European health systems are increasingly facing ethical, political and economic challenges regarding how to assure sustainable and equitable access to effective and safe procedures. This complex challenge highlights the need for organisational and managerial solutions to rethink health care processes with the aim of improving both efficiency and productivity levels.
Azienda Ospedaliera di Padova (AOP) is one of the main university hospitals in Italy and it is part of the National and Veneto Region Healthcare Systems. AOP began the reorganisation of surgical activity in 2000, with the aim to separate flows of simple scheduled procedures from emergencies and complex cases and to create day surgery and week surgery centres. In 2016, the project of reorganisation started, through the implementation of a ‘lean approach’, involving complex surgery and all the operating theatres.
The idea behind this approach is the strong need to deliver safer and more effective surgical care and, at the same time, to reduce health care costs that are progressively becoming unsustainable. Therefore, the specific project objectives are the improvement of efficiency and productivity, safety and effectiveness of surgical care.
The project has been performed in the following major steps:
- Planning, in which the organisational structure of the project was defined establishing the lean team with strong strategic leadership and defining the leadership of the operating theatres;
- Training on the job programme, during which lean principles have been shared and applied to analyse and review the surgical care pathways;
- Fixing the results: definition of the standard operating procedures to fix the improvements achieved;
- Continuous improvement: implementation of safety and quality walkarounds in the operating theatres to create a continuous improvement-oriented organisation.
Relevant results in terms of efficiency, effectiveness and safety of surgical activity have been achieved at the end of the project. This is thanks to the introduction of a performance measurement system in the operating theatres, the improvement of patient care pathways, the definition of standard operating procedures, the organisational and strategic changes introduced and the improved communication.
The project was performed with no additional costs for the AOP, since internal human resources were used (282 employees involved). The key success factors of the AOP project are related to the strong involvement of all the staff in sharing the planning and performing every step of the project with high motivation. This is supported by the commitment of AOP management at strategic level and the constant collaboration with the surgical staff to solve the daily problems.
Although there are various experiences at international level indicating the most effective ways to organise and manage surgical activity, the application of these experiences in specific health contexts is challenging and often hard. In Italy, this is one of the first lean management projects in healthcare characterised by a systemic view, involving all the key figures of the hospital and all the 47 operating theatres. It is able to change the guiding approach in taking decisions and actions, with the aim to create value in operations.
The experience gained by the AOP has led to it being identified as hub centre with a regional value for complex surgical activity. It has been recently been assessed by the Italian Ministry of Health as ‘best practice’ for the reorganisation of the surgical activity for settings and complexity of care. The implementation of this best practice, aimed at improving the management of operating theatres, can be strategic in every health system. It can improve performance and act as a performance measurement system as well, especially in hospitals with greater complexity, characterised by high-value and high-cost surgical activity.