Rebecca Donald - Box Hill Hospital - Redesign & Redevelopment of Operating Theatres, Reflecting...

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..