Project Details
About the Project
This initiative – nicknamed “A Great Day in the OR” – began with a simple premise: What if the multidisciplinary team involved in surgery met first thing in the morning, in advance of the surgical day, to review all the cases for surgery in that OR, consider the pitfalls, and determine the special needs required for each case on the list? Would these OR Huddles lead to improved patient care? And would they indirectly increase the joy at work for those within the surgical team?
The team, comprised of Dr. Al Hayashi, Dr. Jacques Smit, Rio Lagos (med student), Catriona Hopper, Dr. Hamza Khan, Dr. Al Buckley, and Dawn Maroney (Nurse manager VGH), recognized that to be successful, the project required significant engagement between different groups of physicians, nurses, Island Health staff, and surgical team leaders. Any solutions they wished to test would need to be co-created within the group. They began with a series of meetings to socialize the concept of the OR Huddle with the department of Anesthesia, the VGH OR nurses, the Division of General Surgery, and the VGH OR and RJH OR nurse managers. They then embarked on a series of Plan-Do-Study-Act cycles to test the practice of the OR Huddles, assess the impact of changes through short surveys, and document their learnings.
Their results showed steady improvement in perceptions of OR efficiency, through questions such as “Did your team delegate tasks to improve efficiency?” and “Did you feel adequately informed regarding the clinic and resource requirements and availability to efficiently complete the day?”. Respondents also felt OR Huddles fostered useful information sharing between colleagues, shared through such questions as “I learned something new today”, and “I taught something or provided insight to a team member”. As a overarching question to assess the impact of the initiative, a growing proportion of staff responded “Great” or “Very Great” to the question “How great was your day?”.
Much like their original premise, the conclusion of this project was similarly straightforward. In Dr. Hayashi’s words, “A simple change in group practice that costs the team 10 minutes at the start of the day (but doesn’t cost any $ or require any funding) will enable and enhance group cohesion, preparation, and troubleshooting”. Despite taking 10 minutes at the beginning of the day, “this time is made back up with the efficiency garnered throughout the day”.
By the end of the project, the team had developed a Morning Structured Huddle tool that can be used broadly in most ORs in Victoria and could be spread to other centers within and beyond Island Health. Dr. Hayashi reflected on the significance of this initiative in the context of Island Health’s ‘Better Value’ approach: [This] “demonstrates to the health authority that provider-level ideas can be actualized into rewarding projects with no significant costs to the HA”.
Crucially, the funding allocated to physician engagement was essential for the project’s success. “The logistics of getting these large groups together meant ideal times for optimized attendance was after work in the early evening. SIFEI funding has been crucial in supporting dinner meetings to be arranged.”