Surgical Services Team Shines at Continuous Improvement

In 2019, Cleveland Clinic Avon Hospital at Richard E. Jacobs Campus engaged in a continuous improvement (CI) project to solve an issue noted by a surgical technician. Equipment routinely used during operations was housed in a storage room near an administrative hallway rather than outside the operating rooms. A CI team investigated options and ultimately swapped storage areas with the radiology department.

“It seemed like such a small change, but when we quantified the impact using a spaghetti diagram to track the route to get equipment and mapping out the steps taken by surgical technicians, we discovered it saved caregivers enough steps to walk to Florida and halfway back every year,” says Jennifer Shaarda, BSN, RN, Nurse Manager for Surgical Services. The CI project is one of dozens completed since the department formed a model area core team in February 2019. The multidisciplinary team, one of many throughout the health system supported by Cleveland Clinic’s Continuous Improvement Department, embraces continuous improvement principles and drives CI projects.

Kaizen is key to success

Shaarda and Travis Nickels, MD, MBA, Anesthesiology Department Chair and Director of Surgical Operations at Avon Hospital, serve as chairs of the Surgical Services model area core team, which comprises clinical nurses, surgical technicians and staff from anesthesiology and sterile processing. The team bases its work on the Cleveland Clinic Improvement Model, which features four main tenets: organizational alignment, visual management, problem solving and standardization.

One of the main tools used by the team is a Kaizen board located near the OR control desk. Caregivers are encouraged to post ideas on the board, which also tracks CI projects in process and ideas that are on hold. The model area core team huddles in front of the board every other Thursday to review the ideas. On alternating Thursdays, the team meets to discuss ongoing complex CI projects.

Team members also strive to keep all surgical services staff abreast of projects.

“It’s all about communication,” says Sarah Barak, BSN, RN, CCRN, Nurse Manager of the Post Anesthesia Care Unit (PACU) and a member of the model area core team. “We report project updates at huddles and our monthly staff meetings. If a change occurs, I always point out that it came from Kaizen and thank the nurse who submitted the idea. I want people to know the reason change is happening is that one of their co-workers came up with the idea.”

Improvements create efficiencies

Ideas generated by caregivers have led to improvements in the Surgical Services Department, including:

• A revamped case scheduling system that makes the OR more efficient.
• Addition of a surgical services scoreboard that displays information on surgical cases and staffing for the previous day, current day and next day.
• A new women’s locker room to accommodate the growing team of caregivers as the hospital expands.
• Purchase of a bladder scanner for the pre-operative area.
• Improved signage to help patients and families locate the discharge door.
• A practice change to place EKG leads in the pre-operative area, saving time in the OR.

Many of the enhancements save time and money. For example, the Surgical Services Department has decreased average case turnaround time by seven minutes and realized more than $140,000 in inventory savings.

Each accomplishment creates employee buy-in and breeds further success.

“Our department has become stronger by working together to implement positive change,” says Barak. “Caregivers have a platform that works, which promotes connectivity. It makes us a well-functioning team.”

In 2021, Avon Surgical Services won Cleveland Clinic’s Nathan Hurle CI Champion Award for its achievements.

Nurses offer five tips

Shaarda and Barak offer advice to other healthcare professionals who want to foster a culture of continuous improvement:

• Select CI advocates to lead the charge. “Create a team of caregivers who are invested, committed to change and will help you drive it,” says Shaarda. Include experienced nurses who are respected by their peers and can help promote the notion of continuous improvement.
• Rely on experts. “Lean on your continuous improvement specialist, if your organization has them, to help guide you,” says Shaarda. The CI specialist assigned to Surgical Services helped identify potential team members, conducted interviews with caregivers to ascertain areas for improvement, offered suggestions on difficult projects and more.
• Don’t be afraid to delegate. “Believe in the process and push through, but know your limits,” says Shaarda. “What projects do you really need to drive, and which ones can you empower others to do?”
• Start with an easy win. One of the first projects the PACU suggested entailed moving point-of-care pregnancy testing to the pre-operative area rather than post-op, which significantly decreased the time nurses spent walking back and forth. “When caregivers saw from the get-go that something they suggested made an impact, they bought into the process,” says Barak.
• Share the victories. In addition to talking about successful projects at daily huddles and monthly staff meetings, the Surgical Services Department also keeps a Kaizen milestones book by the control desk that contains every idea submitted and implemented.

The focus on continuous improvement – and the subsequent improvements – contribute to employee engagement.

“Caregivers know the little things that make their day difficult will be solved, and they come to work happy, which passes on to the patients,” says Shaarda. “It all comes down to providing the best care for patients.”