Use of PDCA in the Operating Room
From: M. D. Anderson Department of Performance Improvement
Date; January 15, 2008

Narrator: Here with me in the studio now is Dr. Garrett Walsh of Thoracic and Cardiovascular Surgery. Thanks for coming into the studio this morning. We'd like to ask you a few questions to share your thoughts on performance improvement projects. Could you share with the audience your experience with your improvement projects?

Dr. Garrett Walsh: Well fortunately I've had a wonderful opportunity over the last 15 or 16 years that I've been at M. D. Anderson to be a participant in a wide variety of projects including medical records issues that was certainly a sticky area that we have for sometime looking at improvement we're looking specifically at the involved provider database but this is such a large complex institution that there's a variety of projects that we can focus on.

My interest at the present time is looking at specifically performance improvement and quality measures in the operating room. I've recently had the opportunity to participate in the IHC project and we're just actually completing that project now and heading back to Utah for our final presentation. This was a wonderful opportunity to allow us, as faculty, to learn a little bit more about quality improvement and how to structure our projects, how to get an aim statement and measure of baseline metrics and then go on and try to improvement.

Specific things that we've looked at in the operating room is simple things like just getting the OR started in the morning on time, the operating rooms are a very costly part of our institution, it costs us nearly $1,600 an hour to run an operating room, and obviously we have a problem with scheduling of the patients, or the patients don't show up on time or we don't have the right instruments that are coming together for the operation and this can be quite costly, so this is one area we're looking at.

We're also looking at performance improvement projects don't necessarily have to cost money to do and you can actually have improved patient safety and better outcomes with the resources that we have, specifically we're going to be part of, what, a 100,000 might have saved looking at such things as surgical sight infections which is a serious part of taking care of surgical patients, such things as making sure the antibiotics are delivered on time, making sure that the patient has the right temperature in the operating room, when they come out of the operating room at a normal temperature.

Simple things like clipping the patient's hair rather than shaving the patient's hair will cut down significantly in wound infections and also a tighter glucose control, are just some examples of how performance improvement processes looking at specific things can result in not only lives saved but a much more efficient practice.

Narrator: Well thank you Dr. Walsh. From your perspective, how important is effective team work in helping us make cancer history?

Dr. Garrett Walsh: Well I always look at M. D. Anderson like a large family and we have 15,000 employees right now I think at the time of this presentation and to accomplish anything with the patient as our focus required a large amount of people coming together at the same time for the patient. We really cannot accomplish anything without team work and if we use the example of basically anything that we do in taking care of patient in the operating room for instance, I as the surgeon, I'm dependent on good nursing support, we need excellent schedulers, we need people to clean the instruments, we need the biotech people to process instruments, we need lab people, we need anesthesiologists, we need orderlies, we need, I mean ..., the number of people to accomplish one operation is literally hundreds if not several hundred people to accomplish an operation for one patient safely.

So as a surgeon I require good team work and it's absolutely vital that we as an institution focus on all of these patient issues so without good team work then a lot of these projects would fail. The other issue is that each of us becomes experts in our little part of taking care of a patient whether or not we're a lab technician or a radiology technician or a nurse in the OR, or a surgeon, we each have our own specific areas of interest and focus and we become owners of that performance in that part of the puzzle and we have to kind of go to the individuals at the front line who really understand what it takes to process blood or what it takes to process and x-ray and we're depending on those people in their each areas to look at ways of improving their own performance and that's way as I understand this project with a lot of teams ongoing is going to be the cumulative effect of this, is gonna translate into better patient care, much more efficient practice, and a much safer practice in taking care of our patients and our employees.

Narrator: Absolutely. Thank you so much for coming by the studio this morning and I know that our teams out there found your words encouraging as they move forward with their projects. Thank you Dr. Walsh.

Dr. Garrett Walsh: Thanks for having me.