Rebecca Donald - Box Hill Hospital - Redesign & Redevelopment of Operating Theatres, Reflecting on...
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Transcript of Rebecca Donald - Box Hill Hospital - Redesign & Redevelopment of Operating Theatres, Reflecting on...
Redesign and Redevelopment of Opera3ng Theatres Reflec3ng on Experiences from Box Hill Hospital’s Redevelopment including 10 (11) New Theatres
Rebecca Donald – PSM Box Hill Hospital
Who are we.. Eastern Health.. ! One of the 12 Metropolitan Melbourne
Health Services ! Population in our Catchment Area is
800,000 (2008 figure) ! Staff of almost 8,000 ! 3,500 at Box Hill Hospital
Box Hill Hospital Theatres.. ! BHH built 1956 ! 6 theatres ! 1 Endoscopy Room ! 1 Procedure Room (tiny) ! 2 x PACU’s ! Spread over 2 floors – level 2 and Level 4,
*level 2 Original BHH Operating Theatres
The Old Box Hill Hospital..
CSSD and Level 4 Theatres
Level 4 post move and clean..
! Scrub Sink ! Anaesthetic room
! Theatre 2
The New Box Hill Hospital
Old Vs New Staffing.. ! 2 x Floor Co-ordinators ! 2 x Anaesthetic/ PACU
Resource, (APR) ! 3 x Scrub/ Scout
Resources (SSR) ! appropriate staffing for
6 theatres, Endoscopy and Procedure Rooms
! One Floor Co-ordinator ! Anaesthetic Team
Leader ! PACU Team Leader
(SN) ! Holding Bay Nurse ! SS resource/ TL for
every 2 theatres ! Appropriate staffing for
10 Theatres
Iden3fied Challenges.. ! 2 theatre suites – running independently ! Case mix ! Design of both levels – Instrument Core ! Delegation of staff ! Coming together ! Floor Co-ordinator role ! Expectations
Small changes = big news.. ! Removing the staffing allocations board – the start of things to come...
Preparing for the MOVE.. ! Staff engagement – easier said than done ! Strategies – “M” people, staff meetings, displaying of Floor Plans, trial of new Speciality Trolleys, Targeted Engagement meetings, ANUM and Management team Building and others...
Training.. ! Nurse call system ! New monitors and
modules (Phillips) ! Phones ! Resus/ defib ! In theatre cameras
and lighting systems ! DD Safes
! Evacuating training ! Beds and Trolleys ! Pan Flushers ! Electronic Staffing
allocations ! Patient Flow ! NO DOUBLE
STAFFING TIME..
Move Day.. ! Plan to move whole hospital on 1 Day..
TUESDAY 30 th September 2014 ! Theatres normal operating on Monday am,
reduced operating (level 4 only in pm) ! Tuesday – emergency cases only, ED on
Bypass for the day and Maternity open in New Building from 0800am
Theatres.. ! Staffed both Old (level 4) and New
Theatres – plus extras to assist with the physical movement and allocation of instruments, equipment, labelling etc
! Last patient operating in level 4 completed by 11am (Orthopaedics) and first in new theatres at 3pm (Orthopaedics)
! Theatres in old building closed at 3.30pm
Move day.. Lessons learnt ! Everyone needs a job – and a team leader ! Not all senior Nursing staff make good
team leaders.. New leaders were identified in the move.
! Pace yourself.. ! Started operating too soon? ! Have lots of plans but be flexible... ! Breathe..
Surviving the first few days.. ! Putting out fires ! Slow turn over ! Under booked lists
but more emerg. cases.. “build and they will come”
! Holding Bay ! “where ()is it?? ! Lockers
Opening up to 10 theatres – the first months.. ! Staff staying and going – how staff reacted
to the change ! Roles and the change in structure – SSR/
APR roles ! Process change and review ! Theatre Technicians and PSA work flows ! Changes to Theatre Management
and now.. ! Change is an ongoing process ! Accreditation is coming.. ! ROLES ! Processes ! Leaders ! Staffing – Recruitment and Retention ! Continuing Improvements
Lessons Learnt.. • You can never engage with clinical staff too
early –try everything.. • Focus on process rather than resource to
manage risk. • Manage the fatigue factor • The move goes on for months – keep up the
support and risk management • The ‘what's next’ phenomenon. Exhaustion ! Celebrate for longer.
Specific Challenges ! Staffing – on the bus or under it – lots of energy to “bring people along”
! Pre – move a lot of work done by few – Fatigue ! Change in date and the implications for the strategic reduction in annual leave
! Selection of Project Managers and continued interface with current front line managers
! Share the Dream... ! Keep your sense of humour..or get one..
Ques3ons..