Patient safety in the operating theatre: how A3 thinking can help reduce door movement.
OBJECTIVE
Research has often stressed the significance of reducing door movement during surgery for preventing surgical site infections. This study investigated the possible effect of a lean A3 intervention on the reduction of door movement during surgery in a university medical center in the Netherlands.


METHODS
A digital counter recorded door movement during 8009 surgical procedures during 8 months. The number of door movements per surgical procedure ranged from 0 to 555, with a mean of 24 door movements per hour across 26 specialisms.


METHODS
We aimed to reduce door movement in one operating room for orthopedic surgery by a lean A3 intervention. This intervention was executed by means of an A3 report that promotes structured problem solving based on a Plan-Do-Check-Act cycle.


METHODS
The steps of the A3 report was followed and completed one-by-one by a multidisciplinary team. The effect of the changes was monitored over the course of 12 months.


RESULTS
The use of a lean A3 intervention resulted in a sustainable decrease of door movements by 78%, from a mean of 24 to a mean of 4 door movements per hour during orthopedic surgery at one OR.


CONCLUSIONS
This paper shows the relevance of and the possibility for a reduction of door movement during surgery by lean management methods in general and an A3 intervention in particular. This intervention stimulated dialogue and encouraged knowledge-sharing and collaboration between specialized healthcare professionals and this resulted in a thorough root-cause analysis that provided synergy in the countermeasures-with, according to respondents, a sustainable result.
Department of Innovation & Quality, Zaans Medical Center, Koningin Julianaplein 58 (room 4.66), 1502 DV Zaandam, The Netherlands.
Frederique Elisabeth
FE
Simons
Department of Anaesthesiology and Operative Care, VU University Medical Center, De Boelelaan 1117 (6A12), Amsterdam 1081 HV, The Netherlands.
Kjeld Harald
KH
Aij
Department of Medical Humanities, VU University Medical Center, EMGO+ Institute for Health and Care Research, Van der Boechorstraat 7, Amsterdam 1081 BT, The Netherlands.
Guy A M
GA
Widdershoven
Department of Medical Humanities, VU University Medical Center, EMGO+ Institute for Health and Care Research, Van der Boechorstraat 7, Amsterdam 1081 BT, The Netherlands.
Merel
M
Visse
D000046:Academic Medical Centers / Q000458:organization & administration* / Q000706:statistics & numerical data; D017598:Efficiency, Organizational; D006801:Humans; D009426:Netherlands; D009873:Operating Rooms / Q000458:organization & administration* / Q000706:statistics & numerical data; D061214:Patient Safety; D058996:Quality Improvement / Q000458:organization & administration* / Q000706:statistics & numerical data; D013530:Surgical Wound Infection / Q000517:prevention & control*
A3 method; door movement; lean; monitoring; operating room; surveillance