In God We Trust, All Others Must Bring Data Essay

Postgraduate Certificate in Frontline Leadership and Management MARK SHEET Student Name| Hazel Colquhoun| Organisation| N. H. S. G. J. N. H| Assignment Module | Information Management and Decision Making| Date Submittedby student| 18/11/2010| Assessor| 1st | 2nd| | Date Marked| 1st | 2nd| | AGREED INDICATIVE MARK*| | DATE| | Postgraduate Level Marking (Individual Coursework) Band| Mid Point Grade| Description| 70% +| 85%| An excellent assignment that displays very thorough comprehension of all major issues.

Extensive and well informed critical analysis. The presentation is appropriate and of a high standard. Strong evidence of depth and breadth of reading and good use of a range of sources mostly of high quality. Referencing is consistently high standard. | 60% – 69%| 65%| A very good assignment which demonstrates a significant degree of independent criticism and analysis of most major issues. It offers a thorough review and analysis of appropriate materials. Good depth / breadth of reading / research. Very good presentation and referencing. 50% – 59%| 55%| A good assignment which demonstrates a logical and coherent analysis of most relevant issues and contains some evidence of independent criticism and analysis. Overall analysis is clear, expressed well and free from major errors. Reasonable depth / breadth of reading / research. Referencing is good. Good presentation. | 40% – 49%| 45%| A satisfactory assignment which demonstrates reasonable discussion of material and comprehension of most important issues. May contain a few errors, omissions or inadequately expressed ideas. Presentation is to a reasonable standard and some referencing is evident.

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May lack depth / breadth of reading / research. | 35% – 39%| 37%| A marginally failed assignment which may address central issues, but which demonstrates only elementary understanding. Lacks a critical approach and is insufficiently researched or developed. Presentation, expression and / or referencing may be inadequate. | < 35%| 18%| An assignment which is inadequate in terms of understanding of the basic issues. Contains major errors and / or omissions. Usually deficient in some of the following: comprehension, background reading, analysis, presentation and referencing. 0| 0| This grade may be used to record a failure resulting from work, which is submitted late without prior permission, or without adequate explanation. It will also be used to record failure through non-submission or where sources have to be verified. | * PLEASE NOTE THAT THIS IS AN INDICATIVE MARK WHICH WILL REMAIN PROVISIONAL UNTIL RATIFIED, OR OTHERWISE, BY THE ASSESSMENT BOARD TUTOR FEEDBACK Presentation – including structure, visual impact, logical development, referencing, clarity of explanation /10%| |

Reflective learning – to support on-going personal development / 10%| | Content – coverage of issues raised in the selected sections of the assignment brief / 30%| | Application of theory to practice / 20%| | Quality of analysis of key concepts, models and theories / 30%| | Conclusion, recommendations, advice to student in the case of resubmissionTOTAL %|

Date …| Signature…| Assignment Title| In God we trust, all others must bring Data| Module| Information Management and Decision Making| Student Name| Hazel J. Colquhoun | Student ID No| DMU P09133223 | Tutor| Don Garford| Word Count| 3617| In God we trust, all others must bring Data W. Edwards Deming (Deming, 1993)1 The Author will critically evaluate the type and quality of the information available within the Theatres Directorate at Golden Jubilee National Hospital, and how that supports decision making within that Health Board Contents Page . Title 2. Contents 3. Executive summary – Background 4. Executive summary – Findings, Recommendations 5. Introduction to Information Management 6. (cont’d) with Martin and P Powell theory 7. What is an Information System 8. What is data and what is it not? 9. Decision making and Managers 10. The relation of Information and Decision making -Doede Keuning theory 11. Sources of Information 12. Decision Making Tools 13. What I. M. S. do we have access to at GJNH within Theatres Directorate? 14. Example of Successful System in use just now 5. Example of un-successful system with SWOT Analysis of same 16. Glitch Data Collection Sheet 17. Theatre Utilisation Data Sheet 18. Understanding process of Data collection within theatre suite 19. Example of information produced by Data capture against HEAT targets 20. Opera System/ What do we need to know? 21. SWOT analysis of OPERA system/ 22. Improvement theory/Jay Galbraith 23. To conclude/Patient’s journey 24. Conclusion continued/What’s next? 25. Future Recommendations, Developments/Critical reflection project/PDP 26.

Background 27. Background continued… 28. Bibliographies, Useful websites and abbreviations 29. Diagrams Executive Summary: Background: Through its strategic action plan, “Better Health, Better Care” (Government, 2008)2, the Scottish Government set out its single overarching purpose to improve health and health care in Scotland. All Health-boards set local delivery plans to reflect the HEAT Core Set – the key objectives, targets and measures that reflect Ministers’ priorities for the Health portfolio.

The acronym HEAT is: Health Improvement Efficient use of NHS resources and governance Access to services and waiting times guarantees Treatment of high quality appropriate to individual patient needs. The statistics that inform progress and performance against the HEAT targets are reported in NHS Scotland Chief Executive’s Annual Reports. Within this context, Theatre Services were recognised as being critical to the achievement of the 18 Referral to Treatment (RTT) standard by 2011.

The National Theatres Project came about from the HEAT targets given to the theatre areas, to maximise throughput, minimise waiting times, delays and cancellations and become more cost efficient. In November 2006, the National Theatre Project Final Report was published to advise Boards “…to appropriately treat more patients by using resources more productively and efficiently, thereby achieving Best Value for All…” The report stated that this could be achieved through a process of continuous improvement and by focusing on comparability; efficiency and quality.

This report will focus on the management of Information within GJNH by critically evaluating the following * information management and data collection methodology and systems * present information systems (with examples of good and bad) * Managers information requirements * What aids good decision making * What needs to improve to enable decision making * What outcomes can be expected if information management improves Present Methodology: 1. Data collected form varying sources and inputted manually, allowing reporting and benchmarking of designated areas, and evaluation of results 2.

Managers send and receive numerous data reports electronically which they analyse, feedback and make decisions on their findings 3. SPSP (Programme, 2008)3 checklists completed manually for each patient, with a data input clerk tasked with correlating information, 4. PDSA cycles have been introduced to encourage necessary identified changes in April 2010, with work on-going to see if improvements have been made 5. ‘Lean’ tools introduced into the hospital in April 2010, regular meetings continue to check improvements/implementation 6.

All grades of staff were informed of proposed changes and encouraged to participate in local changes 7. Patient journey re-mapped, information collected to assess what could be better Findings: 1. Accurate real-time data essential for decision making 2. Managers need to improve decision making, but this again will rely on what flows of information that are happening around them 3. Decision making is hampered by current systems 4. Inappropriate time used to collate manually inputted data 5. The need to be benchmarked against other similar areas 6.

Still need to improve tools for identifying performance variance 7. ‘Lean tools’ have been introduced, but changes are taking time 8. Ineffective scheduling of Theatre Patients due to using an out-dated system 9. Patients journey from referral to tests to surgery needs tightened up 10. The Staff have felt more valued because their opinions were sought. Recommendations: 1. Centralise audit system, and improve data collection to report on HEAT targets 2. To aim for best system available and not just ‘satisficing’ 3.

Information management systems to be updated to allow better flows of communication between departments 4. Continue using Lean Methods to decrease waste, increase efficiency thus creating value’ 5. Invest in new theatre data capture system 6. Continue use of SPSP to improve patient journey 7. Continue use of PDSA cycles to implement change 8. Make people accountable for their positions 9. Invest in finance to allow budget reports to be up-to-date in line with OPERA 10. Mapping of information lines to improve communications and decision making 11.

Each Theatre Speciality has a page to allow quicker communication between users of the service while changes are being made. 12. Theatre Speciality Clinical Leader’s accountable for accurate OPERA data capture within Speciality to Theatre Manager. Introduction to Information Management Information management is described as the collection and management of information from one or more sources (can be internal or external) and the distribution of that information to one or more audiences. Management means the organisation of and control over the structure, processing and delivery of information.

Anyone who is employed in a Managerial context will on a daily basis, find that the ‘Managing’ part of their job is not feasible without the varying types of information they receive, and are very aware that the quality of information enhances their decision making. Information is required to be timely, complete, reliable and accurate to allow the decision makers (internally and externally) to make strategic plans. It is called the Management Information system because Management use the information to make Management decisions. Management Information Theories include James G.

March and Herbert A. Simon (Simon, 1976)4, who say that the decision makers can only decide on information they have, and that it is impossible to ensure that they have accessed, collected, analysed and processed all the data available, and will therefore find that their decision making is compromised . Herbert Simon’s theories included the up-to-date ‘Administrative Man’ that when making decisions would end up what he called ‘satisficing’, when decision making was made on achieving a satisfactory result, not necessarily the optimum one.

This could be due to varying factors * Not all information available * Internal or external constraints * Budgetary pressures * Timescale pressures * Using first solution that gave what was needed, not necessarily the best * Laziness * Personal * Pressure from important investors/stakeholders According to Terry Lucey (Lucey, 1976)5, ‘a management information system (MIS) takes information from internal and external sources and converts it into a useful form that managers use in decision-making.

Managers make decisions by using the output of the MIS in areas such planning, directing and controlling activities in timely fashion’. He uses the following to illustrate his theory. a) Diagram illustrating T. Lucey theory of data and Information A similar analysis, illustrated below, was made of what information was used using the characteristics C. Martin & P. Powell (Powell, 1992)6 associated with information quality, which still relevant, displayed what we required from a future Information System. b) Diagram of what information needs to be Frequent mistakes are made by organisations such as; Overload of information, the person detailing the report has not understood what is needed to complete the report and what is irrelevant * The report is not up to date, and already the decision makers are behind what is actually the current situation. * The report is not pitched at its audience, format inappropriate * The report is not accurate in figures reported or facts are incomplete * Does the value gained equal or outweigh the cost of producing it? * The information needs to be from reliable sources * Is the information communicated as briefly as possible?

Tom Peters (Peters, 1982)7 added * Accessibility – information should be made available to everyone in an organisation and such an approach is a powerful motivator. This is in opposition to the traditional view that information is power (Bowley 1996). * Consistency – one hospital number across all medical records, and one diagnostic coding system used across the specialties * Definition – Clear unambiguous, concise definitions. * Granularity – Is the collection and reporting at the appropriate level of detail and accuracy What is an Information System? An information system was described by Kenneth C.

Laudon and Jane Price Laudon (Laudon, 1991)7 “a set of procedures that collects (or retrieves), processes, stores and disseminates information to support decision making and control” and that “Understanding information systems, however, requires one to understand the problems they are designed to solve, the architectural and design solutions, and the organizational processes that lead to these solutions. c) Diagram illustrating the information system Steven Alter (Alter)8 argues “A work system is a system in which humans and/or machines perform work using resources (including ICT) to produce specific products and/or services for customers.

An information system is a work system whose activities are devoted to processing (capturing, transmitting, storing, retrieving, manipulating and displaying) information” . This is illustrated below. What is….? | It is ……| Work| Effort applied to accomplish something| Work system| A view of work as occurring through a purposeful system| Work system framework| Model for organizing an initial understanding of how a system operates and what it accomplishes| Basic goals of a work system| Produce the desired results, and perform the work efficiently. Organization| Multiple work systems coordinated to accomplish goals that systems cannot accomplish individually| Business process| Work steps through which work is performed within a work system| Static view| How a work system operates, based on a particular configuration| Dynamic view| How a work system’s configuration evolves through a combination of planned and unplanned change| Work system life cycle| Process through which a specific work system is created and changes over time through planned/unplanned changes. Work system life cycle model| Model of a typical work system life cycle| What is….? | It is ……| Work| Effort applied to accomplish something| Work system| A view of work as occurring through a purposeful system| Work system framework| Model for organizing an initial understanding of how a system operates and what it accomplishes| Basic goals of a work system| Produce the desired results, and perform the work efficiently. Organization| Multiple work systems coordinated to accomplish goals that systems cannot accomplish individually| Business process| Work steps through which work is performed within a work system| Static view| How a work system operates, based on a particular configuration| Dynamic view| How a work system’s configuration evolves through a combination of planned and unplanned change| Work system life cycle| Process through which a specific work system is created and changes over time through planned/unplanned changes. Work system life cycle model| Model of a typical work system life cycle| d) Definition of Work system according to Steven Alter If we read Dr. Deming’s (Deming, 1993)1 ‘The New Economics for Industry’ he quotes * ‘A system is a network of interdependent components that work together to try to accomplish the aim of the system. A system must have an aim. Without the aim, there is no system. The aim of the system must be clear to everyone in the system. The aim must include plans for the future. The aim is a value judgment ’ * “A system must be managed. It will not manage itself.

Left to themselves in the Western world, components become selfish, competitive. We cannot afford the destructive effect of competition. ” * “To successfully respond to the myriad of changes that shake the world, transformation into a new style of management is required. The route to take is what I call profound knowledge—knowledge for leadership of transformation. ” What is data and what is it not? Data can be defined as information in raw or unorganized form (such as alphabets, numbers, or symbols) that refer to, or represent, conditions, ideas, or objects.

Data is limitless and present everywhere in the universe. It is only when it is organised, analysed and communicated that it becomes part of the information decision making process. Beynon-Davies (Beynon-Davies, 2002) 9 uses the concept of a sign to distinguish between data and information; data are symbols while information occurs when symbols are used to refer to something. e) Diagram illustrating process of data Lucey (Lucey, 1976)5 recognises that * ‘Information has no value in itself. ’ ‘Data is only facts and figures until it is interpreted ‘ * ‘If data is flawed, the results are worthless’ Decision Making and Managers Anyone who is employed in a Managerial context will on a daily basis, find that the ‘Managing’ part of their job is not feasible without the varying types of information they receive, and are very aware that the quality of information enhances their decision making. Managing, was well defined long ago by Henri Fayol (Fayol, 1916)10 who summed it up saying, * ”To manage s to forecast and plan, to organize, to command, to coordinate and to control. * To forecast and plan means examining the future and drawing up the plan of action. To organize means to build up the dual structure, material and human, of the undertaking. * To command means maintaining activity amongst the personnel. * To coordinate means bonding together, unifying and harmonizing all activity and effort. * To control means seeing that everything occurs in conformity with established rule and expressed command. ” ) Diagram illustrating Fayol’s requirements of the Manager The main context of the manager’s role requires being able to switch hats as to the type of situation being dealt with, whether it is involving staff, timescales, Organisational Plans, budgetary, etc. The diagram above relates to the many hats Management has to wear. Therefore decision making is required to know when to start and stop a process, and information is required to allow this process to occur. The relation of Information and Decision making

When relating Information Management and subsequently decision making to Managerial roles, it helps if we look at the Organisational Structure within our Health-board. The tier’s shown below also represent the levels of responsibility each post-holder has, with The Executive level having full responsibility for Visioning, Implementation and Strategic decision making, reducing to Middle Management where organisational and operational decisions are made, and Front-line, where leadership qualities are required to ensure operational tasks are carried out within policy. ) Diagram illustrating Doede Keuning organisational structure Doede Keuning (Keuning, 1998)11 describes in his book ‘Management, A Contemporary Approach’ that communication occurs in different ways, shown below h) Diagram Deode Keuning used to illustrate vertical communication approach Communication occurs top down at a strategic level to * Implement policies and communicate Trust Operational decisions Communication occurs from bottom up * When inputting data collected Communication also occurs diagonally within teams or groups at each level to facilitate strategic requirements Sources of information

Information has many sources. Lucey (Lucey, 1976)5 describes the many characteristics that information has. This theory could be explained in the following diagram. i) Diagram show Lucey’s Information Classifications Decision Making Tools Now we have the tools to recognise what our information is, where it comes from and what levels are involved it was important use a tool such as Herbert Simon’s (Simon, 1976)4 to decide what an information system was required to do for us. His theory on decision making has four principal phases ) Diagram illustrating Herbert Simon’s theory about Decision making Using his theory, the Executive/Director levels tasked a Multi-Disciplinary group to be formed within each directorate, to critically look at I. M. S. used by their teams k) Diagram illustrating MDT’s use of Herbert Simon’s theory What I. M. S. do we have access to at GJNH within Theatres Directorate? l) Diagram of I. M. S. used at GJNH by Theatre Directorate Example of Successful system in use just now These Information Systems are used in our Directorate on a daily basis.

Some of these systems are real time, like SSTS, which when inputted accurately apart from paying individuals can be used on its flipside (Business Reports) to access the information required by Human Resources and Managers as to staff absence, sickness episodes, absence reasons… This system has regular downtime, communicated to the relevant people to allow for upgrades, and has matured since first usage in 2003 m) Diagram illustrating SSTS Management Information System This system can be rated a success if we put Martin and Powell’s criteria against it.

It is relevant for purpose, accurate, timely, different users can access different information/data depending on their role in the organisation. Decisions can be made timely by looking at trend such as * % of people of sick per day/month * % of each Staff Band of sick per day/month * % of sick per discipline/speciality * % of sick with stress ( or any other chosen illness) * % of staff with swine flu As said earlier, the Information Systems we use as Managers are tools of communication/information that we input data into, and rely on to give us information/knowledge back out the other side. What do we do with this information?

We require this on a daily basis to allow us to make decisions, be it important or trivial, at a Strategic level or on the ground; it allows us to fulfil our roles. SSTS is seen as a system that meets our requirements for information, but what happens when the systems don’t? Example of Un-successful system in use The MDT chose to look at the existing theatre information system within Golden Jubilee National Hospital. If this system was to be updated it would allow Theatre Services to improve communication flow and therefore decision making, allowing focus on comparability; efficiency and quality.

This reporting system is used by the following specialities. * Cardiac * Thoracic * Cardiology * Orthopaedics * General * Plastic Surgery * Ophthalmic * Endoscopy The present system tries to audit reasons for cancellations in theatres. This is done manually in each theatre, paperwork collected, and data inputted and available at a later date. The theatres rely on getting information from a system that is not run real time, any changes made after operations are agreed are not communicated and this causes many problems.

A SWOT analysis was done of this system to assess what hindered decision making within areas utilising the Theatre Department sessions. Strengths| Weaknesses| * Retrospectively gives performance * Gives idea of what perfect system would show * Was the best we could get at the time| * Not live * Requires data inputting by clerk * Not complete in information required * Required to access several spread sheets to see overall performance * Takes time to see whole picture * Potential for not enough implants * Potential for incorrect equipment| Opportunities| Threats| Basic system- can see where to improve * Cancellations data discussed, but only 2 months retrospectively * Over-run data discussed, but only 2 months retrospectively| * Difficult to see where problem areas are * Difficult to ensure accuracy * Data lost due to timeframe * Patient out of process by time information looked at * Any clerical sickness makes data even more retrospective| n) Swot analysis of present theatre information system The MDT also looked at what Data was collected within theatres, the Glitch Sheet and Theatre Utilisation Sheet being examples of such Data.

Glitch Type| Glitch Code| Reason(s)| Comments| Staff Related| 1. 1| Surgeon/ Anaesthetist Late|  | | 1. 2| Understaffed|  | | 1. 3| Unanswered Bleep|  | | 1. 4| No Porter|  | | 1. 5| No Surgeon Available|  | | 1. 6| No Anaesthetist Available|  | | 1. 7| Staff sickness|  | | 1. 8| Staff holiday|  | | 1. 9| Staff meeting/ training|  | | 1. 10| Insufficient number of appropriately skilled staff for list|  |  | 1. 11| Staff from other theatre seeking equipment/ advice|  | Patient Related| 2. 1| Patient not admitted|  | | 2. 2| Patient not arrived|  | | 2. | Patient location unknown|  | | 2. 4| Patient waiting for diagnostics|  | | 2. 5| Patient not ready – clinical reasons|  | | 2. 6| Patient not “starved”|  | | 2. 7| Emergency patient|  | | 2. 8| Patient DNA|  | Flow Related| 3. 1| Recovery Full|  | Time Related| 4. 1| Late start|  | | 4. 2| Late finish|  | | 4. 3| Waiting for Patient|  | Documentation Related| 5. 1| Site of surgery not documented|  |  | 5. 2| Patient not consented|  | | 5. 3| Theatre List Incorrect/ Incomplete|  | | 5. 4| Missing notes|  | | 5. 5| Documentation not complete|  | | 5. | List order changed on day|  | Theatre Related| 6. 1| Disposable items opened and not used|  |  | 6. 2| Change of procedure|  | Equipment related| 7. 1| Missing/ Unavailable equipment|  |  | 7. 2| Instrument contamination risk|  | | 7. 3| Used previous night|  | | 7. 4| Not available from HSDU|  | | 7. 5| Equipment not available|  | | 7. 6| Lost sets|  | | 7. 7| Sets opened for single instruments|  | | 7. 8| Opened in error|  | | 7. 9| Items out of stock in HSDU|  | Glitch Type| Glitch Code| Reason(s)| Comments| Staff Related| 1. 1| Surgeon/ Anaesthetist Late|  | | 1. | Understaffed|  | | 1. 3| Unanswered Bleep|  | | 1. 4| No Porter|  | | 1. 5| No Surgeon Available|  | | 1. 6| No Anaesthetist Available|  | | 1. 7| Staff sickness|  | | 1. 8| Staff holiday|  | | 1. 9| Staff meeting/ training|  | | 1. 10| Insufficient number of appropriately skilled staff for list|  |  | 1. 11| Staff from other theatre seeking equipment/ advice|  | Patient Related| 2. 1| Patient not admitted|  | | 2. 2| Patient not arrived|  | | 2. 3| Patient location unknown|  | | 2. 4| Patient waiting for diagnostics|  | | 2. 5| Patient not ready – clinical reasons|  | | 2. | Patient not “starved”|  | | 2. 7| Emergency patient|  | | 2. 8| Patient DNA|  | Flow Related| 3. 1| Recovery Full|  | Time Related| 4. 1| Late start|  | | 4. 2| Late finish|  | | 4. 3| Waiting for Patient|  | Documentation Related| 5. 1| Site of surgery not documented|  |  | 5. 2| Patient not consented|  | | 5. 3| Theatre List Incorrect/ Incomplete|  | | 5. 4| Missing notes|  | | 5. 5| Documentation not complete|  | | 5. 6| List order changed on day|  | Theatre Related| 6. 1| Disposable items opened and not used|  |  | 6. 2| Change of procedure|  | Equipment related| 7. | Missing/ Unavailable equipment|  |  | 7. 2| Instrument contamination risk|  | | 7. 3| Used previous night|  | | 7. 4| Not available from HSDU|  | | 7. 5| Equipment not available|  | | 7. 6| Lost sets|  | | 7. 7| Sets opened for single instruments|  | | 7. 8| Opened in error|  | | 7. 9| Items out of stock in HSDU|  | o) Glitch Type Codes for use in theatre department Theatre Utilisation form Date| Surgeon| Surgeon’s Assistant| Theatre| Other Information| Name| CHI No| Procedure| Time into Theatre| Start of Anaes| Knife to Skin| Skin Closure| Time out of Theatre| Scrub Nurse Circ.

Nurse| Specimen| Instruments| Daily Glitch Type |     |  |  |  |  |  |  |  |  |  |  |  | |  |  |  |  |  |  |  |  |  |  |  | |  |  |  |  |  |  |  |  |  |  |  | |  |  |  |  |  |  |  |  |  |  |  | COMMENTS | INCIDENTS | Date| Surgeon| Surgeon’s Assistant| Theatre| Other Information| Name| CHI No| Procedure| Time into Theatre| Start of Anaes| Knife to Skin| Skin Closure| Time out of Theatre| Scrub Nurse Circ. Nurse| Specimen| Instruments| Daily Glitch Type |     |  |  |  |  |  |  |  |  |  |  |  | |  |  |  |  |  |  |  |  |  |  |  | |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | COMMENTS | INCIDENTS | p) Theatre Utilisation form Using Beynon-Davies diagram, the process of Data capture, to collection, collation, and the resultant information is analysed to understand the process. q) Process of Data to information within Theatre Directorate A SWOT analysis was then done of the Data collected to enable understanding of future needs of the Information System required. r) Diagram illustrating SWOT analysis of Data Examples were looked at, see below, to understand what information is required to benchmark against HEAT targets. | ) Diagram showing reduction in waiting times between March 2008 and March 2009, and maintenance of figures So what do we need to improve the Information System here? Within GJNH, the Executive Team, Finance, Theatre Management Team and IT worked together in a Multi-disciplinary team (MDT) to see how data capture of all theatre specialities could be ensured. Or as Dr. Deming (Deming, 1993)1 would say “We should work on our process, not the outcome of our processes” When approaching other Health Boards it became clear that agreeing benchmarks initially was the way to allow National comparisons. Initially a proposal was put forward for I.

T. to design a programme to capture data, but when GJNH was given the chance to join a benchmarking team within Scotland that was going to set up a Theatre System ‘OPERA’ that would allow National figures to be captured in the future and allow linkage with other Heath Boards. To be given the chance of using a system already trialled in several areas, and going through implementation in others was agreed by the MDT as the best solution. Not only would it allow benchmarking to occur easier, it was also financially viable as Scottish Government was sponsoring all Health-boards who accepted the challenge.

The MDT then attended a seminar introducing them to ‘Opera Theatre System’. Their findings were reported back as follows: To summarise * Program to include development of a standardised electronic reporting system for recording changes to theatre schedule. * Inbuilt set of parameters and planning horizons, which will improve forward planning and resource management * Budgetary implications – minimising waste and variation. * To improve communication/planning reducing un-utilised. Utilisation Measures * Standardise recognised operating sessions Optimise surgical operating time * Include anaesthetic and turnaround time * Ensure data required is programmed into system * Allows waiting list management * Pre-admission clinic information utilised * Real time activity management Material Management MRP * The Opera Material Management module supports complete surgical supply chain management and adapts to virtually all recognized logistics strategies and models for the OR. * This includes the definition of all required data for the identification of cost per procedure and per patient as well as billing information. It promises to improve inventory management by offering a material requirements planning (MRP) functionality that helps the OR anticipate its needs and communicate them to its internal and external suppliers * The main objective of an MIS (Management Information System) is to provide information for decision making on planning, initiating, organizing, and controlling the operations of the subsystems of the form and to provide a synergetic organization in the process. Advantage for Management * Data analysis related to surgical services management * Performance indicators Operative reports- transcription * Real-time data/information * Potential to use Lean methods for reducing waste, maximising throughput A SWOT analysis was done of the OPERA System, results as follows. Strengths * Allows disruptions to service to be anticipated * Allows us to learn from mistakes * Allows better management of recovery/ ITU and HDU, ward beds * Prevents overloading of resources * Allows pricing of procedures * Other connected areas able to see real-time journey of patient * No transcription time * Data available on one system Strengths Allows disruptions to service to be anticipated * Allows us to learn from mistakes * Allows better management of recovery/ ITU and HDU, ward beds * Prevents overloading of resources * Allows pricing of procedures * Other connected areas able to see real-time journey of patient * No transcription time * Data available on one system Weaknesses * Expense of initial purchase * Data needs inputted for approximately 6 months to make recommendations * Worries whether it will ‘clash’ with existing systems * Training required for all members of staff

Weaknesses * Expense of initial purchase * Data needs inputted for approximately 6 months to make recommendations * Worries whether it will ‘clash’ with existing systems * Training required for all members of staff Threats * IT not ready for project start date * Staff not fully trained * Program does not include all information required * Allows others to ‘see’ what other teams are doing * Data not captured when IT downtime for upgrading systems Threats * IT not ready for project start date Staff not fully trained * Program does not include all information required * Allows others to ‘see’ what other teams are doing * Data not captured when IT downtime for upgrading systems Opportunities * Links to National Database * Allows adjustment of schedules * Reduced cancellations means service more cost-effective * Real-time resource expenditure * Reduction in clerical budget * Clinical staff freed up to work with patient more * Allows benchmarking against other sites Opportunities * Links to National Database Allows adjustment of schedules * Reduced cancellations means service more cost-effective * Real-time resource expenditure * Reduction in clerical budget * Clinical staff freed up to work with patient more * Allows benchmarking against other sites t) Swot analysis of what Opera Theatre System promises us The MDT agreed that the benefits to using OPERA in the future were many, with improvements promised throughout the hospital, relevant to HEAT targets. u) Diagram illustrating what needs to align up to allow improvement

The potential for improvements by increasing information processing can be aligned with theories that Jay Galbraith (Galbraith, 1977) 12 identified in his book ‘Organization design’. He described five main organization design strategies within two categories, increased information processing capacity and reduced need for information processing. v) Diagram illustrating J. Galbraith design strategies To conclude * Theatres services are recognised to be pivotal in the improvement of the patient journey * Re-mapping of patients journey to ensure all data points captured when planning OPERA usage ) Process mapping of ideal patient journey * OPERA will provide reporting and accountability mechanism for theatre services * OPERA will provide robust and comparative performance measures for Theatre Services at a national level, regional level, and operational level * OPERA promises to focus action improvement priorities within theatre services as well as within the wider organisational improvement agenda * Identify lead in taking project forward, suggested steps below ) Indicative plan of System processes when setting up OPERA system Conclusion continued… Having agreed the purchase of the new Information Management system ‘OPERA’, the following changes are anticipated to happen due to Clinical Staff’s ability to view real-time patient’s journeys * Enhanced decision making due to facts and figures available 24/7 * Speedy decisions due to real-time input, immediate access to data. * Reduction in waiting times Reduction in cancellations * Less variance in waiting times * All parts of process aware where each are in relation to patient’s journey * Area links electronically to allow visibility of cancellations/availability * Inpatients awaiting procedures able to being given priority vacant ‘spaces’ * Accuracy in theatre lists * Accurate scheduling * Outcomes achievable So what’s next? Once Opera Theatre System is in place, I anticipate and plan for the following A timeline identified for each of the proposed changes * To be able to communicate each change to staff in a timely fashion * Have identified training time for existing IT staff and clinical users groups *

Identify where changes will begin * When changes have occurred, audit to ensure changes have achieved results the freeze process * Agree timelines to access data, and check information is suitable for purpose * Identify process for assuring accuracy of data. Using Takt graphs, work to be done on procedures/timing for each area, to give an accurate picture of what information needs collated * To keep utilisation sheets for agreed period to check accuracy of input in new system * To keep ‘Glitch’ sheet for agreed period to make sure new system is capturing reasons for delays * Observe if any difference in use of adverse incident reports/clinical incidents with use of new system compared to old, which are looked at monthly by Clinical Governance Future Recommendations and Developments Anticipated reduction in stock levels within theatre, new system will not allow too many of same procedures to occur on same day * New stock levels to be agreed with Clinical Leaders when Information system is in place * Reduction in overtime due to inappropriate scheduling, cases less likely to over-run * Less Adverse Incident forms due to accuracy of information * MDT meetings to further maximise usage of product * Address shift patterns if required to allow maximisation of throughput in theatre areas * Use root cause analysis to work out delay factors Where delays are identified, use change processes such as Kurt Lewin’s Force Field Analysis to bring about change and improvement * Stop seeing over-runs as normal * Equipment for area used to full potential * Increased awareness if extra equipment needed * Stop under-utilisation of theatre sessions * Address budget-deficits and reduce * Link into Finance, to see products used, operation castings, budgetary reports to become more real-time * Be able to categorise patient’s operating experience

Critical Reflection of subject In today’s workplace, good communication is seen as being at the forefront of success. To start at the basics * an organisation and its managers need to become and remain competent * its information processes, systems and management must be improved and maintained * to attain the best results for accurate decision making, the systems need to be as up-to-date as is possible To make decisions without up to date information, puts everybody at risk.

There is always the chance that someone in the room will have the up to date figures in their head, and could make you look inefficient Information cascade within organisations needs looked at with a view to weeding out what is necessary for each level, to allow each staff member to focus on the real job at hand, looking after the patient. Accurate data capture points are essential to allow good information to be extracted from process. Personnel Development Plan I had never linked the fact that my decisions were based on the information I had to hand.

I realised sometimes that I was struggling to make sense of some things, and retrospectively realise I did not have all the information needed to make the decision. I must have made some decisions by ‘satisficing’, finding the first one that fitted, and now worry, was it truly the right one. I appreciate better also the difference of what goes into setting up new systems of communication, and have asked to be involved in the new ‘Opera’ system being currently purchased for our area. Ensure OPERA product utilised fully, view new reports electronically real-time, and start to audit new information pulled off system.

Use my change head more often. Revisit timeline on already identified days to check if on schedule I will after this module, ask myself these questions? Why did I come to that decision? Was it a time related decision Was it something that fitted with my personality/bias? Was I influenced by others? Did I have all the relevant information? In time, I aim to be able to put all the theories into my daily work schedule. Background The National Theatres Project Group was put together to enable the current performance of Theatres to be improved upon, and it is this area the report ill be focused on. Diagram 5 The objective of the National Theatres Project (NTP) was defined as to treat more patients, using resources more productively and efficiently, achieving Best Value for all. This will be achievable through a process of continuous improvement and by focusing on Comparability| consistent approach to data collection and performance management for theatre services| Efficiency| managing this limited and expensive resource more efficiently| Quality| improving patient experience and health outcomes| HEAT Acronym

A more detailed explanation of the acronym HEAT can be seen below Lean Methodology The NHS like many public sector organisations have been looking for new ways to maximise its results, minimise waste has been expanding its horizons, to look freshly at how other organisations have changed radically has been impressed by the improvement developed originally by Toyota. It has consistently looked at departments, department budgets and targets but has made the mistake of not looking at how things interact with each other and how this could be improved.

Daniel T Jones and Jan Filochowski explained that ‘First, healthcare is full of long, linear (end-to-end) processes, patient processes, diagnosis and treatment processes and support processes, like radiology and pathology. The goal is also clear – alleviation or cure. But none of these processes flow. They are continually disrupted by queues that have characterised UK healthcare (and in many other countries) for as long as any of us can remember. They identified that ‘Blockages occur because we do not have the whole picture and work against each other unknowingly’ (Jones, 2006)13 Lean thinking helps us to see how we have created and chosen queues, and what we need to do to remove them and get things moving’ * is getting the right things to the right place, at the right time in the right quantities, while minimising waste and being open to change. * new concepts, tools and methods that have been effectively utilised to improve process flow. Our Health board has been looking at incorporating ‘Lean’ into our work environment to enable us to meet the Heat targets defined by the Scottish Government. Bibliography 1. Deming, W. Edwards. 1993. The New Economics for Industry, Government, Education, second edition 2.

Better life, better care, Department of Health publication, Feb 2008 3. Scottish Safety Programme, Safe in our hands 2008 4. Simon, Herbert (1976), Administrative Behaviour (3rd ed. ), New York: The Free Press  5. Terry Lucey, Management Information Systems, 1976 6. Martin C, Powell P 1992 Information Systems – A management perspective. (p12 – 16). McGraw-Hill, Maidenhead England 7. Peters, Tom. In Search Of Excellence, 1982 8. Laudon, Kenneth C. , and Jane Price Laudon. Management Information Systems: A Contemporary Perspective. 2nd ed. New York: Macmillan, 1991. 9. Alter, S.

The Work System Method: Connecting People, Processes, and IT for Business Results. Works System Press, CA 10. P. Beynon-Davies (2002). Information Systems: An introduction to informatics in organisations. Basingstoke, UK: Palgrave Macmillan. 11. Henry Fayol, General and Industrial Management, 1916 12. Doede Keuning; Management, A Contemporary Approach (page 542-543) 1998 13. Galbraith, Jay R. Organization Design, (page 49), 1977 14. Jones, Daniel T. and Filochowski, Jan. Think yourself thin. Health Service Journal 2006; 116 (6000): 6-7 (6 April 2006 supplement) (Scroll down to page 6. ) (PDF. ) Useful Websites ttp://www. scotland. gov. uk/Publications/2006/11/24135440/2 http://www. isdscotland. org/isd/5557. html http://www. nodelaysscotland. scot. nhs. uk/Help/Pages/default. aspx www. leanuk. org www. institute. nhs. uk http://www. patientsafetyalliance. scot. nhs. uk/ www. chca. ca/opera. php Abbreviations IMS Information management systems GJNHGolden Jubilee National Hospital SPSPScottish Patient Safety Programme PDSA Plan, Do, Study Act acronym Diagrams a) Diagram illustrating T. Lucey theory of data and Information b) Diagram of what information needs to be c) Diagram illustrating the information system ) Definition of Work system according to Steven Alter e) Diagram illustrating process of data f) Diagram illustrating Fayol’s requirements of the Manager g) Diagram explaining Deode Keuning structure h) Diagram Deode Keuning used illustrating the vertical communication approach i) Diagram show Lucey’s Information Classifications j) Diagram illustrating Herbert Simon’s theory about Decision making k) Diagram showing MDT’s use of Herbert Simon’s theory l) Diagram of IMS used by GJNH by Theatre Directorate m) Diagram illustrating SSTS Management Information System n) Swot analysis of present theatre information system ) Glitch Type Codes for use in theatre department p) Theatre Utilisation Data Sheet q) Process of Data to information within Theatre Directorate r) Diagram Illustrating SWOT analysis of Data s) Diagram showing reduction in waiting times between March 2008 and March 2009, and maintenance of figures t) Swot analysis of what Opera Theatre System promises us u) Diagram of what needs to align up to allow improvement v) Diagram illustrating J. Galbraith design strategies w) Process mapping of Patient’s ideal journey x) Indicative plan of System processes when setting up OPERA System