Patient safety in the operating theatre: how A3 thinking can help reduce door movement

• Published in: International journal for quality in health care 2014-08, Vol.26 (4), p.366-371
• Main Authors: SIMONS, FREDERIQUE ELISABETH, AIJ, KJELD HARALD, WIDDERSHOVEN, GUY A.M., VISSE, MEREL
• Format: Article
• Language: English
• Subjects: Academic Medical Centers - organization & administration; Academic Medical Centers - statistics & numerical data; Biological and medical sciences; Colleges and universities; Efficiency, Organizational; General aspects; Health policy; Humans; Medical sciences; Netherlands; Operating Rooms - organization & administration; Operating Rooms - statistics & numerical data; Patient Safety; Patients; Problem solving; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quality Improvement - organization & administration; Quality Improvement - statistics & numerical data; Quality insurance (general aspects); Surgery; Surgical Wound Infection - prevention & control
• ISSN: 1353-4505; 1464-3677
• DOI: 10.1093/intqhc/mzu033

Issue. Research has often stressed the significance of reducing door movement during surgery for preventing surgical site infections. This study investigated the possible effect of a lean A3 intervention on the reduction of door movement during surgery in a university medical center in the Netherlands. Initial assessment. A digital counter recorded door movement during 8009 surgical procedures during 8 months. The number of door movements per surgical procedure ranged from 0 to 555, with a mean of 24 door movements per hour across 26 specialisms. Choice of solution. We aimed to reduce door movement in one operating room for orthopedic surgery by a lean A3 intervention. This intervention was executed by means of an A3 report that promotes structured problem solving based on a Plan-Do-Check-Act cycle. Implementation. The steps of the A3 report was followed and completed one-by-one by a multidisciplinary team. The effect of the changes was monitored over the course of 12 months. Evaluation. The use of a lean A3 intervention resulted in a sustainable decrease of door movements by 78%, from a mean of 24 to a mean of 4 door movements per hour during orthopedic surgery at one OR. Lessons learned. This paper shows the relevance of and the possibility for a reduction of door movement during surgery by lean management methods in general and an A3 intervention in particular. This intervention stimulated dialogue and encouraged knowledge-sharing and collaboration between specialized healthcare professionals and this resulted in a thorough root-cause analysis that provided synergy in the countermeasures—with, according to respondents, a sustainable result.