b. Locally and regionally (Seattle, WA, WWAMI)

c. Nationally

2. Identify best practices for strategic planning in surgical services

3. Document current processes for strategic planning, where they exist

a. Document other strategic initiatives that affect the OR in UW Medicine and UWMC

4. Strategic planning process evaluation using LEAN principles

5. Coordinated incentive system for all team members aligned with UWMC principles and best industry practice

6. Proposal for optimized strategic planning process

a. Baseline strategic plan (including Marketing)

7. Coordination of PI in surgical services with Center for Clinical Excellence

Essential Metrics:

▪ Pt. Satisfaction feedback - after a number of surgeries get detailed patient feedback

▪ Use of OR space

▪ Lower manipulation of day-to-day work

Project Support:

Lean Expert

Resources:

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