A modified collaborative model to improve surgical flow health care processes in Veterans Affairs Medical Centers

Abstract

The Veterans Health Administration (VHA) Office of Systems Redesign and Improvement, in collaboration with the VHA National Surgery Office and Veterans Affairs Center for Applied Systems Engineering (VA-CASE) - Veterans Engineering Resource Center (VERC), conducted a national process improvement initiative in Fiscal Year 2012 to promote more effective and efficient use of surgical unit resources. This improvement effort adopted a modified collaborative model with the incorporation of symposia and Rapid Process Improvement Workshops (RPIWs) to address concerns from collaborative teams for a more efficient surgical flow. Throughout the seven-month duration of the initiative, 20 teams participated and completed a total of 468 Plan-Do-Study-Act (PDSA) cycles to implement changes and improve performance levels in defined measures. At the conclusion, on average, teams were able to improve performance on the first case on-time start rate by 24%, mean turnover time by 14%, cancellation rate by 5%, and Operating Room (OR) utilization by 8%. The projected annual Cost Savings was estimated to be nearly $25 million. This modified improvement model overcame some of the challenges experienced in a traditional improvement collaborative model such as lack of clarity of clear roles and responsibilities of team members and clear and consistent aims. The operations in surgical flow were improved in multiple ways to achieve overall better performance. Future improvement initiatives have the potential to further enhance performance outcomes by focusing even more efforts on the preparation phase, increasing team participation and leadership buy-in, utilizing on-going reports that track team progress and focusing on sustain and spread.