Lateral violence: Tools managers can use to help shift the culture
An orientee comes to you in tears saying a couple of tenured nurses have snapped at her or huffed impatiently when she asked a question. Several other staff have met with you individually about conflict and hurtful comments they say are happening on one of the specialty teams. You already…
How to have a Leaner OR department
There's plenty of buzz (and confusion) about "Lean health care." Many wrongly assume Lean is simply applying Toyota lean manufacturing tools to health care. Unfortunately, many approach it that way. At the University of Tennessee, we define Lean health care as "…the application of concepts, tools, and management prescriptions to…
Lean thinking: Lessons of Toyota to help improve surgical services
Special focus: Lean in the OR Page 11: How to have a leaner OR department Page 13: Getting staff's buy-in for Lean Page 16: The diary of one OR's kaizen event Page 18: Lean methods for weeding out waste Page 21: Using Lean to steer a department What could a…
Lean methods for weeding out waste
What can a surgical services director learn about running the OR by working at a forklift factory? During 2 weeks in Japan in 2004, Sandra Saltzer, RN, MPA, had a chance to tour 3 factories and actually work in one. At the time, she was director of surgical services at…
Using Lean to steer a department
When a perioperative nurse was recently promoted to be the OR's clinical coordinator, she inherited a department badly in need of coordination. The OR manager was frequently out of the department at meetings, leaving no one to coach the team. Not an experienced manager, the coordinator needed a way to…
The diary of one OR's kaizen event
If you could huddle for 5 days with a few people who really understand your patient flow and you had the resources, what could you achieve? A team at Integris Southwest Medical Center in Oklahoma City took that approach and came up with a surprisingly simple and inexpensive tool to…
Getting the staff's buy-in for Lean
When Pam Murphy, RN, director of surgical services at 144-bed Piedmont Newnan Hospital in Newnan, Georgia, first heard a Lean presentation, she says, "It made sense, because we are so process driven. The whole focus is, 'What is touching the patient, and what is value added?'" Piedmont Newnan's ORs were…
Toward an effective code of conduct
Some facilities have had a code of conduct for years, and managers say it works well. At others, nurses still are too intimidated to remind physicians to wash their hands. In a lively discussion at the Managing Today's OR Suite conference in October 2008 in Washington, DC, it was clear…
Does your staff understand delegation?
An RN is circulating on a case when near the end, the surgeon hands the scrub technician a suture and tells her to close the wound. In another situation, the next case requires medications to be drawn up, and the surgical technologist (ST) offers to do this while the RN…
Spot at-risk behavior, intervene early
Patients can be the eyes and ears for detecting physician behavior that poses a risk to patient safety, a Vanderbilt group has learned. Over 10 to 15 years, Vanderbilt has developed a model for addressing inappropriate behavior that relies on unsolicited patient complaints as an early warning system for at-risk…
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