Martin Feckie is an application developer and nurse who worked to address barriers at his hospital. He hypothesized that surgeons' perceptions of procedure lengths were often shorter than reality. He gathered data on actual procedure times and found variances between surgeons. This led the hospital to review theatre schedules and negotiate lists to improve outcomes like getting staff home on time and reducing overtime and sick leave. However, the process required commitment and not all staff supported it initially.

1. WORKING AROUND
BARRIERS
Martin Feckie RN, MSc - Application Developer / Code Nurse
1
mfeckie@thoughtworks.com

2. Our mission is to better humanity through software
and help drive the creation of a socially and
economically just world.
Sustainable
business
Champion
software excellence
and revolutionize
the IT industry
Advocate passionately
for social and
economic justice

3. 3

4. 4
5 CEO’s in the preceding
6 years
Culture that tolerated
abusive staff to staff
behaviour
Little interest Culture of keeping quiet in changing

5. 5

6. 6

7. Patients
Anaesthetists
7
Nurses
Orderlies

8. A HYPOTHESIS
8
In general, surgeons’
perception of
surgical procedure
length is shorter
than reality

9. 9

10. WHERE SHOULD WE START?
10

11. WHAT ARE THE POTENTIAL VARIABLES?
11
Anaesthetic
Preparation
Surgical
Operating Time
Anaesthesia
Emergence
Turnaround
Time

12. OPERATING ROOM JOURNEY
12
Procedure
Into OR Anaesthesia Prep Prep and Drap
Incision to closure Emergence Transfer to Recovery
4 6 5 40 6 4
0 5 10 15 20 25 30 35 40 45 50 55 60 65 70
Minutes

13. PERCEPTION VS REALITY
13
Surgeon
Reality
Lap Chole Hernia Repair Abcess Drainage
Lap Chole Ventral Hernia Lap Appendix
0 40 80 120 160 200 240 280 320 360 400

14. 14

15. WARM RESPONSE
15

16. PROOF OF CONCEPT
16

17. GETTING SOME SUPPORT
17

18. FOR AND AGAINST
18
AGAINST COUNTER-ARGUMENT
We’ve never done that before Why shouldn’t we try?
If Martin leaves we won’t be
able to use it
We’ll be back to where we
are now, but we’ll know more
If we give access everyone
will want it
Let’s cross that bridge when
we come to it
It is risky because we could
cause the system to hang
Let’s create a mirror of the
database and access only
that

19. SOME RESULTS
19
Surgeon
Elective Caesarian Section
Average
Minutes
StdDev
Coefficient of
Variance
Number of
Procedures
1 81 16 0.2 86
2 64 9 0.15 44
3 55 34 0.62 12
4 60 12 0.21 68

20. SOME RESULTS
20
Surgeon
Elective Caesarian Section
Average
Minutes
StdDev
Coefficient of
Variance
Number of
Procedures
1 81 16 0.2 86
2 64 9 0.15 44
3 55 34 0.62 12
4 60 12 0.21 68

21. SOME RESULTS
21
Surgeon
Tonsillectomy
Average
Minutes
StdDev
Coefficient of
Variance
Number of
Procedures
1 46 8 0.19 8
2 42 10 0.25 16
3 33 3 0.1 9
4 32 9 0.3 19

22. TURNING DATA INTO CHANGE
22

23. THEATRE LIST REVIEW
23
Theatre List Negotiation

24. OUTCOMES
24
Home on time
Less Overtime
Less Sick Leave
Happier Team

25. FLAWS
25
Not everyone was happy!
Not statistically robust
Requires a lot of commitment
Somebody has to be the bad person

26. 26

27. THANK YOU
Want us to work with you?
mfeckie@thoughtworks.com