A Study on Determination and Implementation of Operation Theatre Management System in a Private Hospital, Trichy: A Six Sigma Approach

The study aims in increasing the number of surgeries with the available resources in the operation theatre which ultimately improves the efficiency and effectiveness of operation theatre. Efficiency rate is calculated multiplying the availability of operation theatre, Number of scheduled surgeries and success rate of surgeries. This formula is commonly accepted in calculating the efficiency rate among Industrial sectors. The study covers the activities involved from patients entering pre operation theatre to transferring them to post operation theatre i.e. from admission to discharge process of operation theatre. Methodology adopted in this study is Six Sigma. The Defect per million opportunities analysis reveals that the existing sigma level is 2.6 and the existing efficiency rate is 54.5 percent. It was found that the risk priority number was high in the assessment and preparation of surgery process in which missing of pre-assessment and failure to give timely request for investigation has been identified as the failure modes. This leads to increase in average length of stay which is caused by postponement and cancellation of surgeries; this ultimately leads to reduction in productivity. The vital few items are found to be poor pre admission procedure, in adequacy in manpower, patient delay, drugs delay and slow turnaround time. Improving the efficiency by finding solutions to the root causes leading to substantial improvement in Quality of service can be achieved through Six Sigma approach which is one of the Total quality management concepts and methodologies.


Six Sigma:
A number of hospitals and health systems are finding that Six Sigma is a useful tool for improving quality in the operating room. Six sigma is an integrated approach for pursuing continuous improvement of customer satisfaction as well as organization profits. Six Sigma is able to combine the available knowledge from the various functions in an organization to achieve the best possible process improvements. Organizations that implement six sigma invest in a) Quality improvement b) Cost reduction c) Efficiency improvement.

Benefits of Six Sigma
Since operating rooms (ORs) are resource-intense and costly hospital units. Maximizing OR efficiency is essential to maintaining an economically viable institution. Six Sigma methodologies were developed in the manufacturing industry to increase efficiency by eliminating non-value-added steps.

"SIX SIGMA -CUSTOMER FOCUSED, PROJECT FOCUSED, RESULTS DRIVEN"
Using such technique, this study deals to meet the needs of the patient undergoing surgical intervention. Within a safe environment, hospital has to provide a high standard of holistic care in a professional manner. Six Sigma is a problem solving methodology that improves any existing business process by constantly reviewing and re-tuning the process. To achieve this, Six Sigma uses a Methodology known as DMAIC.

DEFINE PHASE
The primary objectives of the define phase are:  To identify the focus areas or key performance measures.  To identify the improvement opportunity.

SIPOC Diagram
The following SIPOC diagram describes the OT process.

MEASURE PHASE
The primary objectives of the measure phase are;  To develop data collection plan and to collect data  To define the relation between the process variation and process specification.  To find the subgroups those are out of control.  To identify the trend of surgeries performed during the period of study.

DATA COLLECTION PLAN
 Measurement Method -The starting and ending time of procedures was recorded using the data collection sheet as per Annexure A.  Measurement System Analysis -The chances of repeatability error are avoided by using a standard data collection sheet by one operator/data collector.  Sample Size -The patients who got admitted during the period of study has been taken in to account.
Therefore the sample size is 228.

BASELINE PERFORMANCE DPMO (Defects Per Million Opportunity) analysis
The defect per million opportunities has been analyzed to find the present sigma level has been shown in the table.

ANALYSIS PHASE
The primary objectives of the analysis phase are: The Researcher handled documentation and data management, and revised the nursing forms, integrated essential fields on safety and the fields required as per standard requirements. A nursing record form was piloted and nurses' recommendations were integrated, the nursing educators were involved ensuring that guidelines on how to fill the form were communicated to the nurses.
A module has been developed and suggested to the organization has mentioned above.

POSSIBLE IMPROVEMENT SOLUTIONS
The sigma level can be increased up to six levels, which helps in forming an effective and efficient operation theatre.


The efficiency rate can be improved to 90 percent -100 percent to make the Operation theatre more productive.  Operating theatre / reservation schedule table shall be arranged and shall be posted in the room of Anesthesia Head and Chief Matron.  The following details can be furnished in the Operation Theatre Schedule An Operation Theatre Management system shall be implemented which can be a substitute for the Nominal register to minimize paper works and also reduce errors.  It has been suggested to the matron chief to make use of the OT cleaning procedures based on NABH standards, in which a check list shall be prepared for the successful follow up.  A continuous monitoring shall be conducted by the anesthesia head on the above mentioned factors.

CONTROL PHASE
The primary objectives of the control phase are:  To standardize improvement plan to sustain the gains of the improvement  To give suggestions to close the improvement project

RECOMMENDATIONS 
The suggested module has to be implemented and further observation and measurement has to be done to identify the increased sigma level after implementation, which gives the scope for further research.  It is also proposed that the post implementation performance shall be measured to evaluate and sustain the improved performance.